Placental histopathology associated with pre‐eclampsia: systematic review and meta‐analysis

Falco, Maria Letizia; Sivanathan, Janani; Laoreti, A.; Thilaganathan, B.; Khalil, Asma

doi:10.1002/uog.17494

Cited by 114 publications

(101 citation statements)

References 25 publications

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“…More recent data have shown that abnormal placentation is neither specific for nor sensitive to the occurrence of preeclampsia, even though placental lesions are seen more frequently in early preeclampsia (Falco et al . ). Today, evidence is growing that pre‐existing or early pregnancy suboptimal cardiac dysfunction may predispose to subsequent placental maldevelopment (Mahendru et al .…”

Section: Cardiorenal Interactions In the Pathophysiology Of Preeclampsiamentioning

confidence: 97%

“…Similarly, the acute nature of the cardiovascular insult resulting in hypoperfusion of the placenta is short‐lived and unlikely to result in histologically evident placental damage (Falco et al . ). The links between cardiac and renal dysfunction in this process are comparable to those involved in early‐onset preeclampsia; however, venous congestion dominates over arterial hypoperfusion and reflex hypertonia, due to which the clinical presentation of this type of preeclampsia, is less fulminant and usually in a later stage of pregnancy.…”

Section: Cardiorenal Interactions In the Pathophysiology Of Preeclampsiamentioning

confidence: 97%

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Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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It is generally accepted today that there are two different types of preeclampsia: an early‐onset or placental type and a late‐onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early‐ than in late‐onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation‐induced worsening of subclinical pre‐existing chronic cardiovascular dysfunction in early‐onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late‐onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.

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Section: Cardiorenal Interactions In the Pathophysiology Of Preeclampsiamentioning

confidence: 97%

Section: Cardiorenal Interactions In the Pathophysiology Of Preeclampsiamentioning

confidence: 97%

Preeclampsia: a gestational cardiorenal syndrome

Gyselaers

Thilaganathan

2019

The Journal of Physiology

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“…We thank Orabona et al . for their comments on our paper in which it was demonstrated that villous and vascular placental lesions are found more frequently in pre‐eclamptic pregnancies. The authors had previously shown that the incidence of similar placental lesions in pre‐eclampsia was different according to gestational age at pre‐eclampsia onset, with lesions being more prevalent in early‐onset disease.…”

mentioning

confidence: 87%

“…Instead of trying to change clinical diagnostic criteria, we would ask Orabona and colleagues to consider the etiological implications of the findings of both studies. The chronological order of findings (abnormal uterine artery Doppler indices at 12–20 weeks' gestation precedes placental lesions in pre‐eclampsia developing later in pregnancy) would suggest that abnormal uterine flow causes placental lesions, and not vice versa .…”

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confidence: 99%

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Khalil

Thilaganathan

2018

Ultrasound in Obstet & Gyne

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“…Falco et al . conducted a systematic review and meta‐analysis in order to quantify the prevalence of placental villous and vascular histopathological lesions in pregnancies complicated by pre‐eclampsia (PE).…”

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confidence: 99%