morphine and Placenta-Diseases

The placenta should not be overlooked as a source of much valuable diagnostic information. Close evaluation of the placenta and its attached membranes may reveal further information. Essential data may be obtained from pathologic examination, and if questions exist, specimens should be retained with proper care.

Topics: Amniotic Band Syndrome; Chorioamnionitis; Decidua; Female; Humans; Infant, Newborn; Meconium; Placenta; Placenta Diseases; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Umbilical Arteries; Umbilical Cord

Topics: Chorioamnionitis; Chorionic Villi; Cytomegalovirus Infections; Female; Humans; Inflammation; Meconium; Obstetric Labor, Premature; Placenta; Placenta Diseases; Placental Circulation; Pregnancy; Pregnancy Complications, Infectious; Syphilis

Topics: Amniocentesis; Amniotic Fluid; Blood; Electrocardiography; Estrogens; Female; Fetal Diseases; Fetal Heart; Fetoscopy; Heart Rate; Hydrogen-Ion Concentration; Meconium; Obstetric Labor Complications; Phonocardiography; Placenta Diseases; Pregnancy; Pregnancy Complications; Umbilical Cord

As the patterns and frequency of maternal and clinical conditions and outcomes and gross and histological placental features and lesions vary with gestational age at delivery, we aimed to study the impact of these changes on the placental diagnosis, hoping to uncover potential novel clusters of gestational age-associated clinical and pathological diagnoses.. Retrospective statistical analysis of clinicoplacental database.. We analyzed 28 clinical (maternal and fetal) and 49 gross and microscopic placental variables from 3294 consecutively signed placentas received between 2001 and 2012, divided into three gestational age groups: 16-27 weeks, 697 cases; 28-36 weeks, 1365 cases; and 37+ weeks, in all 1232 cases.. Classical statistics by chi-squared and Fischer's tests, and the Ward agglomerative hierarchical clustering and multidimensional scaling techniques, were used.. The placental phenotypes clustered statistically significantly with severe preeclampsia in the second trimester; preterm premature rupture of membranes, placental abruption, and fetal growth restriction in the whole third trimester; and abnormally invasive placenta, thick meconium, maternal diabetes mellitus, and substance abuse in term pregnancies.. The applied statistical analyses made it possible to simultaneously compare the strength of clinicoplacental associations separately in three pregnancy intervals. Placental clinicopathological associations are strongest for the second trimester, i.e. severe preeclampsia and preterm ascending infection-related conditions, but were not significant for other pregnancy complications such as mild preeclampsia, chronic hypertension, diabetes mellitus, or umbilical cord compromise.

Topics: Abruptio Placentae; Adult; Cluster Analysis; Databases, Factual; Female; Fetal Growth Retardation; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Meconium; Phenotype; Placenta; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Retrospective Studies; Substance-Related Disorders

The authors present a case of stillbirth in which histologic examination of the placenta provides the opportunity to make a definitive diagnosis of a death due to fetal thrombotic vasculopathy (FTV). Establishing the etiology in cases of stillbirth may avoid medical malpractice litigation. The better knowledge of the cause of stillbirths also helped obstetricians to recognize factors that could have prejudiced future pregnancies.

Topics: Adult; Erythroblastosis, Fetal; Female; Forensic Pathology; Humans; Liability, Legal; Malpractice; Meconium; Placenta; Placenta Diseases; Pregnancy; Stillbirth; Vascular Diseases

Meconium-associated vascular necrosis (MAVN) is a histological abnormality of human placental chorionic vessels that is associated with poor neonatal outcome. We tested the hypothesis that MAVN shows apoptosis in the walls of chorionic vessels. Archival placental specimens with MAVN (n = 5) were compared with specimens from uncomplicated pregnancies at term (n = 5) and from placentas with intense chorionic vasculitis associated with acute chorioamnionitis with (n = 5) or without (n = 5) a clinical history of meconium in the amniotic fluid. Sections from all placentas were processed by the TUNEL method, and 2 observers who were blinded to specimen diagnosis quantified the immunofluorescent TUNEL staining in both the amnion-facing and villous-facing walls of the larger chorionic vessels in each specimen. Compared with the other 3 groups, only the amnion-facing wall of chorionic vessels in MAVN showed a significantly greater number of apoptotic cells. This was verified by morphological criteria and caspase 3 staining. There were limited or no detectable TUNEL-stained cells in either the villous-facing walls of vessels in the MAVN specimens or in any of the vessels of the placentas from uncomplicated pregnancies. There was a negligible level of apoptosis in chorionic vessels of placentas with intense chorionic vasculitis, with or without meconium, despite the inflammatory response or presence of meconium. We conclude that apoptosis contributes to the pathophysiology of MAVN.

Topics: Apoptosis; Blood Vessels; Caspase 3; Caspases; Chorion; Female; Humans; Immunohistochemistry; In Situ Nick-End Labeling; Meconium; Muscle Cells; Necrosis; Placenta; Placenta Diseases; Pregnancy; Vasculitis

(1) To determine the nature and extent of placental pathologic findings; (2) to associate placental pathologic findings with clinical indicators of infection; (3) to evaluate placental pathology in the context of the guidelines outlined by the College of American Pathologists (CAP).. A retrospective cohort study, through review of maternal and neonatal charts and placental pathology, of 100 sequential pregnancies in which placentas were submitted to pathology. Data were examined using descriptive statistics, and proportional differences were compared using the chi-square test and Fisher's exact test.. Overall, 75% of placentas submitted for pathology review had pathologic abnormalities. Fifty percent had findings consistent with inflammation, 38% had findings consistent with vascular abnormalities, and 18% had findings consistent with meconium. Fetal clinical indicators of infection were associated with placental findings of chorioamnionitis (p < or = 0.01), while maternal clinical indicators were not. Similarly, fetal clinical indicators were associated with placental findings of fetal inflammation (p < or = 0.025), whereas maternal indicators were not associated with placental findings of maternal inflammation. A diagnosis of chorioamnionitis in labour by the attending physician was associated with pathologic findings (p < or = 0.05). A CAP indication was found in 75% of the placentas. There was no difference in incidence of placental pathology between those placentas submitted with and without a CAP indication.. Placental findings of inflammation or infection were associated with fetal clinical indicators of infection, but not with maternal indicators. Placental pathology is very useful in identifying undiagnosed maternal infection or inflammation.

Topics: Adult; Chorioamnionitis; Cohort Studies; Congenital Abnormalities; Female; Fetal Growth Retardation; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Inflammation; Meconium; Obstetric Labor Complications; Obstetric Labor, Premature; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Retrospective Studies

To evaluate the immediate neonatal outcome and the presence of various placental lesions in 96 pregnancies with meconium-stained amniotic fluid.. The patients were divided into a group with acute (N = 41) and subacute and chronic (N = 55) meconium staining of the placenta. Apgar scores, arterial cord pH and admission to the neonatal intensive care unit (NICU) were determined in addition to the findings on gross and microscopic examination of the placentas.. Of the 53 live births with subacute and chronic meconium staining, 13% had Apgar Scores < or = 7 at 5 minutes compared to 7% with acute meconium staining. Similarly, a significantly lower umbilical artery pH was determined in the former group [(32%) versus (7%)], (p < 0.01). When 9 different pathologic lesions of the placenta were evaluated microscopically, the frequency of villous vascular thrombosis (25.4%), infarcts (38%), acute chorioamnionitis (20%), villous edema (9.1%) and villitis (14.5%) was significantly higher in the group with longer meconium exposure compared to the other group (2.4%), (9.7%), (7.3%), (0%), and 1 (2.4%), respectively. In addition, when tested for 4 different lesions, cases with acute meconium were less likely to have one or more lesions. When one or more placental lesions were found, NICU admission rate was significantly higher in the patients with subacute and chronic meconium.. Subacute and chronic meconium discharge is associated with significant placental lesions and an increased risk of adverse pregnancy outcome in the immediate neonatal period.

Topics: Acidosis; Adolescent; Adult; Female; Fetal Hypoxia; Humans; Meconium; Placenta; Placenta Diseases; Pregnancy; Pregnancy Outcome; Thrombosis; Time Factors

It is uncertain how often the passage of meconium in utero is a response to some event causing fetal distress as opposed to being simply the physiologic functioning of a maturing intestinal tract. The extent to which meconium may produce injury or inflammation in pulmonary and placental tissues after intrauterine exposure is also unclear. This study was a retrospective review of 123 cases, 79 stillborn and 44 liveborn less than one month of age, autopsied at The Johns Hopkins Hospital, and showing histologic evidence of intrauterine meconium exposure by aspirated meconium or meconium macrophages in placental tissues. Of 55 cases with pulmonary inflammation, 13 (24%) had fetal pneumonia, 5 (9%) had postnatal bronchopneumonia, and 37 (67%) had inflammation secondary to meconium aspiration. There was inflammation of the umbilical cord in 31 (41%) of the 75 cases with available slides, 11 (15%) had funisitis associated with chorioamnionitis and 18 (58%) were secondary to meconium exposure. There were 19 cases with focal injury of cord vessels from meconium, two of which had cord ulceration. Inflammation of the membranes and chorionic plate was present in 24 (33%) of the 72 cases where it could be assessed, and was due to chorioamnionitis in 11 (46%) and to meconium in 13 (54%). In general, meconium-related inflammations was much less severe in the membranes than in the cord. There were 67 (54%) cases with definite or probable evidence of fetal distress. In 38 (48%) stillborns no cause of fetal death in utero was identified and in 18 (41%) liveborns there was no known prenatal problem. The results support the concept that meconium passage in utero may occur either as a response to fetal distress or as a physiologic process. Inflammation in the lung and placental tissues, and vascular injury in the umbilical cord may arise secondary to in utero exposure to meconium.

Topics: Female; Fetal Death; Fetus; Humans; Infant, Newborn; Inflammation; Meconium; Meconium Aspiration Syndrome; Placenta; Placenta Diseases; Pneumonia; Pregnancy; Retrospective Studies; Umbilical Cord; Vascular Diseases

Two hundred and eighteen cases of hemorrhagic endovasculitis (HEV), a recently recognized abnormality of human placentas, were identified from placentas submitted to the Michigan Placental Tissue Registry over a 2.5-year period. HEV appears to focus on fetal placental blood vessels with resultant fragmentation and destruction of fetal RBCs, hemorrhage into villous stroma, microthrombi in villous capillaries and non-exudative necrosis of medium sized chorionic vessels. Placentas without HEV submitted for evaluation from the same hospitals were selected for comparison. Women with HEV placentas were of similar age, race and parity as control women. The sex of the fetus of HEV cases was somewhat more often female (57% vs. 48%, P = 0.05). The presence of HEV appeared to have a deleterious effect on the outcome of pregnancy: 52% (112/218) of the HEV placentas were associated with stillborn infants, in contrast to only 22% (89/400) of control placentas. The difference in the proportion of stillbirths was greatest when the gestational age was 25 weeks or greater. Other significant positive associations with HEV included the presence of meconium staining, intrauterine growth retardation, smaller placentas, and maternal hypertension or toxemia. Pathologic findings associated with HEV were chronic villitis, erythroblastosis, thrombosis and cord abnormalities. No association was found with infant Apgar score or fetal anomalies. The association of HEV with a high proportion of stillbirths in the registry suggests that further understanding of this lesion might shed light on the problem of unexplained stillbirth.

Topics: Female; Fetal Death; Fetal Diseases; Hemorrhage; Humans; Infant, Newborn; Infant, Small for Gestational Age; Male; Meconium; Placenta Diseases; Pre-Eclampsia; Pregnancy; Registries; Risk; Vasculitis

Topics: Amnion; Amniotic Fluid; Female; Humans; Iron; Meconium; Placenta Diseases; Polyhydramnios; Pregnancy; Pregnancy Complications, Infectious

Topics: Adolescent; Adult; Apgar Score; Body Weight; Female; Fetal Monitoring; Humans; Meconium; Placenta Diseases; Placental Insufficiency; Pregnancy

One hundred four postdate pregnancies were managed according to a well-defined protocol calling for weekly oxytocin challenge tests and urinary estriols three times per week. Although the perinatal mortality rate in these patients was not increased there was a significant increase in the incidence of neonatal morbidity and complications. The clinical syndrome of dysmaturity was seen in 20 per cent of the neonates. When meconium was present in the amniotic fluid the incidence of neonatal and fetal complications was higher. The cesarean section rate was twice the normal rate, with nonprogression of labor being the commonest indication. It is recommended that: (1) pregnancies carried beyond 42 weeks do not require termination simply because they are post dates; (2) all postdate patients should be monitored during labor; (3) trained personnel to initiate neonatal resuscitation should be present at each postdate delivery.

Topics: Amniocentesis; Cesarean Section; Estriol; Female; Fetal Death; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Meconium; Oxytocin; Placenta Diseases; Pregnancy; Pregnancy, Prolonged; Risk

Dysmaturity, diagnosed according to the Clifford criteria, was studied for the first time in a black population. The infants and matched control subjects were participants in the Collaborative Perinatal Study in Philadelphia from birth to 7 years of age. The incidence of dysmaturity was 25/1,000 live births; more boys than girls were born dysmature, reversing the normal male/female ratio found among black infants in the Collaborative Study as a whole. The condition was more common among post-term infants but did occur in earlier gestational weeks. The overall characteristics of the condition among this black population did not differ from those previously reported among white populations of various races. Surviving infants developed mentally and physically as well as control subjects. No prenatal or environmental characteristics were found that distinguished mothers of dysmature infants from those of nondysmature infants.

Topics: Apgar Score; Bilirubin; Black People; Child; Child, Preschool; Female; Follow-Up Studies; Gestational Age; Hematocrit; Humans; Infant; Infant, Newborn; Infant, Postmature; Infant, Small for Gestational Age; Male; Maternal Age; Meconium; Parity; Pennsylvania; Placenta; Placenta Diseases; Pregnancy; Psychological Tests; Skin Diseases; Syndrome; Vernix Caseosa

Over the last 4 years at Los Angeles County-University of Southern California Medical Center, Women's Hospital, clinical interest in antepartum fetal monitoring has increased considerably. As a result of approximately 1,500 tests in some 600 patients at high risk for placental insufficiency, we have reached several conclusions regarding the methods for antepartum fetal monitoring, criteria for interpretation of the results obtained, and the role of antepartum monitoring information in clinical management. In this paper, the results of "stress" monitoring (monitoring in the presence of uterine contractions) are presented. The term "oxytocin challenge test" is used in reference to "stressed" monitoring even though sometimes the contractions were spontaneous, or without oxytocin stimulation.

Topics: Cesarean Section; Electrocardiography; Estriol; Female; Fetal Death; Fetal Heart; Heart Rate; Hemoglobinopathies; Humans; Labor, Obstetric; Meconium; Monitoring, Physiologic; Obstetric Labor, Premature; Oxytocin; Phonocardiography; Placenta Diseases; Placenta Previa; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy, Prolonged; Prenatal Diagnosis; Ultrasonography; Uterus

Topics: Amniocentesis; Amniotic Fluid; Anemia, Sickle Cell; Bilirubin; Birth Weight; Blood; Color; Coloring Agents; Delivery, Obstetric; Embryonic and Fetal Development; Erythroblastosis, Fetal; Female; Gestational Age; Humans; Hyperbilirubinemia; Infant, Newborn; Meconium; Oxazines; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Prospective Studies; Respiratory Distress Syndrome, Newborn; Staining and Labeling; Vagina

Topics: Albumins; Amniotic Fluid; Apgar Score; Aspartate Aminotransferases; Bilirubin; Calcium; Cholesterol; Female; Fetal Death; Gestational Age; Glucose; Humans; L-Lactate Dehydrogenase; Meconium; Nitrogen; Parity; Phosphorus; Placenta Diseases; Pregnancy; Pregnancy Trimester, Third; Urea; Uric Acid

Topics: Albumins; Alkaline Phosphatase; Amniotic Fluid; Bilirubin; Calcium; Cholesterol; Female; Gestational Age; Humans; L-Lactate Dehydrogenase; Meconium; Phosphorus; Placenta Diseases; Pregnancy; Pregnancy Trimester, Third; Proteins

Topics: Amniotic Fluid; Female; Fetal Diseases; Fetal Heart; Germany, West; Gestational Age; Humans; Maternal-Fetal Exchange; Meconium; Obstetric Labor Complications; Placenta Diseases; Pre-Eclampsia; Pregnancy; Umbilical Cord

Topics: Adult; Extraembryonic Membranes; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Maternal-Fetal Exchange; Meconium; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus; Umbilical Arteries

Topics: Amniocentesis; Amniotic Fluid; Blood Urea Nitrogen; Cholesterol; Epithelial Cells; Epithelium; Female; Fetal Death; Humans; Meconium; Methods; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Vernix Caseosa

Topics: Analysis of Variance; Apgar Score; Birth Weight; Computers; Cyanosis; Electrocardiography; Extraction, Obstetrical; Female; Fetal Death; Fetal Heart; Humans; Infant, Newborn; Infant, Premature; Labor Presentation; Labor, Obstetric; Male; Maternal Age; Meconium; Placenta Diseases; Pregnancy; Pregnancy Complications; Twins

Topics: Asphyxia; Blood Transfusion; Color; Cyanosis; Female; Fetofetal Transfusion; Fetomaternal Transfusion; Gestational Age; Heart Defects, Congenital; Hematocrit; Hemorrhage; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lung Diseases; Meconium; Oxygen Inhalation Therapy; Placenta Diseases; Positive-Pressure Respiration; Pregnancy; Resuscitation; Skin Manifestations

Topics: Amniotic Fluid; Female; Histamine; Humans; Meconium; Placenta; Placenta Diseases; Pregnancy

Topics: Acceleration; Amniotic Fluid; Electrocardiography; Female; Fetal Heart; Heart Rate; Humans; Hypoxia; Labor, Obstetric; Meconium; Monitoring, Physiologic; Muscle Contraction; Oscillometry; Phonocardiography; Placenta Diseases; Pregnancy; Pregnancy Complications; Tachycardia; Umbilical Cord; Uterus