Placental disease

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Placental disease
Chorangioma - intermed mag.jpg
Micrograph of a chorangioma. H&E stain.
Specialty Gynecology

A placental disease is any disease, disorder, or pathology of the placenta. [1] [2]

Contents

Ischemic placental disease leads to the attachment of the placenta to the uterine wall to become under-perfused, causing uteroplacental ischemia. Where the term overarches the pathology associated with preeclampsia, placental abruptions and intrauterine growth restriction (IUGR). [3] These factors are known to be the primary pathophysiology cause placental disease. Which is considered to be associated with more than half of premature births. [4]

Abnormalities present within the spiral arteries lead to higher velocities in blood, in turn causes the maternal villi to shred. [5] Which trigger pro-coagulator molecules to be released into the blood stream causing action of the coagulator cascade, eventually leading to placental infarction. [5] Risk factors such as diabetes, chronic blood pressure and multiple pregnancies can increase the risk of developing placental disease. [3] Also, exposure to sudden trauma can increase the risk of placental abruption which coincides with placental disease. [6]

There is no target treatment available for placental disease. Associative prevention mechanisms can be a method of minimising the risk of developing the disease, within early stages of pregnancy.

Placental syndromes include pregnancy loss, fetal growth restriction, preeclampsia, preterm delivery, premature rupture of membranes, placental abruption and intrauterine fetal demise. [7]

Signs and symptoms

The abnormal spiral arteries lead decreased level of oxygen diffusion through the placental villus, [5] which cause chronic hypoxia. The abnormal trophoblast invasion, [5] lead to overall uteroplacental insufficiencies and uteroplacental underperfusion. It is due to the decreased vascularisation, there are reduced levels of nutrient delivery to the foetus. [8] Also, cases of still births can be associated with placental disease. [9]

Causes

Preeclampsia is considered to be linked with Placental Disease, as well as intrauterine growth restriction (IUGR) and placental abruptions are risk factors that lead to placental disease. [10] Especially when these symptoms are evident at early stages of pregnancy. [3] The abnormal invasion of the trophoblast cells, lack of important growth factors such as vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), has an association with the onset of placental disease. [11]

Risk factors

Risk factors associated with placental disease are as follows: [3]

Also, chronic renal disease, collagen vascular disease, thrombophilia, and cardiovascular disease increase the risk of developing placental disease. [8] [12] Moreover, being exposed to severe trauma within the pregnancy period, rapid acceleration and deceleration and uterine compression increase the risk of placental abruption, in turn leading to placental disease. [6]

Adherence/penetration

Inflammatory/infectious

Placental development

Obstruction of os

Vascular

Neoplastic

Trophoblastic neoplasms derive from trophoblastic tissue. Examples include:

Mechanism

In placental disease, there's abnormalities present within the spiral arties of the uterus, where the terminal part of the spinal arteries does not dilate. This leads to decrease oxygen carried past the maternal villi into the intervillus space. The lack of terminal dilation and inclining blood velocity causes shredding of the villi into the maternal blood, releasing blood coagulants activating the coagulation cascade. Which then leads to blocking of the blood vessels causing placental infarction. [5]

Diagnosis

Placental Disease can be diagnosed through technologies such as, Prenatal ultrasound evaluation and invasive foetal testing. The size of the foetus is taken into account through ultrasonography in terms of intrauterine growth restriction (IUGR). In conjunction with taking into account the maternal history. [8] Suspicions may be confirmed by postpartum examination of the placenta.

Prevention

The following factors can be linked with reducing the likelihood of developing placental disease: [11]

Treatment

Treatment of placental disease would require a premature birth, in order to avoid a still birth.

Epidemiology

Placental disease is more common in preterm gestation than with full term. [10] Which leads to serious injuries to both the mother and the new-born. [11] Women who endured placental disease within the first pregnancy has an increased risk of the disease progressing within future pregnancies. [13] The onset of the disease within the first trimester leads to preterm delivery of a premature baby. [14] Preeclampsia is diagnosed in 3-5% of pregnancies that place them at risk of developing placental disease. [6] Ischemic placental disease is linked with approximately more than half of premature births. [4]

Related Research Articles

<span class="mw-page-title-main">Gestation</span> Period during the carrying of an embryo

Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals. It is typical for mammals, but also occurs for some non-mammals. Mammals during pregnancy can have one or more gestations at the same time, for example in a multiple birth.

<span class="mw-page-title-main">Intrauterine growth restriction</span> Medical condition

Intrauterine growth restriction (IUGR), or fetal growth restriction, is the poor growth of a fetus while in the womb during pregnancy. IUGR is defined by clinical features of malnutrition and evidence of reduced growth regardless of an infant's birth weight percentile. The causes of IUGR are broad and may involve maternal, fetal, or placental complications.

<span class="mw-page-title-main">Eclampsia</span> Pre-eclampsia characterized by the presence of seizures

Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. Pre-eclampsia is a hypertensive disorder of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in the urine or other organ dysfunction, and edema. If left untreated, pre-eclampsia can result in long-term consequences for the mother, namely increased risk of cardiovascular diseases and associated complications. In more severe cases, it may be fatal for both the mother and the fetus.

<span class="mw-page-title-main">Pre-eclampsia</span> Hypertension occurring during pregnancy

Pre-eclampsia is a multi-system disorder specific to pregnancy, characterized by the new onset of high blood pressure and often a significant amount of protein in the urine or by the new onset of high blood pressure along with significant end-organ damage, with or without the proteinuria. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances. Pre-eclampsia increases the risk of undesirable as well as lethal outcomes for both the mother and the fetus including preterm labor. If left untreated, it may result in seizures at which point it is known as eclampsia.

Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation. Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetrics. The term "non-reassuring fetal status" has largely replaced it. It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid.

<span class="mw-page-title-main">Chorionic villus sampling</span> Type of prenatal diagnosis done to determine chromosomal or genetic disorders in the fetus

Chorionic villus sampling (CVS), sometimes called "chorionic villous sampling", is a form of prenatal diagnosis done to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorionic villus and testing it for chromosomal abnormalities, usually with FISH or PCR. CVS usually takes place at 10–12 weeks' gestation, earlier than amniocentesis or percutaneous umbilical cord blood sampling. It is the preferred technique before 15 weeks.

Oligohydramnios is a medical condition in pregnancy characterized by a deficiency of amniotic fluid, the fluid that surrounds the fetus in the abdomen, in the amniotic sac. The limiting case is anhydramnios, where there is a complete absence of amniotic fluid. It is typically diagnosed by ultrasound when the amniotic fluid index (AFI) measures less than 5 cm or when the single deepest pocket (SDP) of amniotic fluid measures less than 2 cm. Amniotic fluid is necessary to allow for normal fetal movement, lung development, and cushioning from uterine compression. Low amniotic fluid can be attributed to a maternal, fetal, placental or idiopathic cause and can result in poor fetal outcomes including death. The prognosis of the fetus is dependent on the etiology, gestational age at diagnosis, and the severity of the oligohydramnios.

<span class="mw-page-title-main">Placental abruption</span> Medical condition

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.

Bloody show or show is the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy. It is caused by thinning and dilation of the cervix, leading to detachment of the cervical mucus plug that seals the cervix during pregnancy and tearing of small cervical blood vessels, and is one of the signs that labor may be imminent. The bloody show may be expelled from the vagina in pieces or altogether and often appears as a jelly-like piece of mucus stained with blood. Although the bloody show may be alarming at first, it is not a concern of patient health after 37 weeks gestation.

<span class="mw-page-title-main">Complications of pregnancy</span> Medical condition

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

<span class="mw-page-title-main">Intrauterine hypoxia</span> Medical condition when the fetus is deprived of sufficient oxygen

Intrauterine hypoxia occurs when the fetus is deprived of an adequate supply of oxygen. It may be due to a variety of reasons such as prolapse or occlusion of the umbilical cord, placental infarction, maternal diabetes and maternal smoking. Intrauterine growth restriction may cause or be the result of hypoxia. Intrauterine hypoxia can cause cellular damage that occurs within the central nervous system. This results in an increased mortality rate, including an increased risk of sudden infant death syndrome (SIDS). Oxygen deprivation in the fetus and neonate have been implicated as either a primary or as a contributing risk factor in numerous neurological and neuropsychiatric disorders such as epilepsy, attention deficit hyperactivity disorder, eating disorders and cerebral palsy.

Placental insufficiency or utero-placental insufficiency is the failure of the placenta to deliver sufficient nutrients to the fetus during pregnancy, and is often a result of insufficient blood flow to the placenta. The term is also sometimes used to designate late decelerations of fetal heart rate as measured by cardiotocography or an NST, even if there is no other evidence of reduced blood flow to the placenta, normal uterine blood flow rate being 600mL/min.

<span class="mw-page-title-main">Uterine inversion</span> Medical condition

Uterine inversion is when the uterus turns inside out, usually following childbirth. Symptoms include postpartum bleeding, abdominal pain, a mass in the vagina, and low blood pressure. Rarely inversion may occur not in association with pregnancy.

<span class="mw-page-title-main">Placental growth factor</span> Protein-coding gene in the species Homo sapiens

Placental growth factor(PlGF) is a protein that in humans is encoded by the PGF gene.

<span class="mw-page-title-main">Velamentous cord insertion</span> Velamentous placenta

Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta. Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture.

<span class="mw-page-title-main">Fetal membranes</span> Amnion and chorion which surround and protect a developing fetus

The fetal membranes are the four extraembryonic membranes, associated with the developing embryo, and fetus in humans and other mammals. They are the amnion, chorion, allantois, and yolk sac. The amnion and the chorion are the chorioamniotic membranes that make up the amniotic sac which surrounds and protects the embryo. The fetal membranes are four of six accessory organs developed by the conceptus that are not part of the embryo itself, the other two are the placenta, and the umbilical cord.

<span class="mw-page-title-main">Circumvallate placenta</span> Medical condition

Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.

<span class="mw-page-title-main">High-risk pregnancy</span> Medical condition

A high-risk pregnancy is a pregnancy where the mother or the fetus has an increased risk of adverse outcomes compared to uncomplicated pregnancies. No concrete guidelines currently exist for distinguishing “high-risk” pregnancies from “low-risk” pregnancies; however, there are certain studied conditions that have been shown to put the mother or fetus at a higher risk of poor outcomes. These conditions can be classified into three main categories: health problems in the mother that occur before she becomes pregnant, health problems in the mother that occur during pregnancy, and certain health conditions with the fetus.

A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy. A major component of this risk can result from necessary use of drugs in pregnancy to manage the disease.

Maternal health outcomes differ significantly between racial groups within the United States. The American College of Obstetricians and Gynecologists describes these disparities in obstetric outcomes as "prevalent and persistent." Black, indigenous, and people of color are disproportionately affected by many of the maternal health outcomes listed as national objectives in the U.S. Department of Health and Human Services's national health objectives program, Healthy People 2030. The American Public Health Association considers maternal mortality to be a human rights issue, also noting the disparate rates of Black maternal death. Race affects maternal health throughout the pregnancy continuum, beginning prior to conception and continuing through pregnancy (antepartum), during labor and childbirth (intrapartum), and after birth (postpartum).

References

  1. ↑ Furuya M, Ishida J, Aoki I, Fukamizu A (2008). "Pathophysiology of placentation abnormalities in pregnancy-induced hypertension". Vasc Health Risk Manag. 4 (6): 1301–13. doi: 10.2147/vhrm.s4009 . PMC   2663465 . PMID   19337544.
  2. ↑ Cheng MH, Wang PH (January 2009). "Placentation abnormalities in the pathophysiology of preeclampsia". Expert Rev. Mol. Diagn. 9 (1): 37–49. doi:10.1586/14737159.9.1.37. PMID   19099348. S2CID   21428301.
  3. 1 2 3 4 Parker S, Werler M (2014). "Epidemiology of ischemic placental disease: A focus on preterm gestations". Seminars in Perinatology. 38 (1): 133–138. doi:10.1053/j.semperi.2014.03.004. PMC   4824536 . PMID   24836824.
  4. 1 2 Ananth C, Vintzileos A (2008). "Medically Indicated Preterm Birth: Recognizing the Importance of the Problem". Clin Perinatol. 35 (1): 53–67. doi:10.1016/j.clp.2007.11.001. PMID   18280875.
  5. 1 2 3 4 5 Roberts J (2014). "Pathophysiology of ischemic placental disease". Seminars in Perinatology. 38 (1): 139–145. doi:10.1053/j.semperi.2014.03.005. PMC   4040272 . PMID   24836825.
  6. 1 2 3 Adam T, Yeh C, Bennett-Kunzier N, Kinzler W (2014). "Long-term maternal morbidity and mortality associated with ischemic placental disease". Seminars in Perinatology. 38 (1): 146–150. doi:10.1053/j.semperi.2014.03.003. PMID   24836826.
  7. ↑ Kosinska-Kaczynska, Katarzyna (2022). "Placental Syndromes—A New Paradigm in Perinatology". Int. J. Environ. Res. Public Health. 2022 (19): 7392. doi: 10.3390/ijerph19127392 . PMC   9224387 . PMID   35742640.
  8. 1 2 3 Baschat A, Hechert K (2004). "Fetal Growth Restriction due to Placental Disease". Seminars in Perinatology. 28 (1): 67–80. doi:10.1053/j.semperi.2003.10.014. PMID   15058904.
  9. ↑ Verspyck E, Borg J, Roman H, Thobois B, Pia P, Marpeau L (2010). "Hereditary thrombophilia and recurrence of ischemic placental disease". American Journal of Obstetrics and Gynecology. 2002 (1): 54e1–54e5. doi:10.1016/j.ajog.2009.08.019. PMID   19782960.
  10. 1 2 Ananth C, Vintzileos A (2011). "Ischemic placental disease: epidemiology and risk factors". European Journal of Obstetrics & Gynecology and Reproductive Biology. 159 (1): 77–82. doi:10.1016/j.ejogrb.2011.07.025. PMID   21839575.
  11. 1 2 3 Friedman A, Cleary K (2014). "Prediction and prevention of ischemic placental disease". Seminars in Perinatology. 38 (1): 177–182. doi:10.1053/j.semperi.2014.03.002. PMID   24836830.
  12. ↑ Wu, Fred M.; Quade, Bradley J.; Carreon, Chrystalle Katte; Schefter, Zoë J.; Moses, Abigail; Lachtrupp, Cara L.; Markley, John C.; Gauvreau, Kimberlee; Valente, Anne Marie; Economy, Katherine E. (March 2022). "Placental Findings in Pregnancies Complicated by Maternal Cardiovascular Disease". JACC: Advances. 1 (1): 100008. doi: 10.1016/j.jacadv.2022.100008 . ISSN   2772-963X. PMC   11198399 . S2CID   247511090.
  13. ↑ Ananth C, Peltier M, Chavez M, Kirby R, Getahun D, Vintzileos A (2017). "Recurrence of Ischemic Placental Disease". Obstetrics & Gynecology. 110 (1): 128–133. doi:10.1097/01.AOG.0000266983.77458.71. PMID   17601907. S2CID   35554331.
  14. ↑ Vintzileos A, Ananth, C (2014). "First trimester prediction of ischemic placental disease". Seminars in Perinatology. 38 (1): 159–166. doi:10.1053/j.semperi.2014.03.006. PMID   24836828.
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