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Biomedical subjects

K Benirschke

Publications and source records attributed to K Benirschke.

At least 55 records · Page 3Linked to original sources
PubMed1992

Maternal floor infarction: relationship to X cells, major basic protein, and adverse perinatal outcome.

OBJECTIVE: Maternal floor infarction of the placenta is characterized by gross placental abnormalities and histologic evidence of X-cell proliferation. Previously, pregnancy-associated major basic protein has been localized to the placental X cell and identified at elevated levels in serum and amniotic fluid in all normal pregnancies. Here we test the hypothesis that pregnancy-associated major basic protein is localized to the X cells in maternal floor infarction and that it contributes to the pathophysiologic features of pregnancies complicated by maternal floor infarction. STUDY DESIGN: Seven patients with eight pregnancies complicated by maternal floor infarction were evaluated. We analyzed placental tissue, serum, amniotic fluid, and placental cyst fluid for pregnancy-associated major basic protein. RESULTS: Placental tissue from pregnancies complicated by maternal floor infarction had increased numbers of X cells and fibrinoid material that occupied or surrounded degenerating villi and that stained intensely for pregnancy-associated major basic protein. Serum pregnancy-associated major basic protein levels were variable and likely cannot be used to predict the occurrence of maternal floor infarction. CONCLUSION: Pregnancy-associated major basic protein, a potent cytotoxin, is localized to X cells and is deposited in close proximity to chorionic villi in maternal floor infarction and may contribute to the pathophysiology of this disorder.

Adult↗
PubMed1992

Intrauterine death in multiple gestation.

Intrauterine death of one fetus in a multiple gestation is associated with significant morbidity and mortality in the surviving infant. This study is a retrospective review of 38 twin and 3 triplet gestations involving the intrauterine death of at least one fetus. The obstetrical history, placental pathology, autopsy findings, and neonatal history of the surviving infant are reviewed. Three cases involved the recent stillbirth of both twins, the remaining cases involved a surviving infant. In one case, neonatal death of a surviving twin occurred on day 19. In two sets of triplets, two stillbirths occurred, in the third case two infants were liveborn. The incidence of preterm delivery was 34%, which decreased to 18% if fetal cotwin death had occurred before 20 weeks gestation. Cesarean section was the method of delivery in 16 cases. There was an excess of velamentous cord insertions, which was most pronounced in the stillborn twin. Monochorionic placentation was found in 72%, also an excess. Neurological damage was known to have occurred in 19 of the 39 surviving infants. Fifteen of these 19 (79%) were associated with monochorionic placentation. The neurologically damaged twin infants, when compared to the normal infants, had the cotwin die later in gestation (31 vs 16.5 weeks), had a shorter duration between the death of the cotwin and delivery (2.5 vs 21 weeks), and delivered earlier in gestation (36.5 vs 39.5 weeks). The probable cause of neurological damage, in our opinion, was either exsanguination into the dead twin fetus, or disseminated intravascular coagulation which occurred in at least 13 cases. The incidence of antepartum death in a multiple gestation, and the potential for neurological damage is probably higher than previously thought. A review of the literature is presented and the clinical implications of this phenomenon are discussed.

Brain Damage, Chronic↗
PubMed1992

Postnatal white matter necrosis in preterm infants.

One hundred twenty-seven infants less than 36 weeks of gestation (mean +/- SE = 31 +/- 3.2 weeks) were studied with echoencephalography to determine the incidence and complications associated with white matter necrosis. Ten infants (8%) developed cysts ten or more days after birth, indicating postnatal onset of white matter necrosis. Univariate analysis showed that postnatal white matter necrosis was significantly associated with maternal infection (other than urinary infection), respiratory distress syndrome, and longer requirement of an oxygen concentration greater than 40%. Forward logistic regression analysis showed postnatal white matter necrosis to be associated with maternal infection, chronic placental infarction, congenital pneumonia, and longer requirement of an oxygen concentration greater than 40%. Neurodevelopmental outcome was abnormal during infancy in 4 of the 6 survivors with postnatal white matter necrosis. Severe respiratory disease and maternal and/or fetal infection appear to increase the risk of the immature brain to white matter necrosis, predisposing the infants to subsequent neurodevelopmental delay.

Echoencephalography↗
PubMed1991

Ovarian dysgenesis in individuals with chromosomal abnormalities.

To understand better the pathogenesis of ovarian dysgenesis in individuals with abnormalities such as 45,X Turner syndrome, trisomy 13, and trisomy 18, we have examined microscopically the ovaries of 36 infants with a number of chromosomal abnormalities confirmed by karyotype analysis. All infants with trisomy 13, trisomy 18, triploidy, and 45,X were found to have severe ovarian dysgenesis characterized by a virtual absence of primary oocytes. The ovaries of individuals with 21 trisomy and of those with partial deletion or duplication of an autosome demonstrated variable findings, which ranged from complete absence of oocytes to a mild diminution of oocyte numbers. The results of this study suggest that the attrition of germ cells in these infants is a result of faulty meiotic pairing and that ovarian dysgenesis is a more frequent finding in children with karyotypic abnormalities that has been realized previously.

Abnormalities, Multiple↗
PubMed1991

Association of immunoreactive eosinophil major basic protein with placental septa and cysts.

A protein that is immunochemically indistinguishable from the major basic protein of the eosinophil granule is present at elevated concentrations in the plasma of pregnant women. Major basic protein has been localized to placental trophoblasts known as X cells. Because X cells are located in placental septa and septal cysts, we tested whether the numbers of these structures are correlated with plasma levels of major basic protein. Data analysis revealed strong positive correlations between maternal plasma major basic protein concentrations and the number of placental septa, septal cysts, and subchorial cysts and the presence of subchorial fibrin deposits. No significant correlation was found between plasma major basic protein levels and other variables examined, such as placental weight. Thus major basic protein is a specific marker for septa and cysts, presumably because it is an X-cell product. The study of major basic protein may aid in delineating the function and ontogeny of X cells, as well as their role in fibrin deposition and in septa and cyst formation.

Blood Proteins↗
PubMed1991

Morbidity associated with prenatal disruption of the dividing membrane in twin gestations.

We report eight cases of intrauterine rupture of the dividing membranes in diamniotic twin gestations and the resulting perinatal morbidity and mortality. The poor outcomes associated with these intrauterine amniotic ruptures included fetal and neonatal death secondary to cord entanglement, preterm rupture of the membranes, preterm labor and delivery, and amniotic band syndrome. The overall perinatal mortality rate was 44% (seven of 16), and the mean gestational age at delivery was 29 weeks (range 22-34). Possible etiologies for this intrauterine diamniotic rupture include fetal trauma to the dividing membranes, amniocentesis, infection, and developmental disturbances. A new theory is examined to explain the surviving twin's morbidity associated with intrauterine death of the co-twin. This study suggests that intrauterine rupture of diamniotic twin membranes carries a perinatal mortality consistent with that of true monoamniotic gestations and that, in fact, this entity may be more common than previously thought. Finally, a suspected monoamniotic gestation cannot be ruled out by the historic presence of a dividing membrane on previous ultrasound examination.

Adolescent↗
PubMed1991

The placenta in the context of history and modern medical practice.

This is a brief summary of the development of our understanding of the anatomy and physiology of the human placenta. The article also traces the origin of some of the commonly used terminology that pertains to the placenta, and it makes reference to the major discoveries made in the understanding of human placentation. The legal implications for the current need of placental examination are traced and recommendations are made for future studies that might be conducted. Finally, questions are raised how to begin gaining some understanding of the mechanisms guiding the evolution of common placental features.

Europe↗
PubMed1990

Antenatal origin of neurologic damage in newborn infants. II. Multiple gestations.

Necrosis of the cerebral white matter may be identified in living infants with echoencephalography. Echoencephalographic studies were performed in 89 twins and 12 triplets at less than 36 weeks of gestation to determine the incidence and complications associated with antenatal necrosis of the cerebral white matter. Antenatal necrosis of the cerebral white matter was identified when brain atrophy or cavities in the white matter were present by day 3 of life. Fourteen infants (13.8%) were considered to have antenatal necrosis of the cerebral white matter. The incidence of antenatal necrosis of the cerebral white matter was higher in monochorionic than in dichorionic infants (30% vs 3.3%; p less than 0.001). Univariate analysis showed that antenatal necrosis of the cerebral white matter was significantly associated with polyhydramnios, intrauterine fetal death of the cotwin, hydrops, multiple placental vascular connections, and placental artery-to-artery, vein-to-vein, and artery-to-vein anastomosis. Logistic regression analysis showed that antenatal necrosis of the cerebral white matter was predicted by the presence of either artery-to-artery or vein-to-vein anastomosis and by intrauterine fetal death of a cotwin. Vein-to-vein anastomosis had the strongest association, because 89% of seven infants with vein-to-vein anastomosis demonstrated antenatal necrosis of the cerebral white matter (p = 0.003). Monochorionic multiple gestations frequently are complicated by antenatal necrosis of the cerebral white matter. Multiple vascular connections with vein-to-vein anastomosis appear as the most important associated factor for antenatal necrosis of the cerebral white matter in this population.

Analysis of Variance↗
PubMed1990

Oligohydramnios sequence and renal tubular malformation associated with maternal enalapril use.

We present the case of a child who died of pulmonary hypoplasia as a result of the oligohydramnios sequence. The mother was taking enalapril, as well as propranolol and hydrochlorothiazide, for treatment of hypertension associated with systemic lupus erythematosus. Autopsy examination revealed severe renal tubular malformation. Correlation of animal data with previous case reports of neonatal anuria in association with maternal angiotensin converting enzyme inhibitors suggests that these agents may have a deleterious effect on fetal renal development and general well-being.

Amniotic Fluid↗
PubMed1990

The placenta in the litigation process.

The placenta accurately reflects many important prenatal events. It is therefore important that it be examined. This is especially useful in cases of possible future litigation, the "bad-baby cases." There is much experience now that pathologic findings in the placenta often have a decisive role in the accurate disposition of legal cases. This presentation describes the examination of the placenta and provides a brief review of the nature of placental lesions that most often impact cases of alleged malpractice.

Female↗
PubMed1990

Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning.

Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. The presence of an acadiac twin requires the normal (or "pump") twin to provide circulation for itself, as well as the acardiac sibling. In many cases the acardiac twin is almost equal to the normal twin. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We reviewed the perinatal courses of 49 acardiac twin pregnancies to identify factors prognostic of favorable outcome. The overall perinatal mortality was 55%, primarily associated with prematurity. Mean (+/- SD) gestational age at delivery was 29 +/- 7.3 weeks, with a mean (+/- SD) normal twin weight of 1378 +/- 1047 gm. The acardiac weight averaged 651 +/- 571 gm. However, the occurrence of hydramnios, the occurrence of preterm labor, and perinatal outcome were strongly related to the ratio of the acardiac and pump-twin's weight. The mean overall ratio of the twin weights was 52% +/- 42%. However, the mean weight ratio for patients delivered before 34 weeks was 60% versus 29% (p less than 0.04). Preterm delivery was strongly associated with the development of hydramnios and congestive heart failure in the pump twin (p less than 0.01). If the twin-weight ratio was above 70% (25% of cases), the incidence of preterm delivery was 90%; hydramnios, 40%; and pump-twin congestive heart failure, 30% compared with 75%, 30%, and 10%, respectively, when the ratio was less (p less than 0.05). Regression of the weight of the acardiac twin against its longest dimension (L) resulted in this equation for prediction of acardiac weight: Weight (grams) = 1.2 L2-1.7L; r = 0.79, p less than 0.01. These data suggest that estimation of the relative weights in acardiac twins provides prognostic information regarding outcome. Poor outcome occurs with congestive heart failure and hydramnios in the normal twin. Use of the above data may assist in counseling patients and determining optimal management.

Adult↗
PubMed1990

The association of maternal floor infarction of the placenta with adverse perinatal outcome.

Maternal floor infarction of the placenta is a relatively rare disorder that on gross examination is characterized by a thickened gray-yellow maternal floor of the placenta with histologic evidence of massive fibrin deposition involving the decidua basalis and the contiguous villi. This lesion has been associated with fetal death, preterm delivery, and intrauterine growth retardation and is thought to be recurrent. Sixty cases of maternal floor infarction were identified in 48 women. Fetal death occurred in 24 of the 60 cases (40%). Preterm birth occurred in 21 of 36 (58.3%) live-born infants, and 19 of the 35 (54.2%) live-born infants for whom a birth weight was known had evidence of intrauterine growth retardation. Among the 41 multiparous patients in our series there were five documented recurrences (12.2%). Review of the past reproductive history of these 48 patients (196 pregnancies) demonstrated a significant incidence of fetal death (24.1%), intrauterine growth retardation (31.3%), and preterm death (35.4%). The association of fetal death and maternal floor infarction emphasizes the importance of a placental examination with all cases of fetal death and infants with intrauterine growth retardation. Given the risk of recurrence, the identification of maternal floor infarction should alert the clinician to the potential for growth retardation, preterm birth, and fetal death in subsequent pregnancies.

Female↗
PubMed1990

Lack of specific placental abnormality associated with cocaine use.

Detailed gross and histologic examinations were performed on 13 placentas from pregnancies complicated by maternal cocaine use. There were no characteristic changes in placental morphologic features that would explain the increased morbidity associated with cocaine use. It is likely that cocaine exerts its deleterious effects through acute or chronic pathophysiologic changes rather than alterations in placental architecture.

Chorioamnionitis↗
PubMed1990

Two live-born infants with trisomy 22.

The autopsy findings and karyotypes of two live-born fetuses with full trisomy 22 are discussed. Confined placental mosaicism was documented in one of the two cases. Confined placental mosaicism may play a role in the intrauterine survival of some trisomy 22 conceptions.

Abnormalities, Multiple↗
PubMed1990

Ultrastructural study of the amniotic epithelium in a case of gastroschisis.

A distinct vacuolar change in the amniotic epithelium has been reported in association with gastroschisis. Ultrastructural examination of the placenta from a case with gastroschisis demonstrated numerous lipid droplets in the epithelial cells. The epithelial cells were otherwise intact and did not appear degenerated. The appearance of the lipid was different from meconium in macrophages in the underlying chorion.

Abdominal Muscles↗