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Leptin receptor expression increases in placenta, but not hypothalamus, during gestation in Mus musculus and Myotis lucifugus.

In addition to effects on appetite and metabolism, the hormone leptin is required for reproduction in mammals. Maternal plasma leptin is increased above non-pregnant levels in all mammals thus far examined, including humans. The increase in plasma leptin appears to result in part from upregulation of adipose leptin secretion (e.g., in mice), or from production and secretion of leptin from the placenta (e.g., in humans and some bats). The placenta may also modulate maternal leptin levels via production of a plasma leptin-binding protein (mice, humans). Thus, the placenta plays a coordinating role in regulation of maternal leptin during pregnancy. In this study, the hypothesis that the placenta is also a target organ for leptin in diverse taxa was tested by examining the expression of leptin receptors (Ob-R) in placentae from species of distantly related mammalian taxa, Mus musculus (the laboratory mouse) and Myotis lucifugus (the little brown myotis, also called the little brown bat). A partial sequence of M. lucifugus Ob-R cDNA was first obtained and found to share approximately 78-88% homology at the nucleotide level with known mammalian Ob-R cDNAs. Using probes and primers designed from this sequence, receptor expression was detected in numerous tissues of M. lucifugus, including placenta, which expressed two major receptor isoforms as judged by molecular size. In both species, Ob-R mRNA expression in placenta significantly increased from early to late gestation. Expression of Ob-R mRNA was not affected by cAMP treatment in vitro. The increase in Ob-R mRNA expression in placenta was specific, since Ob-R mRNA expression did not change during gestation in either species in hypothalamus, the major site of the central actions of leptin. Thus, Ob-R is expressed in placenta throughout gestation in mice and bats, and its expression increases over the course of gestation, which raises the possibility that leptin may exert temporally distinct effects on placental growth or function throughout gestation. Because similar placenta-specific changes in leptin receptor expression occurred in species from distantly related mammalian taxa which collectively comprise approximately 70% of all known mammalian species, it is possible that placental actions of leptin are conserved across mammals, even in those species (such as the Swiss-Webster strain of mouse) in which the placenta does not itself produce leptin.

Animals↗

Relationship between pregnancy-induced hypertension and placenta previa: a population-based study.

OBJECTIVE: Our purpose was to investigate, in a large population-based cohort, the hypothesis that the risk of pregnancy-induced hypertension is lower among pregnancies complicated by placenta previa compared with pregnancies occurring in women with fundally implanted placentas. STUDY DESIGN: Data for this retrospective cohort study were derived from the computerized Atlee perinatal database of the Reproductive Care Program, Nova Scotia, Canada. Women who were delivered in the province between 1980 and 1993 were included in the study. Patients with pregnancy-induced hypertension were clinically diagnosed by the presence of elevated blood pressure, proteinuria, or edema. The risk of pregnancy-induced hypertension was compared between women diagnosed with placenta previa and those with a normally implanted placenta, after adjustment for potential confounders through multivariable logistic regression models based on the method of generalized estimating equations. RESULTS: During the 14 years (1980 to 1993), 121,082 singleton pregnancies were registered in the program, 416 (0.4%) of which had a confirmed diagnosis of placenta previa. Women with chronic hypertension had a relative risk of 1.2 (95% confidence interval 0.4 to 3.7) for placenta previa compared with normotensive women. However, the risk of pregnancy-induced hypertension was reduced by half among those with placenta previa (relative risk 0.5, 95% confidence interval 0.3 to 0.7). Adjustments for potential confounders, including maternal age, parity, prepregnancy body weight, prior cesarean delivery, prior spontaneous or induced abortions, and cigarette smoking, had no influence on this association. Analyses on the basis of stratification of women by parity (nulliparous vs multiparous), cigarette smoking (smoker vs nonsmoker), and gestational duration (< 28, 28 to 32, 33 to 36, and > 37 completed weeks) consistently showed reduced risks for pregnancy-induced hypertension among women with placenta previa, indicating that the association was not a result of shortened duration of gestation among women with placenta previa. CONCLUSIONS: The results from this study clearly show a decreased frequency of pregnancy-induced hypertension among those pregnancies with placenta previa. We speculate that the pathophysiologic mechanisms for this finding may be due to altered placental perfusion seen among women diagnosed with placenta previa.

Adult↗

Up-regulation of CCR5 expression in the placenta is associated with human immunodeficiency virus-1 vertical transmission.

The role of placenta in vertical transmission is not yet fully understood. A protective role of the placenta during gestation is suggested by the finding that caesarian sections reduce the risk of transmission of human immunodeficiency virus (HIV)-1 from mother to child three- to fourfold. Here we investigated whether the immunological milieu of the placenta might be important in HIV-1 transmission. In situ imaging of immunohistochemically stained placenta sections and reverse transcriptase-polymerase chain reaction demonstrated a fourfold increase in CCR5:CXCR4 expression ratio in placentae from transmitting women compared to placentae from nontransmitting women. This chemokine receptor repertoire was consistent with an up-regulation of interleukin-4 and interleukin-10 expression in placentae from nontransmitting placentae compared to transmitting placentae. In situ imaging demonstrated that CCR5 and CXCR4 were expressed on placental macrophages and lymphocytes but not in trophoblasts. Simultaneous immunofluorescence/ultrasensitive in situ hybridization for HIV-1 gag-pol mRNA revealed that HIV-1 infects primarily CXCR4-expressing cells in placentae from nontransmitting women whereas predominantly CCR5-expressing cells were infected in placentae from transmitting women. These data are consistent with transmission of a homogeneous population of nonsyncytium-inducing HIV-1 isolates that use CCR5 as co-receptor.

Cytokines↗

Placenta accreta--summary of 10 years: a survey of 310 cases.

The objective was to study the incidence, risk factors, and outcome of pregnancies complicated by placenta accreta in our population. Retrospective analysis of all deliveries between the years 1990-2000, and identification of all cases of placenta accreta, defined by clinical or histological criteria. For comparison purposes we defined two sub-groups: (i) all cases that ended with severe outcome and (ii) all patients who had a previous event of placenta accreta in one or more of their previous deliveries. We evaluated the potential risk factors leading to these conditions. The SPSS software package was used for statistical analysis. Univariate and multivariate analyses were performed by stepwise logistic regression. The study covered 34 450 deliveries from which 310 cases of placenta accreta were diagnosed (0.9 per cent). The risk factors associated with placenta accreta were previous cesarean delivery (12 per cent), advanced maternal age, high gravidity, multiparity, previous curettage and placenta previa (10 per cent). Hysterectomy was performed in 11 patients (3.5 per cent) with one case of maternal death, whereas 21 per cent of the patients required postpartum blood products transfusion. Antenatal diagnosis of placenta accreta or percreta by ultrasound or MRI, was achieved only in eight of the cases. In the sub-group of 15 patients (4.8 per cent) with severe outcome, the only significant risk factors were increased parity (O.R.=1.29, 95 per cent CI 1.056-1.585), anteriorly low placenta (O.R.=6.1, 95 per cent CI 1.4-25.3) and repeated cases of caesarean sections (O.R.=3.3, 95 per cent CI 0.9-12.5), whereas in the 49 (16 per cent) patients with repeated cases of placenta accreta the only significant risk factor was the number of deliveries (O.R.=1.5, 95 per cent CI 1.0-2.2). Repeated cesarean delivery, high parity, and anteriorly low placental location are associated with severe outcome in case of placenta accreta. Women with repeated events of placenta accreta may have better outcome and a genetic factor may serve as a cause for this condition.

Academic Medical Centers↗

Increased apoptosis in the syncytiotrophoblast in human term placentas complicated by either preeclampsia or intrauterine growth retardation.

OBJECTIVE: This study was undertaken to determine whether preeclampsia and intrauterine growth retardation are associated with an increase in placental apoptosis. STUDY DESIGN: Tissue specimens from 7 normal term placentas and each of 7 term placentas complicated by severe preeclampsia or intrauterine growth retardation were analyzed. Fas antigen and Bcl-2 protein expression were examined by the avidin/biotin immunoperoxidase method, whereas apoptosis was assessed by the terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling (TUNEL) method and transmission electron microscopy. RESULTS: Fas antigen was immunolocalized in syncytiotrophoblasts in all placentas examined. No changes in the intensity of Fas antigen immunostaining in syncytiotrophoblasts were apparent among those placentas. Bcl-2 protein was abundantly immunolocalized in syncytiotrophoblasts in normal term placentas, but least abundant in term placentas complicated by severe preeclampsia or intrauterine growth retardation. Apoptosis was apparent in the nuclei of both cytotrophoblasts and syncytiotrophoblasts. The apoptosis positive rate of syncytiotrophoblast nuclei in severe preeclamptic and intrauterine growth retardation term placentas was significantly higher than that in normal term placentas (severe preeclampsia, P <.001; intrauterine growth retardation, P <.01). Transmission electron microscopy revealed the appearance of apoptotic nuclei in trophoblasts in severe preeclamptic term placenta. CONCLUSION: Decreased expression of Bcl-2 protein in syncytiotrophoblasts in severe preeclamptic and intrauterine growth retardation placentas may result in the increase in apoptosis in syncytiotrophoblasts in those placentas.

Apoptosis↗

Risks associated with cesarean sections in women with placenta previa.

OBJECTIVE: To investigate the risks associated with cesarean section performed because of placenta previa. METHODS: We retrospectively reviewed the records of 88 women with singleton pregnancies complicated by placenta previa who underwent cesarean sections and those of 176 (control) women with singleton pregnancies who required cesarean section because of complications other than placenta previa. RESULTS: The duration of gestation was 35.3 +/- 3.6 weeks for subjects with placenta previa and 36.9 +/- 3.8 weeks for the control subjects. The mean birth weight was 2,650 g +/- 75 g for infants of women with placenta previa and 2,644 g +/- 38 g for infants of the control subjects. Blood loss during surgery was greater for women with placenta previa than for the control subjects (1,154 ml +/- 924 ml vs 632 ml +/- 357 ml, p < 0.001). Blood transfusion was required in 13 of 88 (15%) women with placenta previa, compared with 4 of 176 (2.3%) of the control subjects (p < 0.001). An emergency cesarean hysterectomy was performed on 4 of the 88 (4.5%) women with placenta previa, and in none of the control subjects (p < 0.05). The Apgar score was < or = 7 at 5 minutes in 17 infants of the 88 (22%) women with placenta previa, compared with 17 infants of the 176 (11%) control subjects among infants born at > or = 33 weeks' gestation (p < 0.05); among infants with a birth weight > or = 2,000 g, the corresponding numbers were 15 (21%) and 13 (9.2%), respectively (p < 0.05). CONCLUSIONS: Cesarean section in the women with placenta previa was associated with increased blood loss, resulting in a blood transfusion rate 6.5 times higher than in the control subjects. These findings suggest that placenta previa might adversely affect the neonatal outcome.

Adult↗

Placenta praevia: maternal morbidity and place of birth.

BACKGROUND: International guidelines recommend that women with placenta praevia should be delivered by an experienced operator at a hospital with an on-site blood bank. AIM: To determine the risk factors, level of care at the birth hospital and incidence of maternal morbidity for women with placenta praevia. METHODS: Data were obtained from linked hospital separation and perinatal databases for 375,790 women giving birth in a NSW hospital, 1998-2002. We defined clinically significant placenta praevia as those women who were delivered by Caesarean section at or after 26 weeks gestation. Outcomes for women with and without placenta praevia were compared. Among women with placenta praevia, antenatal predictors of maternal morbidity were assessed. RESULTS: A total of 1612 (4.3/1000) women had significant placenta praevia. Women with placenta praevia were more likely to be older, have a prior Caesarean section, require general anaesthetic for delivery and deliver preterm. Among women with placenta praevia, 61% delivered in hospitals with 24-h on site blood banks, 33% in hospitals with on-call blood bank services after hours and 6% in hospitals with no blood bank. Two hundred and twenty three (14%) women with placenta praevia suffered a major morbidity (OR = 15.0, 95%CI 12.9-17.4). The proportion of this morbidity that occurred among women delivered electively at term was 40% in hospitals with 24 h blood banks and 55% in other hospitals (P = 0.06). CONCLUSIONS: For women with placenta praevia, the risk of major morbidity is high, yet 39% deliver in hospitals without immediate access to a 24-h blood bank. Australian guidelines on the appropriate level of care for women with placenta praevia are needed.

Adolescent↗

Histopathological study of placental bed biopsy in placenta previa.

BACKGROUND: To study placental bed biopsy changes in placenta previa and normally implanted placenta. SUBJECT AND METHOD: Fifty placental bed biopsies from 50 patients with placenta previa and 50 placental bed biopsies from normally implanted placenta were taken at cesarean section. Placental bed biopsy was stained with hematoxyline and eosin for histological examination. Both the groups were compared for trophoblastic invasion and vascular changes of placental bed spiral arteries. Statistical analysis was done by Chi-square test. RESULTS: Placenta bed biopsy was representative in 42/50 (84%) biopsy samples of the study group (placenta previa) and 35/50 (70%) of the control group (normally located placenta). Trophoblastic giant cell migration into decidua was present in 100% of representative samples of both the groups while migration into myometrium was seen in 66.67% and 51.14% of samples of study and control group. Average number of trophoblastic giant cells per sample was significantly higher in placenta previa (decidua 41.3%, myometrium 52%) than the control group (decidua 17.4%; myometrium 14.5%). Trophoblastic giant cell infiltration into myometrial spiral arterioles was higher in placenta previa (81.83 cells per vessel). Percentage of myometrial spiral arterioles showing physiological changes was significantly higher in the study group (50.39%) compared to the control group (21.14%). Incidence of inflammatory cell infiltration was higher in the study group (42.86%). Hemorrhage into decidua and myometrium were seen in biopsy samples of the placenta previa. CONCLUSION: Placenta previa is associated with significantly higher trophoblastic giant cell infiltration and physiological changes of the myometrial spiral arterioles.

Adult↗

Placenta previa: the role of ultrasound in assessment during third trimester.

OBJECTIVE: To assess the role of ultrasound in detecting the migration of placenta previa during the third trimester at Lady Willingdon Hospital and Jinnah Hospital, Lahore during the period July 2000 to September 2002. METHODS: Eighty pregnant women with the diagnosis of placenta previa at 28 to 32 weeks of gestation were included in the study. After base line ultrasound, scan was repeated every two weeks until delivery or placental migration for more than 3 cm from internal cervical os. Detailed information for placental position, distance from cervical os and relation to presenting part was recorded. Women with major degree placenta previa were admitted in the hospital at 32 -34 weeks of gestation. Delivery plan was made according to degree of placenta previa by completed 37 weeks of gestation. Cesarean section was done for the women with major degree placenta previa and minor degree placenta previa with antepartum hemorrhage and obstetric indication RESULTS: Out of 80 women placental migration to a distance of more than 3-5 cm from the internal cervical os occurred in 20 cases (12 anterior/anterolateral, 8 posterior/posterolateral) by 36 weeks of gestation and 20 had complete placenta previa. Out of remaining 40 cases, 12 patients had vaginal delivery and 28 had cesarean section. Placental migration was not observed in women with total placenta previa or posterior placenta previa when the distance of lower edge of placenta was less than 1 cm from the internal os. CONCLUSION: Ultrasound is important for the diagnosis of placental localization and placental migration during third trimester. Placental migration takes place more often in anterior than in complete or posterior placenta previa.

Cesarean Section↗

Effect of gestational diabetes and maternal hypertension on gross morphology of placenta.

BACKGROUND: Gestational diabetes is much more common than pre-existing diabetes i.e. it complicates 2% to 5% of pregnancies. When metabolic control is good, perinatal mortality should be no higher than in general population. However, macrosomia continuous to be a problem in higher than average proportions of such cases. Macrosomia also involves placenta within the chronic hypertensive disease, the most common diagnosis is essential vascular hypertension. METHODS: Total 60 full term placenta, 20 from normal and 20 each from gestational diabetics and chronic hypertensive mothers were studied grossly. Shape, attachment of umbilical cord, weight, diameter and central thickness of all placentas were noted. RESULTS: The study demonstrates that there is change of shape i.e. two lobes in one placenta from diabetic group. All other placentae were singly lobed and discoidal shape with central attachment of umbilical cord to the foetal surface of placenta. Weight central thickness and diameter were significantly greater in diabetic group as compared to normal and hypertensive group. Hypertensive group shows non significant decrease in weight of placentae while there was no change in central thickness and diameter of placenta in hypertensive than the normal group. CONCLUSIONS: On the basis of results of present study, it is concluded that diabetic's placentae showed increase in weight, central thickness and diameter. One out of 20 placentae in diabetic group also showed change of shape and attachment of umbilical cord to one love. Hypertensive's placentae showed no significant change in weight, shape central thickness and attachment of umbilical cord when compared with normal group.

Adult↗

[Evolution of the allantoid placenta in placental mammals].

The article surveys the literature concerning comparative morphology of allantoic placenta and presents some evolutionary-morphological conclusions. The initial form of allantoic placenta is non-deciduate that occurs in 7 orders of placental mammals. The non-deciduate placenta is especially characteristic for lower primates and Cetacea. The non-deciduate placenta in lower primates and the fact that in some modern species of insectivores the non-deciduate placenta is also preserved speaks in favour of the opinion that insectivores of the Cretaceous period had non-deciduate placenta. The non-deciduate placenta in Cetacea that take their origin from ancient carnivores (from procreodonts) demonstrates, in its turn, that the non-deciduate placenta was the initial form. The deciduate placenta was the means for changing many of vital activities of the organism--it is connected with shortening or lengthening of individual life duration and duration of pregnancy. In the course of evolution the allantoic placenta improved towards intensified metabolism between the embryo (fetus) and the maternal organism. Relations between the evolution of mature specimens and evolutional changes in placenta are at their initial stage of investigation.

Adaptation, Biological↗

The effect of retained placenta and metritis complex on reproductive performance in dairy cattle -- a case control study.

A study of the computer stored records of 293 dairy cows and 652 calvings reveals the effects of retained placenta and metritis complex on reproductive performance. The overall incidence rate of retained placenta was 11.2%. Retained placenta was 4.6 times more likely to occur following twin births than following single births. Most cases of retained placenta occurred during the fall. Forty-five percent of that seasonal increase was explained by an increased number of calvings. Metritis complex was diagnosed following 54.8% of retained placenta cases. Retained placenta alone did not significantly impair reproductive performance. Metritis complex, in the presence or absence of retained placenta, caused a significant (P</=0.05) increase in days open, services per conception, calving to first heat intervals and days from calving to first service. There is an indication (interaction P</=0.1) that cows with both retained placenta and metritis complex are more severely affected than cows with either retained placenta or metritis complex alone. The influence of retained placenta on fertility appears to depend on the proportion of cows with retained placenta that have metritis complex.

Animals↗

Exclusion of the placenta during fetal cardiac bypass augments systemic flow and provides important information about the mechanism of placental injury.

The in utero correction of congenital cardiac malformations requires the availability of fetal cardiac bypass. One difficulty with fetal cardiac bypass is that very high flow rates are necessary when the placenta is left in the bypass circuit; the placenta requires about 40% of fetal cardiac output, which results in a normal cardiac output of 400 ml/kg per minute. Previous attempts to perform fetal cardiac bypass failed to consistently achieve these high flow rates because of cannula size limitations. On the basis of previous work done in our laboratory with an isolated-placenta model, which demonstrated that at normothermia the placenta would tolerate at least 30 minutes of cessation of umbilical blood flow, we hypothesized that exclusion of the placenta from the fetal cardiac bypass circuit would reduce fetal cardiac output by one half and allow us to obtain better systemic perfusion without compromising placental function. Cardiac bypass was performed in 20 late-gestation fetal lambs. In 10 lambs, no drugs were given; 5 served as controls in which the placenta was perfused; in the last 5, the placenta was excluded by clamping the umbilical cord during bypass. The latter 10 lambs were treated with indomethacin, which is known to improve placental blood flow after fetal cardiac bypass. We measured blood gases and determined regional blood flow with radiolabeled microspheres to assess placental function after bypass. The 5 control fetuses experienced rapid hypercapnea and hypoxemia after bypass, in association with minimal placental blood flow; when the placenta was excluded, arterial carbon dioxide tension rose somewhat more slowly, and placental blood flow after bypass was significantly better. When indomethacin was given, arterial blood gases in both groups showed a mild increase in carbon dioxide tension and similar placental blood flows (about 30% of baseline) after bypass. Indomethacin is known to block the vasoconstrictive response of the placenta to fetal cardiac bypass, implicating the release of vasoactive cyclooxygenase products as the cause of the adverse effects. In this study, placental perfusion on bypass without indomethacin caused much more severe placental dysfunction than did bypass with the placenta excluded from the circuit. The use of indomethacin improved postbypass placental function in both groups, but this effect was much more dramatic in the placenta-perfused group.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

[Placenta membranacea. Review of the literature, a case report].

Placenta membranacea or placenta diffusa is a rare abnormality in which all or most of fetal membranes remain covered by chorionic villi, because the chorion has failed to differenciate into chorion laeve and chorion frondosum. This condition is associated with recurrent antepartum bleeding, abortion in the second trimester of the pregnancy, preterm delivery, fetal death, intra-uterine growth retardation, post partum haemorrhage and placental retention. In this paper, we report our first case of placenta membranacea. A 30-year-old black woman, gravida 3, para 1, was admitted at 23 weeks of gestation for vaginal bleeding. She was placed on complete bed rest. Ultrasonographic examination showed a placenta covering the anterior and posterior uterine walls and the internal cervical os. At 28 weeks and 34 weeks of gestation, ultrasound examination showed the same findings: total placenta previa covering the entire uterine wall and presenting many lacuna. At 38 weeks, she underwent a cesarean section. The placenta adhered firmly to the myometrium. Because the attempts to remove the placenta was unsuccessful, it was performed a total hysterectomy. The total blood loss was 7000 ml. Anatomo-pathologic examination of the placenta led do the diagnosis of placenta membranea, total previa and increta. In the literature, 35 cases of placenta membranacea have been reported; of these, there are ten cases associated with total hysterectomy.

Adult↗

Evidence for the functional activity of hypoxia-inducible transcription factors overexpressed in preeclamptic placentae.

Placentas from women with preeclampsia overexpress the hypoxia-inducible transcription factor proteins, HIF-1alpha and -2alpha (Rajakumar 2001, Biol Reprod 64; p499-506 and p1019-1020). As a first step in evaluating whether HIF-alpha overexpressed in preeclamptic placentae is capable of transactivation, we tested its ability to bind to the DNA hypoxia response element (HRE). Six pairs of normal and preeclamptic placentae obtained by cesarean section were investigated. Three biopsy sites per placenta were analyzed. We first confirmed HIF-1alpha protein overexpression in the preeclamptic placentae using Western analysis. The ratios of the arbitrary densitometry units for HIF-1alpha protein from the preeclamptic and normal placentae (PE/NP) in the three biopsy sites were: 1.9 +/- 0.3, 1.7 +/- 0.2 and 1.8 +/- 0.2, each p < 0.05 vs 1.0. (A ratio of >1.0 indicates that HIF-1alpha protein expression in placentas of women with PE exceeds that in placentas of NP women.) Conventional methods for extracting nuclear proteins and subsequent analysis by electrophoretic mobility shift assay were not suited for the frozen, archived samples (data not shown). Therefore, we employed DNA affinity chromatography using a biotinylated oligonucleotide representing the HRE of the erythropoietin gene coupled to streptavidin-coated Dynabeads. The HRE-bound proteins were then characterized by Western blot analysis. The PE/NP ratios of HRE-bound HIF-1alpha in the three biopsy sites from the six pairs of normal and preeclamptic placentae were 1.7 +/- 0.2, 2.1 +/- 0.4 and 2.4 +/- 0.5, each p < 0.05 vs 1.0. Having established DNA-binding potential at least in vitro, we subsequently analyzed three proteins that have been shown to be regulated by HIF-alpha as downstream, molecular markers of HIF-1alpha activity in vivo. VEGF receptor Flt-1 and Flk-1 play key roles in angiogenesis. Tyrosine hydroxylase is the rate-limiting enzyme in catecholamine synthesis. All three genes contain functional HRE in their promoter sequences. Total proteins were extracted from the same biopsy samples that were used for total and HRE-bound HIF-1alpha. Using specific antibodies we performed Western analysis and the levels of these three proteins were quantitated. The Flt-1 and tyrosine hydroxylase proteins were significantly higher, and Flk-1 significantly lower in placentae from preeclamptic compared to normal pregnancies. In summary, HIF-1alpha protein overexpressed in preeclamptic placentae is capable of binding to its DNA recognition sequence in vitro, and modulates gene expression in vivo.

Adult↗

Postpartum MR diagnosis of retained placenta accreta.

Retained placenta accreta can cause catastrophic postpartum hemorrhage. This study aims to determine whether MR imaging can differentiate retained placenta accreta from postpartum hemorrhage caused by other conditions. Fourteen cases suspicious for retained placenta were examined with MR imaging. Signal intensity, the enhancing pattern of uterine contents, and flow voids within the myometrium were retrospectively studied. As hysterectomy was performed in only two cases, final diagnosis was based on clinical outcome and analysis of uterine contents. Final diagnoses were retained placenta accreta in seven cases, retained normally attached placenta in four, hematoma in two, and placental site trophoblastic tumor (PSTT) in one. All seven cases with placenta accreta had a very hyperintense area on T2-weighted images, showing transient early enhancement. None demonstrated delayed strong enhancement around the hyperintense area. In two cases with retained normally attached placenta and in both with hematomas, there were no hyperintense areas on T2-weighted images. Of these, only one showed transient early enhancement. Flow voids were observed in four cases with placenta accreta, one with normally attached placenta, and the case with PSTT. A markedly hyperintense area on T2-weighted images and transient early enhancement without delayed strong enhancement between the mass and the myometrium can indicate retained placenta accreta.

Adult↗

Placenta accreta in Kuwait: does a discrepancy exist between fundal and praevia accreta?

OBJECTIVE: The purpose of this retrospective study was to compare maternal and neonatal outcome in relation to site of placenta accreta by stratifying the site of placenta accreta into upper and lower uterine segment implantation. SUBJECTS AND METHODS: Sixteen cases of placenta accreta which were reported in the Maternity Hospital of Kuwait over 11 years from January 1981 to July 1993 - (1990 and 1991 excluded) were retrospectively analyzed using the hospital medical records. RESULTS: The incidence of placenta accreta was 9.8 per 100,000 deliveries. The rate of accreta in patients with placenta praevia was 880 per 100,000 placenta praevia, compared to a rate of 5 accreta per 100,000 placenta implanting in the upper uterine segment. There were no differences between accreta found in the upper segment and lower segment for maternal and neonatal mortality, maternal complication, past obstetric history and possibility of conserving the uterus. Significant differences were found in the birth weight, gestational age at birth, antenatal symptoms, time of diagnosis and mode of delivery when accreta was stratified by site of implantation. CONCLUSION: Placenta praevia is a definite risk factor for placenta accreta. Combined abnormal penetration of placenta as in accreta and abnormality in site as in praevia does have a significant clinical implications.

Adult↗

Expression of mitochondrial thioredoxin-dependent antioxidant protein, SP-22, in normal human and inflammatory mouse placentae.

The aim of this study was to elucidate whether a novel mitochondrial antioxidant protein, SP-22, is localized in placenta and whether its expression is induced in placenta of lipopolysaccharide (LPS)-exposed mouse. Western blot analysis of normal human placenta indicated that the SP-22 protein was located in the mitochondrial fraction. Immunohistochemical analysis of SP-22 in normal placenta showed that immunoreactive SP-22 was distributed mostly in cytotrophoblastic cells but with almost no signal in syncytiotrophoblasts. The positive signals were also detected in the decidual cells and stromal cells in stem villi of normal placenta. We also examined LPS-mediated inflammatory placenta on day 13 of pregnancy at various time points after LPS injection (50 microg/kg, intraperitoneally). Western blot analysis indicated that LPS approximately quadrupled the expression of SP-22 in placenta of LPS-exposed mouse. When the SP-22 protein was localized immunohistochemically, the decidua and the diploid trophoblasts in the basal zone were intensively stained in placenta of LPS-exposed mouse compared to the control. The localization and inducible expression of SP-22 protein in placenta suggest a possible role in antioxidant system in mitochondria of normal and inflammatory placentae.

Animals↗