Ultrasonographic monitoring of the placenta in patients with bleeding during the first and second trimesters (original) (raw)
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Comparison of Preeclamptic and Normal Placentas with Histopathological and Clinical Findings
Çukurova anestezi ve cerrahi bilimler dergisi, 2020
Introduction: Preeclampsia (PE) is one of the most important reasons leading to maternal, and neonate morbidity and mortality. The pathophysiology of PE has yet to be fully elucidated. Hypoperfusion, hypoxia and ischemia are the critical components in the etiopathogenesis of PE. Here, we aimed to investigate the association between chronic villitis, infarction, edema, calcification, chorangiosis, perivillous fibrin deposits, fibrosis in villi, syncytial knot increase, retroplacental detachment, average placental weight, age, gravity, parity, abortion, hemoglobin, platelet, lactate dehydrogenase (LDH), D-dimer and protein 24 levels, and the clinical results. Materials and Methods: With no significant differences in age, gravity, abortion and parity values, 91 pregnant women diagnosed with PE in the preeclamptic placentae in our pathology department between 2015 and 2018, and 92 normal healthy pregnant women were included as the study and the control groups. Patients and babies' data were obtained from their files, and the laboratory data were obtained from the hospital automation records. Hematoxylin and eosin-stained preparations of the placentae were removed and re-evaluated from the archive. The data were analyzed by number, percentage, mean, standard deviation, and correlation tests. Numeric variables were investigated by t test in independent groups while categorical data were assessed by chisquare test. Results with p<0.05 were considered statistically significant. Results: As to age, gravity, parity, abortion, hemoglobin, platelet, LDH, D-dimer and protein 24 levels, no statistical difference was found between the study and control groups (p>0.05). Mean placental weight was 330.8±89 g and 431±59 g in the study and control groups. Retroplacental detachment was 7% in six cases (6/85) in the study group, while 1% in one case (1/92) in the controls. Mean gestational weeks were found as 33±3 and 38±1 weeks in the study and control groups. No statistically significant association was determined between the study and control groups for gravity, abortion, chorangiosis, villitis, edema, chorioamnionitis, calcification, perivillous fibrin and syncytial knot increase (p>0.05). Conclusion: Based on our findings, there were some differences in placental histopathology of preeclamptic patients; the differences may be related to placental insufficiency. However, the absence of differences in various placental histopathological parameters also supports that every perinatal problem is not associated with a placental abnormality, nor is every placental pathology associated with a perinatal malfunction.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Placenta previa is one of the major causes for obstetric hemorrhagic morbidity and mortality with increasing incidence in recent times. This study aims at determining risk factors, maternal and fetal outcome associated with placenta previa.Methods: This was an observational, retrospective study conducted at a tertiary care hospital in Mumbai from May 2017 to March 2020. A total of 102 women with placenta previa during the study period were included, their case records critically analyzed to identify risk factors, maternal outcome in relation with blood transfusion required, ICU admission, obstetric hysterectomy and fetal outcome pertaining to prematurity, asphyxia and mortality.Results: A total of 102 patients were analyzed. Placenta previa was more common in >26 years of age, multipara (64.7%), with previous history of caesarean sections (21.5%) and previous curettage (11.7%), 44.2% babies born were preterm, 4.4% stillbirths and 8.5% neonatal deaths. Maternal complic...
Anatomical and Histopathologic Analysis of Placenta in Dilation and Evacuation Specimens
Abstract Background: Anatomical and histopathologic examination of placenta in cases of abortion is crucial as to clarify the underlying causes of many adverse pregnancy outcomes. Dilation and evacuation (D&E) is the most common mode of uterine evacuation that commonly examined in pathology sections. The aim of this study is to discuss the various placental pathologies, and to demonstrate the importance of careful pathologic examination of D&E material, also to review the anatomy of placenta and to compare our findings with other publications worldwide. Material and Methods: A retrospective descriptive study for 200 placental tissues was collected in 18 months period and revised for normal anatomy and various placental pathologies. These placentas were obtained by dilation and evacuation (D&E) technique. All cases were undergone for histopathological sections that were stained by Hematoxylin and Eosin (H&E). Results: Placental infarction was observed in 25% of cases, and chorioammnitis was the most common form of placental infection and found in 12.5%. Molar changes were represented a lowered percentage of placental pathologies that found in 9% of specimens. Conclusion: Study and recognition of placental lesions among general surgical pathologists have clinical significance and awareness of deficiency, standardization of diagnostic criteria, and increased knowledge in placental pathology improve the quality of diagnosis in this area. Keywords Anatomical, Histopathologic, Placenta, Abortion
Background: The placental examination provides important information about the effect of maternal abnormalities on the placenta or the cause of preterm delivery, fetal growth restriction, or fetal neurodevelopmental damage. In this study, the frequency of placental pathologies of patients in a tertiary hospital was investigated. Methods: In this longitudinal and cross-sectional study, all removed placentas after any type of pregnancy termination referred to a pathological examination, within one year (2019–2020). All placentas were examined macroscopically and microscopically by two pathologists. Results: Unfortunately, because of the covid-19 pandemic, the number of pregnant women in our hospital declined. A total of 258 placentas were examined. The type of delivery in 193 cases (79.4%) was cesarean section and 50 cases (20.6%) had a vaginal delivery. In the pathological assessment of placentas, 238 (92.2%) cases were normal and 20 cases (7.8%) were abnormal. Infarct and chorioamni...
Ultrasound of the Placenta: A Systematic Approach. Part I: Imaging
Placenta, 2008
Diagnostic ultrasound has been in use in clinical obstetrics for close to half-a-century. However, in the literature, examination of the placenta appears to be treated with less attention than the fetus or the pregnant uterus. This is somewhat unexpected, given the obvious major functions this organ performs during the entire pregnancy. Examination of the placenta plays a foremost role in the assessment of normal and abnormal pregnancies. A methodical sonographic evaluation of the placenta should include: location, visual estimation of the size (and, if appearing abnormal, measurement of thickness and/or volume), implantation, morphology, anatomy, as well as a search for anomalies, such as additional lobes and tumors. Additional assessment for multiple gestations consists of examining the intervening membranes (if present). The current review considers the various placental characteristics, as they can be evaluated by ultrasound, and the clinical significance of abnormalities of these features. Numerous and varied pathologies of the placenta can be detected by routine ultrasound. It is incumbent on the clinician performing obstetrical ultrasound to examine the placenta in details and in a methodical fashion because of the far reaching clinical significance and potentially avoidable severe consequences of many of these abnormalities.
Case Reports in Obstetrics and Gynecology, 2014
Background. Placenta accreta is a potentially life-threatening obstetrical condition and is responsible for many emergency Caesarean hysterectomies. Early prenatal diagnosis may help minimize maternal morbidity and mortality. This report highlights risk factors, early diagnostic findings and complications associated with placenta accreta, and the role of first trimester sonography in diagnosis. Case. A 38-year-old pregnant woman, G2P1L1 with history of one previous Caesarean section, presented with vaginal bleeding at 13 weeks' gestation. Ultrasound examination was highly suspicious of placenta previa with accreta. During an earlier 12-week scan for nuchal translucency measurement, the placenta was suboptimally visualized. She was counselled regarding potential maternal and fetal complications as well as management options. At 33 weeks' gestation Caesarean hysterectomy was performed due to vaginal bleeding. Conclusion. Early ultrasound screening in high-risk patients may be advantageous in order to identify placenta accreta and conduct appropriate patient counseling regarding risks and management options.
Sonographic Findings of Morbidly Adherent Placenta in the First Trimester
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016
The purpose of this study was to evaluate the association between first-trimester sonographic findings and morbidly adherent placenta at delivery. We conducted a retrospective review of all first-trimester sonographic examinations from pregnancies that underwent third-trimester sonography for placenta previa or low-lying placenta between September 1997 and October 2011. Only women with a prior cesarean delivery were included. Transabdominal and transvaginal images from these first-trimester studies were reviewed for the following sonographic parameters: distance from the inferior border of the gestational sac to the external cervical os, location of the decidua basalis, presence of anechoic areas, uterine-bladder interface irregularity, and smallest anterior myometrial thickness. Morbidly adherent placentation was confirmed on histologic examination of hysterectomy specimens. Statistical methods included univariate and multivariate analyses. Thirty-nine patients met inclusion criter...
2002
Background: The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy. Method: A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied.