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PubMed2006

Evidence of placental abruption as a chronic process: associations with vaginal bleeding early in pregnancy and placental lesions.

BACKGROUND: Clinicians widely regard placental abruption as an acute event, though accumulating data point towards abruption being the end-result of chronic processes early in pregnancy, and perhaps even extending to conception. The Collaborative Perinatal Project was a prospective cohort study performed from 1959 to 1966 in the United States. Since enrolled pregnancies were managed without the biases created by modern perinatal surveillance and interventions, the natural history of disease in these data is ideal to study obstetrical complications such as placental abruption. OBJECTIVE: We assessed the associations versus contributions of the clinical feature of early gestational vaginal bleeding and histologic lesions (chronic and acute) with placental abruption. STUDY DESIGN: Women enrolled in the Collaborative Perinatal Project (1959-1966) were used, restricting the analysis to those that delivered singleton births (n=46,364). Risks of placental abruption were compared between women with and without vaginal bleeding at <20 weeks gestation. We also examined the relationships between placental abruption and chronic and acute histologic lesions, including infarcts, decidual necrosis, presence of macrophages in the decidua, amnion or chorion, and neutrophil infiltration in the amnion, chorion, placental surface, and umbilical vein. RESULTS: Any episode of vaginal bleeding at <20 weeks in pregnancy conferred an increased risk of placental abruption (adjusted relative risk (RR) 1.6, 95% confidence interval (CI) 1.3, 1.8). The greatest risk occurred with bleeding in both the first two trimesters (RR 3.1, 95% CI 2.3, 4.1). The presence of histologic lesions in the placenta, cord and membranes similarly carried an increased risk of placental abruption, even in the absence of vaginal bleeding. The risk of abruption was, however, highest in the presence of both histologic lesions and vaginal bleeding early in pregnancy. CONCLUSION: Vaginal bleeding early in pregnancy and histologic lesions of the placenta, umbilical cord, and membranes are associated with increased risk of placental abruption in later pregnancy. However, the increased risk associated with placental lesions, especially chronic inflammatory lesions, even in the absence of early vaginal bleeding, suggests that prolonged inflammation may be implicated in placental abruption.

Abruptio Placentae↗
PubMed2006

Placental apoptosis and adhesion molecules expression in the placenta and the maternal placental bed of pregnancies complicated by fetal growth restriction with and without pre-eclampsia.

The aim of the study was to examine the expression of adhesion molecules VCAM-1 and ICAM-3 in placental tissue samples and placental bed (maternal decidual tissue) biopsies of pregnancies complicated by pre-eclampsia (PE) and fetal growth restriction (FGR), and to determine whether PE and FGR are associated with an increase in placental apoptosis. We studied placentas and placental bed samples of 49 third trimester pregnancies complicated by FGR (26 with associated PE, 23 without PE) and 25 normotensive healthy pregnant women. Placental apoptosis was assessed by the TUNEL method. Immunohistochemistry was used to assess expression of the VCAM-1 and ICAM-3. There was no significant difference in the staining intensity of VCAM-1 in placentas (p=0.472) and placental bed biopsies (p=0.754) of women delivering appropriate for gestational age and growth restricted fetuses (with and without associated PE). The amount of lymphocytes staining positively with ICAM-3 was significantly higher in both placental and placental bed biopsies of women delivering growth restricted fetuses compared with control pregnancies (p<0.001). Fetal growth restricted pregnancies with associated PE showed higher staining of ICAM-3 in placental compared with placental bed samples (p=0.049). In fetal growth restricted placentas, apoptotic nuclei were more abundant compared with control placentas (p<0.001). Increased expression of ICAM-3 on lymphocyte surface of both maternal and fetal side, suggests lymphocyte overactivation in PE and FGR. Increased placental apoptosis may play an important role in the pathogenesis or sequelae of PE.

Adult↗
PubMed2001

Placental weight and placental ratio as predictors of later blood pressure in childhood.

OBJECTIVE: A significant inverse relationship between blood pressure and birth weight is firmly established. This association may be the result of fetal adaptations to an adverse intrauterine environment. Further markers of intrauterine growth include the weight of the placenta and the placental ratio (the ratio of placental weight to birth weight). A number of studies suggest that a decreased placental weight or an elevated placental ratio may be independent risk factors for subsequent high blood pressure. The overall evidence for this is, however, inconclusive. The purpose of the present study was to clearly define the relationships between placental weight, placental ratio and subsequent blood pressure during childhood. DESIGN: Prospective cohort study of 2507 singleton children, born at term during 1989-1992. Blood pressures were recorded at ages 1, 3 and 6 years, using a semi-automated oscillometric device. RESULTS: Inverse relationships existed between both systolic and diastolic blood pressure and placental weight, adjusted for current weight at ages 1, 3 and 6 years. The relationships between placental weight and systolic blood pressure were statistically significant at ages 1 and 3 years. There was no consistent relationship between placental weight and later blood pressure within birth weight categories. No clinically or statistically significant association was seen between the placental ratio and either systolic or diastolic blood pressures at any age. CONCLUSIONS: Birth weight, rather than placental weight or their ratio, is the early life factor most importantly related to subsequent blood pressure in childhood.

Birth Weight↗
PubMed1987

[The changes in EPH gestosis placental amino acid transport activity (using human placental microvillous membrane vesicles)].

To elucidate the change in EPH gestosis placental amino acid transport activity, we investigated the uptake of L-alanine into microvillous membrane vesicles prepared from EPH gestosis placenta and from normal placenta by using a rapid filtration technique. 1. Alkaline phosphatase (ALP) was the marker enzyme of microvillous membrane vesicles (MMV). The ALP activity of mild EPH gestosis placental MMV didn't differ from that of normal placental MMV. On the other hand, the ALP activity of severe EPH gestosis placental MMV decreased compared to that of normal placental MMV. 2. The uptake of L-alanine into human placental MMV was dependent on the Na+ electrochemical gradient, so the transport across human placental MMV was a secondarily active one. The L-alanine transport activity of mild EPH gestosis placental MMV didn't differ from that of normal placental MMV. On the other hand, the L-alanine transport activity of severe EPH gestosis placental MMV decreased prominently compared to that of normal placental MMV.

Alanine↗
PubMed1994

Reduction of annexin-V (placental anticoagulant protein-I) on placental villi of women with antiphospholipid antibodies and recurrent spontaneous abortion.

OBJECTIVE: The mechanism by which antiphospholipid antibodies are associated with pregnancy loss and thromboembolic conditions has yet to be elucidated. Annexin-V, an anticoagulant phospholipid-binding protein, is normally present in syncytiotrophoblasts lining the placental villi, where it may play a role in the maintenance of intervillous blood fluidity. We therefore investigated the distribution of annexin-V in placentas of patients with antiphospholipid antibodies in situ and then used short-term villous cultures to study the direct effect of antiphospholipid antibodies on the immunolocation of annexin-V. STUDY DESIGN: We performed a blinded study by means of computerized morphometric analysis of placental tissues that were stained for annexin-V with affinity-purified polyclonal antibody in an avidin-biotin peroxidase system. The distribution of villous surface annexin-V on cross sections of placentas of patients with antiphospholipid antibodies was compared with that of placentas from patients with uncomplicated pregnancies, elective abortions, and pregnancy losses not associated with antiphospholipid antibodies (n = 8 for each group). We quantitated villous surface annexin-V in cultured placental villi that were incubated with antiphospholipid antibodies immunoglobulin G compared with normal immunoglobulin G and measured annexin-V levels by enzyme-linked immunosorbent assay in conditioned media and in the villi. RESULTS: The mean villous surface annexin-V of the group with antiphospholipid antibodies was 26.2% +/- 17% (SD) versus 93.9% +/- 5.7% in the normal control group (p < 0.0001). Villi from patients undergoing elective abortions and with pregnancy losses that were not attributed to antiphospholipid antibodies also showed higher mean villous surface annexin-V levels (86.9% +/- 10.6% and 83.5% +/- 11.3%, respectively, p < 0.0001). Organ culture of normal placental villi with affinity-purified immunoglobulin G from patients with antiphospholipid antibodies showed a dose-dependent decrease of villous surface annexin-V over a concentration range of 1.5 micrograms/ml to 1.5 mg/ml. Annexin-V concentrations in conditioned media were significantly lower in the presence of antiphospholipid antibodies immunoglobulin G compared with normal immunoglobulin G (49.4 +/- 8.9 ng/gm wet weight vs 57.2 +/- 11.5 ng/gm, respectively, p < 0.05). In contrast, the mean level of annexin-V in placental villi incubated with antiphospholipid antibodies immunoglobulin G was greater than in villi incubated with normal immunoglobulin G, 1328 +/- 130 ng/gm wet weight versus 1183 +/- 165 ng/gm (p < 0.02). CONCLUSIONS: Patients with antiphospholipid antibodies and a history of previous pregnancy losses have a significant reduction in annexin-V immunostaining on placental villous surfaces, and antiphospholipid antibodies immunoglobulin G can directly decrease levels of villous surface annexin-V on cultured placental villi. Assays of annexin-V in the conditioned media and cell pellets of cultured placental villi suggest that the mechanism for antiphospholipid antibodies-mediated reduced annexin-V surface staining is an inhibition of annexin-V transport to the villous surface rather than displacement by antiphospholipid antibodies from the surface. This antiphospholipid antibodies-induced deficiency of placental surface annexin-V may contribute to the placental thrombosis observed in these patients.

Abortion, Habitual↗
PubMed1991

Placental toxicology: tobacco smoke, abused drugs, multiple chemical interactions, and placental function.

There are increasing numbers of reports on the tobacco smoking and ingestion of abused drugs (e.g. morphine, cocaine) by pregnant women and the effects of the substances on the developing fetus and newborn infant. The passage of drugs and chemicals from the mother to the fetus is influenced by the placental transport and metabolism of the substances. Further, these drugs and chemicals affect the nutrient transport systems in the placenta. The three major drugs of abuse-nicotine, morphine and cocaine-depress both active amino-acid uptake by human placental villi and transplacental amino-acid transport by reason of the drugs' influence on placental cholinergic and opiate systems. Part of this depression (10-16%) is not reversible. Nicotine blocks the cholinergic receptor and thus blocks acetylcholine (ACh)-facilitated amino-acid transport. Morphine stimulates opiate kappa receptors and depresses ACh release. Cocaine blocks Ca2+ influx and thus blocks ACh release. ACh causes dilation of blood vessels and maintains placental blood flow by the activation of endothelial muscarinic receptors. By interfering with ACh release and placental blood flow, the three drugs of abuse may depress the diffusion of amino acids and other nutrients from the trophoblast into the placental circulation. Three regulatory systems are delineated for amino-acid uptake by the placenta: placental ACh, phospholipid N-methyltransferase, and the gammaglutamyl cycle. These systems operate in concert with one another and are dependent on cellular formation of adenosine 5'-triphosphate (ATP). Placental hypoxia induced by carbon monoxide and other tobacco gases depresses the energy-dependent processes and thus the ATP levels of placental cells. Maternal tobacco smoking and drug abuse cause placental insufficiencies for amino-acid transport, which may partially explain the fetal intrauterine growth retardation caused by these substances. Part of the amino-acid deficits may be compensated for by the induction of new amino-acid transport systems. Specific receptors or drug-binding proteins for the three drugs of abuse are present in the placenta. A DNA adduct selective for maternal smoking has been demonstrated in the placenta. DNA adducts selective for cocaine, morphine and other environmental chemicals have yet to be demonstrated ins the placenta.

Amino Acids↗
PubMed1987

Effect of restriction of placental growth on fetal and utero-placental metabolism.

The effect of restriction of placental growth on the supply of glucose to the gravid uterus and fetus and on fetal and utero-placental metabolism of glucose and lactate was examined in this study. Endometrial caruncles were removed from 13 sheep (caruncle sheep) prior to mating, which restricted placental growth in the subsequent pregnancy. Half the fetuses of caruncle sheep were small or growth retarded, with the remainder normal in size. After insertion of vascular catheters at 110 days gestation, the caruncle sheep, together with 16 control sheep, were studied between 121 and 130 days of gestation. Glucose delivery to and consumption by the gravid uterus and its contents, both as a total and per kg of tissue mass, was significantly lower in caruncle ewes with small fetuses, although glucose extraction was similar to that in controls. Utero-placental glucose consumption was significantly lower in caruncle ewes carrying small fetuses compared to that in control ewes, both as a total and per kg of placenta. Small caruncle fetuses were hypoxaemic and hypoglycaemic and the lactate concentration in the common umbilical vein was significantly higher than in control sheep. Glucose delivery to and consumption by the fetus was significantly lower in normal-sized and in small caruncle fetuses compared to controls. Fetal glucose consumption per kg of fetus was similar in control and caruncle sheep. Fetal glucose extraction increased as fetal weight decreased. Utero-placental production of lactate was similar in control and caruncle ewes. However, uterine output of lactate decreased as placental weight fell. Utero-placental production of lactate per kg of placenta was significantly higher in caruncle ewes compared to controls and increased as oxygen content in blood from the fetal femoral artery decreased. Fetal lactate consumption per kg of fetus increased as the concentration of lactate in blood from the common umbilical vein increased. It is concluded that intrauterine growth retardation due to restriction of placental growth is associated with a reduced supply of glucose to both the pregnant uterus and fetus and a redistribution of glucose therein to the fetus, both directly as glucose and indirectly as lactate. This reflects the disproportionate maintenance of fetal weight relative to that of the placenta, reduced utero-placental consumption of glucose per kg of placenta, conversion of a greater proportion of that glucose or other substrate(s) to lactate by the placenta and an increase in the fraction of the lactate produced by utero-placental tissues that is secreted into the fetal circulation.

Animals↗
PubMed1982

Fetal weight and its relationship to placental blood flow and placental weight in experimental intrauterine growth retardation in the rat.

The effects of experimental intrauterine growth retardation on fetal and placental weight and placental blood flow were studied in rats on day 21.5 of pregnancy. Two experimental approaches were employed. (1) Uterine artery ligation on one side on day 18.5 induced large individual variations in fetal and placental weight as well as in placental blood flow. We showed that fetal weight and placental blood flow were closely related for the values of flow ranging from 0.2 to 1.0 ml.min-1 and the values of fetal weight ranging from 2.5 to 4.5 g. In the opposite horn (control horn), variations of flow ranged from 1.0 to 2.2 ml.min-1 and they occurred without notable change of fetal weight. A relationship between fetal and placental weight was observed as well. In the ligated horn smaller fetuses had smaller placental weight. (2) Maternal fasting, 48 hours before term i.e. between 19 and 21 day of pregnancy decreases both fetal weight and placental blood flow by about 10% and 50% respectively as compared to the control values on day 21. Placental weight is virtually unchanged. The present data allow us to conclude that a marked decrease in maternal placental blood flow might be one of the main causes leading to intrauterine growth retardation.

Animals↗
PubMed1987

Effects of continuous intravenous infusion of an ovine placental extract enriched in placental lactogen on plasma hormones, metabolites and metabolite biokinetics in non-pregnant sheep.

Continuous intravenous infusions of saline or of a placental extract containing ovine placental lactogen were given to three non-pregnant, non-lactating ewes over periods of 36 h, 1 week apart. During saline infusion no placental lactogen was detected in jugular vein plasma. but infusion of the placental extract raised the placental lactogen concentration from undetectable to 40-50 micrograms/l, similar to concentrations in ewes with one fetus on day 90 of pregnancy. By comparison with the saline control period, infusion of the placental extract consistently increased both plasma concentrations and irreversible loss of nonesterified fatty acids. Plasma concentrations of glucose and urea, but not irreversible loss of these metabolites, were consistently increased. Although the placental extract was not subjected to extensive purification, it was enriched in placental lactogen and contained no detectable contamination with insulin, prolactin or growth hormone. The results are suggestive of a role for placental lactogen in modifying metabolism and acting during pregnancy to provide nutrients for fetal metabolism.

Animals↗
PubMedDate not supplied

Placental expression of VEGF, PlGF and their receptors in a model of placental insufficiency-intrauterine growth restriction (PI-IUGR).

Placental development requires adequate and organized interaction of vascular growth factors and their receptors, including vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). Both VEGF and PlGF, acting through the tyrosine kinase receptors VEGFR-1 and VEGFR-2, have been implicated in playing a role in ovine placental vascular development. The present studies describe the placental expression of components of the VEGF family at two maturational time points (55 and 90 days post coitus, dpc) in a hyperthermic-induced ovine model of placental insufficiency-intrauterine growth restriction (PI-IUGR). Both caruncular and cotyledonary VEGF and PlGF mRNA concentration increased with gestational age (P< 0.05), whereas only cotyledonary VEGF and PlGF protein concentration increased over gestation (P< 0.002). At 55 dpc, VEGF mRNA concentration was elevated in hyperthermic (HT) ewes, compared to control thermoneutral (TN) animals (TN; 0.52+/-0.08 vs HT; 1.27+/-0.17 VEGF/GAPDH, P< 0.001). At 90 dpc, expression of PlGF and VEGF mRNA was not altered by the HT treatment. Both TN cotyledonary VEGFR-1 and VEGFR-2 mRNA expression levels rose significantly over the period studied (P< 0.05 and P< 0.01 respectively). Receptor mRNA concentration in HT cotyledonary tissue was significantly reduced at 90 dpc (VEGFR-1; TN 0.21+/-0.02 vs HT 0.11+/-0.01 VEGFR-1/actin, P< 0.05, VEGFR-2; TN 0.18+/-0.05 vs HT 0.07+/-0.01 VEGFR-2/actin, P< 0.01). Soluble VEGFR-1 (sVEGFR-1) mRNA was not detected in these tissues. These alterations in growth factor and growth factor receptor mRNA expression, as a result of environmental heat stress early in placental development, could impair normal placental vascular development. Furthermore, alterations in VEGF, VEGFR-1 and VEGFR-2 mRNA expression, during the period of maximal placental growth, may contribute to the development of placental insufficiency, and ultimately intrauterine growth restriction.

Adult↗
PubMed2003

A proinflammatory cytokine response is present in the fetal placental vasculature in placental insufficiency.

OBJECTIVE: Vascular disease in the umbilical placental circulation is associated with fetal growth restriction and adverse outcome. It may be identified antenatally by the study of umbilical artery Doppler flow velocity waveforms. The cause of this vascular disease is unknown. We have previously provided indirect evidence for endothelial cell activation and a proinflammatory cytokine response. Recently, a family of inhibitors of cytokine signaling has been identified, referred to as the suppressors of cytokine signaling (SOCS). Activation of SOCS occurs when cytokines are produced in stimulated cells. We tested the hypothesis that endothelial cell activation was present in umbilical placental vascular disease and was associated with production of proinflammatory cytokines and members of the family of SOCS. STUDY DESIGN: Placentas were collected at delivery and microvascular endothelial cells were isolated. We studied 13 normal pregnancies and 10 with umbilical placental vascular disease identified by an abnormal umbilical artery Doppler study. Placental pieces were digested with collagenase and purified by adherence to Dynabeads coated with monoclonal antibody against CD31. The RNA was extracted from isolated endothelial cells. The messenger RNA expression of cytokine production (interleukin-6 and interleukin-8) and the members of SOCS family (CIS, SOCS1, SOCS2, and SOCS3) were assessed by use of semiquantitative reverse transcriptase-polymerase chain reaction. RESULTS: In the microcirculation of the placenta, endothelial cell expression of interleukin-6 messenger RNA (2.50+/-0.60 vs 1.25+/-0.26) and interleukin-8 messenger RNA (2.83+/-0.55 vs 1.58+/-0.27) was up-regulated in umbilical placental vascular disease in comparison to normal pregnancy. The endothelial cell mRNA expression of SOCS2 (3.36+/-0.77 vs 1.76+/-0.29) and SOCS3 (2.77+/-0.60 vs 1.48+/-0.26) was enhanced in placental vascular disease. There was no significant difference in expression of CIS and SOCS1 in microvessel endothelial cells. CONCLUSION: We have demonstrated that microvessel endothelium of the fetal placental vasculature produces both the proinflammatory cytokines (interleukin-6 and interleukin-8) and members of SOCS family (SOCS2 and SOCS3) in umbilical placental vascular disease. This cytokine production may play a key role in the interaction of endothelial cells of the placenta villi with neighboring cells. The up-regulation of SOCS2 and SOCS3 indicates these are the major negative regulators in umbilical placental microvessel endothelial cell activation pathways. By its occurrence, this also confirms the presence of a proinflammatory cytokine response.

Adult↗
PubMed1989

[The correlation of reduced amniotic fluid volume, placental maturity and morphologic placental changes in placental insufficiency].

A reduced quantity of amniotic fluid is diagnosed semiquantitatively in 41 pregnant women in the 38th to 40th week of gestation. In 21 cases, the birth of a mature hypotrophic child below the 10th weight percentile is registered. Sonographically, the placentas of the mature eutrophic children significantly more frequently show a grade III maturity and the placentas of the mature hypotrophic children a grade II maturity. In contrast to the values found in the placentas of eutrophic children and in the placentas with grade III maturity, a significantly decreased villous vascularization is determined in the placentas of hypotrophic children and in placentas with grade II maturity. The area of attachment of the placenta is 301 cm2 for the eutrophic children and 222 cm2 for the hypotrophic children. All findings are discussed and compared with the relevant data of the pertinent literature.

Amniotic Fluid↗
PubMedDate not supplied

Placental steroid metabolism in a case of placental sulfatase deficiency.

The importance of the placental 3 beta-steroid sulfatase for placental biosynthesis of estrogens is demonstrated by a case report of a placental sulfatase deficiency. The absolute deficiency of this enzyme in our case is demonstrated in vivo by the intravenous dehydroepiandrosterone sulfate loading test and in vitro by placental enzyme tests. Steroid concentrations in serum after injection of dehydroepiandrosterone sulfate (DHEA-S) are compared with those in a group of pregnant women without placental enzyme defects and in a group of nonpregnant women. Placental in vitro tests demonstrate the intact 3 beta-hydroxysteroid dehydrogenase-delta 4,5 isomerase-aromatase-system in the placenta with sulfatase deficiency. The lack of placental hydrolysis results in low concentrations of estrone and estradiol-17 beta in the maternal serum, which are only 5.9% and 12.5%, respectively, of the mean values of the control group. This indicates that more than 90% of estrone and more than 85% of estradiol-17 beta measured in the maternal serum are from DHEA-S as precursor. The remaining concentrations are converted mainly from dehydroepiandrosterone (DHEA), which needs no hydrolysis. Maternal serum concentrations of estriol are under the detection limit of the radioimmunoassay. This is due to the absence of the so called "neutral pathway" and the "phenolic pathway" with 16 alpha-hydroxydehydroepiandrosterone sulfate (16 alpha-OH-DHEA-S) and DHEA-S respectively as precursors. The insignificance of the "placental pathway" for the total biosynthesis of estriol is demonstrated. The placental sulfatase seems to have no great importance for the biosynthesis of the C21-steroids.

Androstenedione↗
PubMed1987

Bovine placental prostaglandin synthesis in vitro as it relates to placental separation.

Bovine placentomes were collected during late gestation, prepartum and immediately postpartum. Postpartum tissues were collected prior to fetal membrane separation. Maternal and fetal placentomal components each were examined for their ability to synthesize prostaglandins (PG's) from arachidonic acid (AA) and metabolize PGF2 alpha and PGE2 in vitro. Maternal placental PG synthesis was lower (P less than .05) than that for fetal placental tissue and was primarily PGF's. Fetal placental PG synthesis increased (P less than .05) prepartum and was primarily PGE's. Fetal placental PGE production predominated (P less than .05) postpartum if the fetal membranes were retained, while PGF production predominated (P less than .05) if the membranes were released. Maternal and fetal placental tissues were unable to convert PGE2 to PGF2 alpha (P greater than .05). Postpartum fetal placental tissue was able to convert PGF2 alpha to PGE2 (P less than .05) if the fetal membranes were retained but not if the membranes were released (P greater than .05). These results indicate that fetal placental synthesis of PGF's may be related to placental membrane separation. The shift in fetal placental PG production from PGE's to PGF's may be due to a cessation of the ability of released fetal tissue to convert PGF2 alpha to PGE2.

Animals↗
PubMed1999

A history of placental dysfunction and risk of placental abruption.

In a population-based historic cohort study, we assessed the possible association of fetal growth retardation, preterm birth and pregnancy-induced hypertension in the immediately preceding pregnancy with placental abruption in the current pregnancy, which would suggest a shared aetiological factor. We also assessed whether chronic hypertension, diabetes mellitus and a history of Caesarean section are associated with placental abruption. Preterm birth and small-for-gestational-age (SGA) in the immediately preceding delivery were associated with an increased risk of placental abruption with unadjusted odds ratios (ORs) of 2.1 [95% CI = 1.9, 2.4] and 1.6 [95% CI = 1.5, 1.8] respectively. Women with a history of an SGA preterm birth in the immediately preceding delivery and an appropriate-for-gestational-age infant in the current had an adjusted OR of 3.2 [95% CI = 2.3, 4.5]. The adjusted odds ratio of placental abruption in women who had pregnancy-induced hypertension in the previous pregnancy, but not in the current, was 1.4 [95% CI = 1.2, 1.7]. Women who delivered a preterm or SGA infant in the previous delivery and had chronic hypertension or diabetes mellitus in the current had adjusted ORs of 2.3-5.7 and 2.5-6.0 respectively. Caesarean section in the previous delivery increased the risk of placental abruption by 40%. These results suggest that pregnancy-induced hypertension, intrauterine growth retardation, preterm delivery and placental abruption share an aetiological factor or represent different clinical expressions of recurring placental dysfunction. Chronic hypertension and diabetes mellitus may cause or aggravate such dysfunction thus causing placental abruption. A history of Caesarean section is associated with an increased risk of placental abruption.

Abruptio Placentae↗
PubMed1985

In vitro degradation of oxytocin by pregnancy serum, placental subcellular fractions and purified placental aminopeptidases.

The degradation of oxytocin (formula; see text) by human placental particulate and soluble fractions, pregnant and non-pregnant sera, and purified enzymes such as microsomal placental leucine aminopeptidase (P-LAP), retroplacental serum P-LAP and placental post-proline endopeptidase, was studied by measuring liberated amino acids with a high performance liquid chromatograph (HPLC). While the placental particulate fraction degraded oxytocin almost completely into single amino acid and amide, the placental soluble fraction did not liberate any amino acid and amide. Purified retroplacental P-LAP liberated Tyr2, Ile3, Gln4 and Asn5 from the cyclic structure of oxytocin actively. Pregnancy serum containing the retroplacental P-LAP liberated also these amino acids and amides. Purified microsomal P-LAP liberated Leu8 in addition to these amino acids and amides. Although purified placental post-proline endopeptidase or porcine kidney leucine aminopeptidase (LAP) could not liberate any amino acid and amide from oxytocin, the combination of the post-proline endopeptidase with porcine kidney LAP or with placental microsomal P-LAP actively liberated all amino acids and amides detectable by HPLC. When the ratio of amino acid liberation velocity to LAP activity measured with leu-p-nitroanilide was calculated, the ratios for cyclic amino acids such as Tyr2 and Ile3 were high with the placental particulate fraction, the mixture of post-proline endopeptidase and microsomal P-LAP, retroplacental P-LAP, and pregnancy serum. The ratio for Leu8 was high with the placental particulate fraction and the mixture of post-proline endopeptidase and microsomal P-LAP.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed2000

Hemeoxygenase expression in human placenta and placental bed implies a role in regulation of trophoblast invasion and placental function.

The purpose of this study was to examine the expression of hemeoxygenases HO-1 and HO-2, which are responsible for the production of carbon monoxide (CO), in the human placenta and placental bed and to determine the role of inhibitors of HO on placental perfusion pressure. We hypothesized that HO is expressed within the placenta and that invading cytotrophoblast cells (CTB) express HO isoforms. The expression of HO-1 and HO-2 was studied on placenta and placental bed biopsies, obtained using a transcervical sampling technique, from normal human pregnancies between 8 and 19 wk gestation and at term. In the placenta, HO-2 immunostaining was prominent in syncytiotrophoblast in the first trimester and reduced toward term (P<0.0005). HO-2 endothelial immunostaining was weak in the first trimester, but increased by term (P<0.0005). Within the placental bed, HO-2 was expressed by CTB in cell columns, the cytotrophoblast shell, and cell islands. Both intravascular CTB and interstitial CTB expressed HO-2. HO-1 immunostaining was low in the placenta but intense on the CTB within the placental bed. A striking feature was the absence of HO-1 from the proximal layers of cell columns, with strong expression on the more distal CTB layers of the cell columns. In placental perfusion studies, a significant dose-dependent increase in perfusion pressure was observed in the presence of zinc protoporphyrin, an inhibitor of HO. These results suggest a role for CO in placental function, trophoblast invasion, and spiral artery transformation. Hemeoxygenase expression in human placenta and placental bed implies a role in regulation of trophoblast invasion and placental function.

Blotting, Western↗
PubMed1983

A prospective study of three biochemical fetoplacental tests: serum human placental lactogen, pregnancy-specific beta 1-glycoprotein, and urinary estrogens, and their relationship to placental insufficiency.

The relationship between abnormal biochemical fetoplacental test results and placental insufficiency was studied in a group of high-risk obstetric patients. The urinary estrogen: creatinine ratio and serum human placental lactogen (hPL) and pregnancy-specific beta 1-glycoprotein (SP1) were measured in more than 1,600 patients. Fifty-one patients were found to have abnormal biochemical results, and the placentas from these patients were sent for the assessment of placental insufficiency by pathologic examination, which was expressed as a placental insufficiency score. Low hPL was found to be the best biochemical indicator of placental insufficiency, and 84% of the patients with a low level of hPL had an elevated placental insufficiency score. The combination of low levels of hPL and urinary estrogen was found to be the best indicator of placental insufficiency associated with retarded intrauterine growth, and 83% of the patients who had low results in both of these tests had elevated placental insufficiency scores and were delivered of light-for-dates infants. The measurement of SP1 was found to be of limited value in detecting retarded growth, but patients with low SP1 values showed an increased incidence of fetal hypoxia. Attention is drawn to the fact that the discrepancies that occur in the various estimations are not necessarily due to artifact, and specific pathologic processes which could account for some of the anomalous results are identified.

Apgar Score↗