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PubMed1993

[Ultrasonographic study of low-lying placenta and its clinical significance].

Low-lying placenta is reported to cause PROM, preterm labor, and abnormal bleeding during pregnancy and labor, but it has not been clearly defined how low the placenta has to be implanted to categorize it as "low-lying". In the present investigation, using ultrasonography, the distance between the placental implantation site and the internal cervical os in relation to gestational outcome was investigated to clarify the diagnosis and clinical significance of low-lying placenta. 1. Placental implantation site in normal gestation 1) In none of the cases at week 28 of gestation or later, the distance was 2cm or less between the lower edge of the placenta and the internal cervical os. At week 32 or later, the distance was 3cm or less in none. 2) At week 36 or later, it was 5 cm or more in all cases. 2. Low-lying placenta in association with gestational or labor outcome When "low-lying placenta" was tentatively defined as the placenta implanted within 2cm from the internal os and "normal placenta" as one implanted 2.1 cm or more from the internal os, the following findings were obtained. 1) The incidence of low-lying placenta was 2.8% (49/1,771) at gestational weeks 20 < or = - < 24, 0.96% (17/1,771) up to gestational week 29, and 0.73% (13/1,771) up to 1 week prior to labor. 2) The incidence of bleeding during gestation, preterm labor, PROM and emergency C/S was higher in the 13 cases with low-lying placenta remaining until labor than in 1,749 cases (p < 0.05) normally sited.(ABSTRACT TRUNCATED AT 250 WORDS)

Cesarean Section↗
PubMed1998

Transport of maternal LDL and HDL to the fetal membranes and placenta of the Golden Syrian hamster is mediated by receptor-dependent and receptor-independent processes.

Maternal lipoproteins provide nutrients to the fetus via the placenta, yolk sac, and uterine membrane plus decidua. To determine the transport processes that are responsible for the removal of lipoproteins from the maternal circulation, we measured the clearance rates of maternal LDL and HDL in vivo, as well as the tissue distribution of expression of the LDL receptor, glycoprotein 330 (gp330) and the newly described HDL receptor, SR-BI, in the placenta, yolk sac, and uterine membrane plus decidua at mid- and late-gestation of the hamster. In mid-gestation (day 10.5), LDL clearance rates of the placenta and yolk sac were similar to those in the liver (approximately 100 microl/h per g) and higher than those in the decidua (18 +/- 3 microl/h per g). Clearance rates for HDL-apoA-I and HDL-cholesteryl ether were similar to those of LDL in the placenta and decidua whereas rates in the yolk sac were dramatically higher (>1700 microl/h per g). Additionally, albumin was cleared in the placenta and decidua at approximately 16 microl/h per g whereas the yolk sac cleared the protein at much higher rates (196 +/- 22 microl/h per g). Low levels of LDL receptor were detected by immunoblot analysis in the placenta with trace amounts in the yolk sac. Gp330 and SR-BI were both barely detectable in the placenta but were expressed at high levels in the yolk sac. As gestation progressed to day 14.5, LDL and HDL clearance rates decreased in all three tissues; immunodetectable LDL receptor decreased in the placenta whereas the expression of gp330 and SR-BI in the placenta and yolk sac remained relatively constant. These data suggest that the clearance of maternal lipoproteins by the placenta, yolk sac, and decidua are mediated by receptor-mediated as well as receptor-independent processes.

Animals↗
PubMed1998

The effect of vitamin C and E on placental lipid peroxidation and antioxidative enzymes in perfused placenta.

BACKGROUND: To investigate placental lipid peroxidation products and antioxidative enzymes after vitamin C and/or E infusions into the maternal circulation of normal and preeclamptic placentas perfused in vitro. METHODS: Placentas from 29 normal and six preeclamptic women delivered between 27 and 41 weeks of gestation were used in the study. RESULTS: Neither vitamin C (500 microM) nor vitamin E (50 microM) had any effect on placental lipid peroxidation or antioxidative enzymes in normal placentas. Vitamin C infused in preeclamptic placentas decreased peroxidation potential, as an indicator of lipid peroxidation to the same level it was in normal placentas (812 vs. 649 mV/mgprot; p=0.420). The activity of superoxide dismutase (SOD) was lower (1350 vs. 2030 ng/mgprot; p=0.023) in preeclamptic placentas, and the activities of glutathione peroxidase (0.22 vs. 0.08 micromol/min x mgprot; p=0.010) and glutathione-S-transferase (19.8 vs. 13.1 micromol/min x mgprot; p=0.016) were higher in preeclamptic compared to normal placentas. CONCLUSION: In this study, based on in vitro perfused normal and preeclamptic placentas, exogenous antioxidative vitamins had no effect on lipid peroxidation or endogenous antioxidative enzymes in normal placenta, but reduced placental lipid peroxidation and could potentiate the activity of some endogenous placental antioxidative enzymes in preeclamptic placenta.

Ascorbic Acid↗
PubMed2001

High temporal resolution dynamic contrast MRI in a high risk group for placenta accreta.

Antenatal diagnosis of placenta accreta with MR is not easy even now because T2-weighted images (T2WI) cannot differentiate chorionic villi from decidua basalis. We performed dynamic contrast MRI to study whether trophoblastic villi could be separately demonstrated from the decidua basalis, and whether the contrast resolution between the placenta and myometrium could improve compared to T2WI. Six pregnant women with prior cesarean section were examined at 34-38 gestational weeks. Sagittal T2-weighted images with fast spin echo sequences and dynamic contrast studies with fast field echo sequence every 10-14 s after contrast injection were performed. We analyzed the enhancing pattern of the placenta and compared the contrast between placenta and myometrium. We reviewed medical records to identify complications during the placental delivery and the complications of their newborns. In the early phase after contrast enhancement, multiple foci of the strong lobular enhancement were observed in all cases. Other parts of placenta were slowly but strongly enhanced following them. We speculated that the former corresponded to intervillous space and the latter decidua basalis. The contrast between placenta and myometrium tended to be distinct near the inner cervical os on both T2WI and dynamic contrast study. On the other hand, it was indistinct in the upper part of the uterine body on T2WI despite it was clearly demonstrated on dynamic contrast study. The placentae were delivered without any complication in all cases. Although two neonates showed fetal distress, none of the infant remained any sequelae at the time of the discharge. The other four were well although one of them complicated with meconium staining. As dynamic contrast MRI can differentiate chorionic villi and decidua basalis, and can provide excellent contrast between placenta and myometrium at anywhere within the uterus, it may be a promising technique for antepartum diagnosis of the placenta accreta.

Chorionic Villi↗
PubMed2000

Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound.

OBJECTIVE: The aim of this study was to evaluate the efficacy of transabdominal color Doppler ultrasound in diagnosing placenta previa accreta. DESIGN: Eighty patients with persistent placenta previa underwent transabdominal B-mode and color Doppler ultrasound evaluation in the second and third trimesters because they had a high risk of placenta accreta. Color Doppler imaging criteria used included diffuse intraparenchymal placental lacunar flow; focal intraparenchymal placental lacunar flow; bladder-uterine serosa interphase hypervascularity; prominent subplacental venous complex; and loss of subplacental Doppler vascular signals. The color Doppler images were interpreted prospectively for signs of placenta previa accreta according to the exhibited color Doppler sonographic features. RESULTS: Sixteen of the 80 patients exhibited characteristic color Doppler imaging patterns highly specific for placenta accreta according to the preceding criteria, and 14 of these had histopathological proof of placenta accreta. Two patients had false-positive color Doppler imaging evidence mistaken for interphase hypervascularity caused by bladder varices. Thirteen patients underwent hysterectomy in the group suspicious for accreta. Of the 64 patients with negative color Doppler imaging results, three had placenta accreta, while two required cesarean hysterectomy; the remaining patient underwent uterine artery ligation for bleeding from the lower uterine segment. The sensitivity of color Doppler imaging in the diagnosis of placenta previa accreta was 82.4% (14/17) and the specificity was 96.8% (61/63). The positive and negative predictive values were 87.5% (14/16) and 95.3% (61/64), respectively. CONCLUSIONS: Variable vascular morphological patterns of placenta previa accreta were exhibited and categorized by transabdominal color Doppler sonography in the antenatal period. The identification of these specific vascular patterns had a positive impact on the peripartum clinical management of the affected patients.

Abdomen↗
PubMed1997

Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging.

PURPOSE: To determine the value of transabdominal ultrasound (US), transvaginal US, color Doppler US, power Doppler US, and magnetic resonance (MR) imaging in the diagnosis of placenta accreta. MATERIALS AND METHODS: Nineteen patients in the third trimester of pregnancy who were at risk for placenta accreta underwent color Doppler and power Doppler US; 18 patients also underwent MR imaging. Images were interpreted prospectively for signs of accreta by two reviewers. The reviewers' confidence in their diagnosis was graded on a five-point scale. RESULTS: Outcomes at delivery were as follows: normal placenta (n = 11), hysterectomy owing to uncontrollable bleeding (n = 1), and placenta accreta (n = 7). Five cases of lower-uterine-segment placenta accreta were diagnosed with a high level of confidence with vaginal and power Doppler US. In one patient with a posterior placenta who had previously undergone myomectomy, MR imaging enabled the diagnosis of placenta accreta, which was not well depicted at US. CONCLUSION: In patients with a history of uterine scars, vaginal US with power Doppler US performed well in the evaluation of lower-uterine-segment placenta accreta. MR imaging depicts posterior placenta accreta.

Female↗
PubMed1997

Accuracy of prenatal sonography for detecting circumvallate placenta.

OBJECTIVE: We determined the accuracy of prenatal sonography for detecting placental circumvallation, a placental abnormality associated with increased fetal morbidity and mortality. MATERIALS AND METHODS: We analyzed 62 healthy pregnant (range, 18-36 weeks) patients with focused placental sonography for detection of morphologic abnormality using the published criteria for circumvallate placenta (irregular edge, uplifted margin, or placental sheet or shelf). Placental marginal sonograms were taken at 30 degrees intervals around the entire placental margin. Five experienced sonologists who were unaware of the pathologic findings independently reviewed the placental images and graded the placentas from 1 (definitely normal) to 5 (definitely circumvallate). Receiver operating characteristic (ROC) curves and area under the ROC curve were calculated for each reader. Gross and microscopic pathology was used as the gold standard for all cases. RESULTS: In the 62 patients, sonography revealed 49 normal placentas (79%), 12 partially circumvallate placentas (19%), and one completely circumvallate placenta (2%). ROC curves for the reviewers resulted in values for area under the curve ranging from .39 to .58. The sonologist who achieved the highest value for the area under the curve classified the 13 cases of proven circumvallation as one case of definite circumvallation, four cases as uncertain or equivocal, and eight cases as probably or definitely normal placentas. Of the normal placentas, 35% were graded as probably or definitely circumvallate by at least one sonologist. All sonologists misgraded the case of complete circumvallation as normal. CONCLUSION: Focused placental sonograms interpreted by experienced sonologists fail to detect the placental edge abnormality in most cases of circumvallation. In our study, 17 of 49 normal placentas were diagnosed as probably or definitely circumvallate by one or more observers. Our sonologists' interpretations of sonograms showed that complete circumvallation was difficult to assess. Although our study had a limited number of patients, the accuracy of sonography of the placenta for revealing circumvallation appears to be limited.

Case-Control Studies↗
PubMedDate not supplied

High incidence of respiratory distress syndrome (RDS) in infants born to mothers with placenta previa.

OBJECTIVE: To evaluate the incidence of respiratory distress syndrome (RDS) in infants born to mothers with placenta previa and to assess the risk factors for RDS. METHODS: Ninety-nine pregnant women with placenta previa who delivered by cesarean section at 30-35 weeks of gestation were compared retrospectively with 102 pregnant women matched for week of gestation and birth year, who underwent elective cesarean section. Maternal characteristics, neonatal outcome, and incidence of RDS were analyzed. Umbilical cord blood samples were collected at delivery and were used to determine cortisol, epinephrine, and norepinephrine levels. Student's t-test, the chi-square test, and Fisher's exact test were used for statistical comparisons. P < 0.05 was considered significant. The Mann-Whitney U test was used for comparison of continuous variables. RESULTS: Preeclampsia, histological chorioamnionitis, and premature rupture of membranes were significantly lower in the placenta previa group (placenta previa: 2.0% vs. control: 14.7%, P < 0.01; 14.1% vs. 30.1%, P < 0.01; 7.1% vs. 17.6%, P < 0.05, respectively). The incidence of RDS was significantly higher in the placenta previa group than in the control group (29.3% vs. 6.9%, P < 0.0001). The cortisol level in umbilical cord blood in the placenta previa group was lower than in the control group (median 7.3, range 4.4-14.9 microg/dl vs. median 10.6, range 4.9-30.3 microg/dl, P < 0.05). There were no significant differences in epinephrine or norepinephrine levels between the two groups. CONCLUSIONS: The incidence of RDS in infants delivered at 30-35 weeks' gestation by cesarean section was significantly higher in mothers with placenta previa than in women without placenta previa. This may reflect decreased fetal stress since the cord blood cortisol levels were found to be lower in women with placenta previa.

Cesarean Section↗
PubMed2006

In uniparental Phodopus sungorus, new mothers, and fathers present during the birth of their offspring, are the only hamsters that readily consume fresh placenta.

Placentophagia is common among parturient female mammals but non-parturient females generally refuse placenta. Biparental male dwarf hamsters (Phodopus campbelli) readily consume placenta. The present study quantified placentophagia and liver acceptance in the closely related Siberian hamster P. sungorus in which males do not participate in the birth and are not responsive to a displaced pup. Sexually naïve P. sungorus males and females refused both placenta and liver (all groups <10%). Reproductive females specifically consumed placenta on the day before (G17), and the day of, parturition (G18) (>80%). Males rejected both tissues on G17 and accepted placenta soon after the birth (G18) (80%) only if they were present during the birth. Palatability of the placenta was not responsible for the species difference as P. campbelli accepted P. sungorus placenta. Results are consistent with a neophobic reaction to both placenta (conspecific or heterospecific) and liver as P. sungorus also rejected P. campbelli placenta.

Animals↗
PubMed1986

Plasmodium berghei: histology, immunocytochemistry, and ultrastructure of the placenta in rodent malaria.

The pathological changes associated with malarial infection in pregnancy were studied in rats and mice infected with Plasmodium berghei at different stages of gestation. Histopathological and ultrastructural studies of infected placentae near term in both species revealed disruption of architecture with gross thickening and necrosis of cells in the labyrinthine zone and fibrosis of the trilaminar trophoblast separating the maternal and fetal circulations. In the mouse, the extent of histopathological alterations in infected placentae ranged from the presence of immature erythrocytes in the fetal circulation in low grade maternal infection, to the marked deposition of fibrinoid material on the trilaminar trophoblast and inflammatory masses in severely infected placentae. In the rat, histopathological aberrations in the placentae were marked by placental stroma edema, fibrosis, and cellular infiltration. Immunohistological studies of cryostat sections of placentae from infected animals showed more parasites and pigment in infected mouse placentae than in the corresponding rat organ, but in both species parasites and pigment were largely confined to the maternal blood spaces and were only occasionally found in necrotic areas of trophoblast. No clear differences were observed between infected and control placentae in terms of the amount of IgG, IgM, or IgA which were each present in various amounts. These observations and the rarity of congenital malaria in the animals indicate that the placenta constitutes a major barrier to infection of the fetus. However, the pathological aberrations in the infected placentae may impose a biochemical stress upon the fetus which may account for the low birthweight, the increased frequency of abortion, and the greatly increased maternal and fetal death rates observed in malaria.

Animals↗
PubMed1990

Eicosanoid production and transfer in the placenta of the diabetic pregnancy.

The metabolism of arachidonic acid (AA) and the transfer of its metabolites was determined in in vitro perfused placental tissue from normal pregnancies and those complicated by maternal insulin-dependent diabetes mellitus (IDDM). 14C-labelled AA was recirculated in the fetal circulation for 60 min while 3H-AA was recirculated in the maternal circulation. Placental effluent was subjected to high performance liquid chromatography (HPLC) and analysis of dual-label scintillation counts. Placentae from IDDM pregnancies converted 3-6 times more radiolabelled AA to eicosanoids than did normal placentae. In addition, the transfer of eicosanoids into the opposing circulation was doubled in placentae from IDDM pregnancies compared to normal placentae. The predominant direction of eicosanoid transfer in both groups of placentae was in the fetal-to-maternal direction. The relative amounts of eicosanoids produced was also altered in placentae from IDDM pregnancies. Increased amounts of thromboxane (Tx) B2 and hydroxyeicosatetraenoic acids (HETEs) were present in both circulations of placentae from IDDM pregnancies. Levels of 6-keto prostaglandin F1a (6KPGF1a) were significantly reduced in both circulations in placentae from IDDM pregnancies. Thus, the ratio of TxA2 to PGI2 and the ratio of HETEs to PGI2 were both significantly increased in placentae from IDDM pregnancies. These results suggest an imbalance in eicosanoid production which may be relevant to abnormal placental structure and function in IDDM pregnancies.

6-Ketoprostaglandin F1 alpha↗
PubMed2006

Expression of CD44 adhesion molecules on human placentae.

OBJECTIVE: This study was performed to characterize CD44 expression in human placentae. STUDY DESIGN: We conducted reverse transcriptase polymerase chain reaction (RT-PCR) analyses of CD44H (hematopoietic form, also called CD44s) and CD44R1 (epithelial form) in 14 normal term placentae, and immunohistochemical analysis of CD44H and CD44v6 in 31 placentae (25 term and 6 first-trimester). RESULTS: All 14 term placentae expressed CD44H (double bands) suggesting expression of alternative isoforms on the placentae. CD44R1 was expressed on 3 of 14 (21.4%) term placentae. Immunohistochemical analysis revealed expression of CD44H in all the placentae examined. However, positive staining for CD44v6 was observed in 3 of 6 (50%) first-trimester and only 6 of 25 (24%) term placentae showing decreased expression on term placentae. Positive staining for CD44v6 was observed on the trophoblast surface of immature villi especially in the sub-chorionic area where hypoxic conditions prevail. CONCLUSION: These results suggest that CD44 splicing variants might play a role in the invasion of trophoblast into maternal tissue in early pregnancy.

Alternative Splicing↗
PubMed2006

Patterns of human cytomegalovirus infection in term placentas: a preliminary analysis.

BACKGROUND: Primary maternal CMV infection is the major risk factor for symptomatic congenital infection as maternal immunity reduces the risk of transmission to the fetus. Analysis of first trimester placentas showed that virus replicates in the uterus and is transmitted to the placenta causing focal infection. OBJECTIVES AND STUDY DESIGN: We examined 78 term placentas from uncomplicated deliveries for the presence of CMV DNA and evaluated evidence of infection by means of immunohistological and serological analysis. RESULTS: PCR analysis of villus biopsy samples and decidua showed that CMV DNA was present in 62% of tissues. Seven placentas with neutralizing titers were further examined by immunohistology for expression of viral proteins. In placentas with high levels of CMV DNA, fetal blood vessels in the villus core contained neutrophils with viral replication proteins, and macrophages/dendritic cells with glycoprotein B (gB). Cord blood samples from 1 of 11 placentas contained CMV DNA, an indication of replication in the fetal compartment. In placentas with low levels of viral DNA, macrophage/dendritic cells in the villus core contained CMV gB. This pattern was comparable to that seen in early gestation placentas from women with strong neutralizing antibodies. CONCLUSIONS: The results show CMV replication proteins in focal areas of the placenta, implying virus transmission to the fetal circulation. These preliminary results suggest that the incidence of asymptomatic congenital CMV infection might be higher than currently estimated.

Cytomegalovirus↗
PubMed2006

Vasoreactivity of chorionic plate arteries in response to vasoconstrictors produced by preeclamptic placentas.

Inadequate blood flow and increased vasoconstriction of the placenta contribute to pregnancy associated disorders such as preeclampsia (PE). Because placental vessels lack autonomic innervation, humoral effects of the placenta must play critical roles in regulation of fetal-placental vascular contractility. In this study, we examined the nature of humoral factors produced by PE trophoblasts on placental vessel contractility using an organ bath perfusion model. Vasomotor responses were studied in vitro using placental chorionic plate arteries. Vessel rings from third branch chorionic plate arteries were dissected from human placentas following normal or PE delivery. The arterial rings were equilibrated in Krebs Henseleit buffer and exposed to placental conditioned medium, which was prepared by culture of villous tissue from PE placentas. Receptor antagonists for angiotensin II (ANG II), thromboxane (TX), and endothelin (ET) were used to determine which humoral factor produced by placental tissue (trophoblasts) was more effective in promoting vasoconstriction. The role of angiotensin converting enzyme (ACE) and non-ACE ANG II generating enzymes in regulation of placental vasomotor tone were also investigated. A total of 80 arterial rings from 48 placentas were studied. Our results showed: 1) enhanced vasomotor tone in arteries from PE placentas compared to those from normal placentas; 2) PE-CM induced vaso-constrictive activity could be partially attenuated by receptor antagonists for TX, ANG II and ET, respectively; and 3) chymostatin (a chymase inhibitor) produced a stronger inhibitory effect than captopril (ACE inhibitor) on PE conditioned medium induced vasoconstriction. Our data demonstrate increased vasocontractility in PE placentas and suggest that the non-ACE pathway is probably a major source of ANG II produced in the human placenta.

Arteries↗
PubMed1992

A novel change in cytologic localization of human chorionic gonadotropin and human placental lactogen in first-trimester placenta in the course of gestation.

Cytologic localization of human chorionic gonadotropin and human placental lactogen in developing human early placenta was analyzed by avidin-biotin immunoperoxidase techniques with an affinity-purified polyclonal antibody to beta-human chorionic gonadotropin carboxyl terminal peptide and a polyclonal antibody to human placental lactogen. In 4- to 5-week placentas human chorionic gonadotropin and human placental lactogen were found to be primarily localized to cytotrophoblasts, whereas in 6- to 12-week placentas these substances were exclusively localized to syncytiotrophoblast. We previously reported that a similar change in cytologic localization of epidermal growth factor and its receptor from cytotrophoblasts to syncytiotrophoblast in first-trimester placenta appeared between 5 and 6 weeks of gestation. Because epidermal growth factor was demonstrated to stimulate human chorionic gonadotropin and human placental lactogen production by early placental tissues, their simultaneous expression, as well as epidermal growth factor and its receptor in the cytotrophoblast of 4- to 5-week placenta and in the syncytiotrophoblast of 6- to 12-week placenta, implies that human chorionic gonadotropin and human placental lactogen production by first-trimester placenta may be regulated in an autocrine manner, wherein epidermal growth factor may serve as the signal. These findings suggest that in very early placenta, before 6 weeks of gestation, no sequential expression of human chorionic gonadotropin and human placental lactogen closely linked to syncytia formation may exist and that both can be expressed in the cytotrophoblast or undifferentiated stem cell of villous trophoblast in very early placenta.

Chorionic Gonadotropin↗
PubMed1999

Tissue-specific ontogenic expression of prostaglandin H synthase 2 in the ovine myometrium, endometrium, and placenta during late gestation and at spontaneous term labor.

OBJECTIVE: The purposes of this study were to determine (1) whether uterine tissues as well as the fetal placenta are involved in the development of prostaglandin-synthesizing capacity associated with impending labor in pregnant sheep and (2) whether the key enzyme of prostaglandin synthesis, prostaglandin H synthase 2, is differentially expressed in the different intrauterine tissues during late gestation and in association with labor. STUDY DESIGN: Myometrium, endometrium, and fetal placenta were removed from ewes at 95 days' gestation, (n = 3), 101 to 110 days' gestation (n = 3), 111 to 120 days' gestation (n = 3), 121 to 130 days' gestation (n = 3), 131 to 140 days' gestation (n = 3), and 141 to 145 days' gestation (n = 4) and from ewes in spontaneous term labor at 143 to 147 days' gestation (n = 4). Expressions of prostaglandin H synthase 2 messenger ribonucleic acid and protein were determined by Northern blot and Western blot analyses. Prostaglandin H synthase 2 was localized in the fetal placenta by immunohistochemical means. RESULTS: Levels of both prostaglandin H synthase 2 messenger ribonucleic acid and protein increased gradually from 115 days' gestation in the fetal placenta and from 131 days' gestation in the endometrium. A further and more significant increase in prostaglandin H synthase 2 concentration occurred in the placenta and endometrium during spontaneous term labor. In contrast, myometrial concentrations of prostaglandin H synthase 2 messenger ribonucleic acid and protein remained at steady basal levels during the course of pregnancy and increased only during labor. Prostaglandin H synthase 2 was localized in the trophoblast cells of the fetal placenta. CONCLUSIONS: Tissue-specific ontogenic expression of prostaglandin H synthase 2 was observed in myometrium, endometrium, and placenta during late ovine gestation and spontaneous term labor. Fetal placenta and endometrium showed increased expression of prostaglandin H synthase 2 messenger ribonucleic acid and protein during late ovine gestation, whereas myometrial prostaglandin H synthase 2 concentration remained low throughout late gestation. Prostaglandin H synthase 2 concentrations in the myometrium, endometrium, and placenta are all upwardly regulated during labor.

Animals↗
PubMed2001

Plasma placenta growth factor levels in midtrimester pregnancies.

OBJECTIVE: Previous studies have shown decreased levels of placenta growth factor in serum of pregnant women with preeclampsia. The aim of this study was to investigate whether levels of placenta growth factor are decreased before the clinical onset of preeclampsia, and whether placenta growth factor levels are decreased in pregnancies complicated by intrauterine growth restriction. METHODS: From an ongoing longitudinal study, 101 plasma samples were collected from 72 pregnant women at weeks 11-21 of gestation. Placenta growth factor levels were determined retrospectively in plasma using an enzyme-linked immunosorbent assay. Correlations between plasma concentrations of placenta growth factor and pregnancy outcome were evaluated. RESULTS: Plasma samples of 72 patients were analyzed. Forty-four patients had no pregnancy complications, 18 developed preeclampsia, and 10 women had pregnancies complicated by intrauterine growth restriction. Between week 17 and week 21 of pregnancy, a significantly lower level of placenta growth factor was found in plasma of patients who later developed preeclampsia (n = 10), compared with control pregnancies (n = 25, P = .004). In women with a growth-restricted baby at birth (n = 5), levels of placenta growth factor were also low. CONCLUSIONS: Our results show that plasma placenta growth factor levels are decreased before preeclampsia is clinically evident. The data suggest that placenta growth factor may be useful to determine the relative risk of developing preeclampsia and intrauterine growth restriction.

Adult↗
PubMed1998

Intraumbilical oxytocin for the management of retained placenta: a randomized controlled trial.

OBJECTIVE: To evaluate the ability of intraumbilical oxytocin injection as a treatment for retained placenta after vaginal delivery to reduce the incidence of manual removal and postpartum hemorrhage. METHODS: A randomized controlled trial was set up in a university and a district general hospital. We recruited 81 women with singleton pregnancies who underwent vaginal delivery and who failed to deliver the placenta after 20 minutes of active management of the third stage of labor. Study subjects were randomized to receive either 1) an intraumbilical injection of oxytocin (20 IU in 20 mL of saline); 2) an intraumbilical injection of saline (20 mL); or 3) no treatment. Outcome measures were expulsion of the placenta within 45 minutes of delivery, need for manual removal of the placenta under anesthesia, and postpartum hemorrhage (defined as a blood loss greater than 500 mL). RESULTS: Women given an intraumbilical injection of oxytocin had a significant increase in spontaneous expulsion of the placenta within 45 minutes of delivery and fewer manual removals of the placenta, compared with women without treatment (odds ratio [OR] 11.6, 99% confidence interval [CI] 1.4, 272.8; and OR 7.4, 99% CI 1.1, 86.5; respectively). When women given intraumbilical oxytocin were compared with women given only intraumbilical saline, the difference was not statistically significant (OR 6.6, 99% CI 0.9, 77.2 for spontaneous expulsion of the placenta; and OR 4.7, 99% CI 0.8, 39.5 for manual removal). There was no significant difference in the incidence of spontaneous expulsion and manual removal of the placenta between women given intraumbilical saline injection and women without treatment (OR 1.8, 99% CI 0.1, 53.9; and OR 1.6, 99% CI 0.1, 22.4; respectively). CONCLUSION: The results of our study suggest a clinically important beneficial effect of intraumbilical oxytocin injection in the management of retained placenta.

Adult↗