fibrin and Placental-Insufficiency

Topics: Animals; Blood Cell Count; Blood Coagulation; Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Eclampsia; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysis; Hemostasis; Heparin; Humans; Hypertension; Placental Insufficiency; Pre-Eclampsia; Pregnancy

Pregnant women have an increased risk of getting infected with SARS-CoV-2 and are more prone to severe illness. Data on foetal demise in affected pregnancies and its underlying aetiology is scarce and pathomechanisms remain largely unclear.. Herein we present the case of a pregnant woman with COVID-19 and intrauterine foetal demise. She had no previous obstetric or gynaecological history, and presented with mild symptoms at 34 + 3 weeks and no signs of foetal distress. At 35 + 6 weeks intrauterine foetal death was diagnosed. In the placental histopathology evaluation, we found inter- and perivillous fibrin depositions including viral particles in areas of degraded placental anatomy without presence of viral entry receptors and SARS-CoV-2 infection of the placenta.. This case demonstrates that maternal SARS-CoV-2 infection in the third trimester may lead to an unfavourable outcome for the foetus due to placental fibrin deposition in maternal COVID-19 disease possibly via a thrombogenic microenvironment, even when the foetus itself is not infected.

Topics: COVID-19; Female; Fibrin; Humans; Placenta; Placental Insufficiency; Pregnancy; SARS-CoV-2; Stillbirth

Epithelial membrane protein-2 (EMP2) is a tetraspan protein predicted to regulate placental development. Highly expressed in secretory endometrium and trophectoderm cells, previous studies suggest that it may regulate implantation by orchestrating the surface expression of integrins and other membrane proteins. In order to test the role of EMP2 in pregnancy, mice lacking EMP2 (Emp2

Topics: Animals; Disease Models, Animal; Female; Fetal Growth Retardation; Fibrin; Gene Knockout Techniques; Homologous Recombination; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Male; Membrane Glycoproteins; Mice; Mice, Inbred C57BL; Neovascularization, Pathologic; Oxygen; Placenta; Placental Insufficiency; Placentation; Pregnancy; Trophoblasts; Uterus

Maternal floor infarction is a relatively rare condition characterized clinically by severe early onset fetal growth restriction with features of uteroplacental insufficiency. It has a very high recurrence rate and carries a significant risk or fetal demise. Pathological characteristics include massive and diffuse fibrin deposition along the decidua basalis and the perivillous space of the basal plate. We present a case of recurrent maternal floor infarction and propose diagnostic clues as well as potential therapeutic options.

Topics: Adult; Female; Fetal Death; Fetal Growth Retardation; Fibrin; Humans; Infarction; Placenta; Placental Circulation; Placental Insufficiency; Pregnancy; Secondary Prevention; Severity of Illness Index; Up-Regulation; Uterine Diseases

Placental insufficiency is a major cause of fetal growth restriction (FGR) and accumulating evidence indicates several aspects of placental morphology are altered in this condition. MRI provides quantitative indices that may be used in non-invasive assessment of the human placenta, such as relaxation time measurements, T1 and T2. We hypothesised that placental relaxation times relate to alterations in placental tissue morphology and hence may be useful in identifying the changes associated with FGR. We report on the first phase of testing this hypothesis, in a study of women in normal pregnancy.. To assess relaxation time measurements in the placenta in normal pregnancy and correlate these with gestational age and stereological analyses of placental morphology following delivery.. 30 women underwent MRI examination (1.5 T) between 20 and 41 weeks gestation. Placental T1 and T2 measurements were acquired from a mid-depth placental region, co-localised to a structural scan. Fixed, wax-embedded sections of these placentas collected at delivery were stained with hematoxylin/eosin and subjected to stereological analysis.. Placental T1 and T2 show a significant negative correlation with gestation, (Pearson correlation p=0.01, 0.03 respectively). 17 placentas were analysed stereologically. In the group as a whole there was no significant correlation between T1 and T2 and morphological features. However, in a subset of 7 pregnancies scanned within a week of delivery, a significant positive correlation was observed between the fibrin volume density and the ratio of fibrin: villous volume densities and T2 (Spearman correlation p=0.02, 0.03 respectively).. The correlations between placental T1 and T2 and gestation show that these variables are clearly influenced by changes in placental structure. Fibrin might be a key component but further work is needed to fully elucidate the major structural influences on placental T1 and T2.

Topics: Female; Fetal Growth Retardation; Fibrin; Humans; Magnetic Resonance Imaging; Placenta; Placental Insufficiency; Pregnancy

Topics: Adult; Chorionic Villi; Diagnosis, Differential; Female; Fetal Growth Retardation; Fibrin; Humans; Infant, Newborn; Placental Insufficiency; Pregnancy; Pregnancy Trimester, Third; Prenatal Diagnosis; Twins

To establish the incidence, recurrence rate and consequences of massive perivillous fibrinoid.. Retrospective analysis of the histology of all placentas with a diagnosis of massive perivillous fibrinoid between 1991 and 1998, together with the maternal case records.. The histopathology department of the Rotunda Hospital, Dublin, Ireland.. A relatively homogeneous group of pregnant women in the northern part of Dublin City, which is the catchment area for the Rotunda Hospital, delivered between 1991 and 1998.. Retrospective review of archival placental pathology and maternal charts.. The incidence of massive perivillous fibrinoid, perinatal outcome and recurrence rate.. The incidence of massive perivillous fibrinoid was 0.028%, with a recurrence rate of approximately 18%. All the infants suffered intrauterine growth restriction; there was a 31% fetal loss rate and a 33% preterm delivery rate.. Massive perivillous fibrinoid is associated with intrauterine death, intrauterine growth restriction and preterm delivery. It has a significant recurrence rate and both the clinical findings of intrauterine growth restriction and the postmortem findings imply a syndrome of chronic placental insufficiency.

Topics: Abortion, Habitual; Adult; Chorionic Villi; Female; Fetal Death; Fetal Growth Retardation; Fibrin; Gestational Age; Humans; Microscopy, Electron; Obstetric Labor, Premature; Placental Insufficiency; Pregnancy; Recurrence; Retrospective Studies

Placental bed biopsies were performed during caesarean section in a series of 137 patients. Analysis of the morphological findings confirms that vascular physiological changes were reduced in pre-eclampsia and in normotensive intrauterine growth retardation. In pre-eclampsia, acute atherosis in the decidual segments of uteroplacental arteries was a prominent feature. Intimal thickenings of the myometrial segments of the uteromaternal arteries were also noted. Normotensive intrauterine growth retardation cases were characterized by intimal thickenings of the myometrial segments of the uteroplacental arteries. Immunofluorescent investigations have demonstrated that the deep vascular stenoses were not associated with immunoglobulin deposition while in distal arterial segments displaying acute atherosis a positive immunofluorescence for IgG and fibrin and, more irregularly, for C'3 and IgM could be noted. These findings lead us to suggest that an immunological mechanism may be involved in the pathogenesis of acute atherosis.

Topics: Complement C3; Female; Fetal Growth Retardation; Fibrin; Fluorescent Antibody Technique; Humans; Immunoglobulin G; Ischemia; Placenta; Placenta Diseases; Placental Insufficiency; Pre-Eclampsia; Pregnancy