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Chronic intervillositis

Leehe Vardi, Helen Paterson, Noelyn Anne Hung
Chronic histiocytic intervillositis (CHI) is a rare placental lesion associated with adverse obstetric outcomes and high recurrence rate. We report a case of six consecutive pregnancies in one woman, where CHI was detected following an intrauterine death in the fifth pregnancy, after being missed in four earlier losses. The successful sixth pregnancy was treated with a combination of immunosuppressive and antithrombotic agents. While low-molecular-weight heparin (LMWH) and aspirin had been shown to improve pregnancy outcome in recurrent pregnancy loss, there was limited evidence of improved outcome in CHI...
January 10, 2017: BMJ Case Reports
Estelle Dubruc, Frédérique Lebreton, Catherine Giannoli, Muriel Rabilloud, Cyril Huissoud, Mojgan Devouassoux-Shisheboran, Fabienne Allias
BACKGROUND: Alloimmunization against human platelet antigens (HPAs) can occur prenatally and induce fetal/neonatal alloimmune thrombocytopenia (FNAIT). The aim of this study was to identify placental histological features associated with platelet alloimmunization and their clinical significance. METHODS: This study examined 21 placentas from FNAIT-affected pregnancies and 42 age-matched control cases, all collected from pathology departments in the Rhône-Alpes region...
December 2016: Placenta
J Man, J C Hutchinson, A E Heazell, M Ashworth, I Jeffrey, N J Sebire
OBJECTIVES: Placental abnormalities are a common cause of death in stillbirth, ranking second only to unexplained deaths, though there is wide variation in the proportion attributed to placental disease. In clinical practice, interpretation of the significance of placental findings is difficult, since many placental features in stillbirths overlap with those in live births. Our aim was to examine objectively classified placental findings from a series of > 1000 autopsies following intrauterine death in order to evaluate the role of placental histological examination in determining the cause of death...
October 25, 2016: Ultrasound in Obstetrics & Gynecology
Khrystyna Levytska, Mary Higgins, Sarah Keating, Nir Melamed, Melissa Walker, Neil J Sebire, John C P Kingdom
Objectives Current guidelines for diagnosis and management of early-onset intrauterine growth restriction (IUGR) rely on umbilical artery Doppler (UAD), without including uterine artery Doppler (UtAD). We hypothesized that IUGR cases with abnormal UAD but normal UtAD has a different spectrum of placental pathology compared with those with abnormal UtAD. Study Design Retrospective review of pregnancies with sonographic evidence of IUGR and abnormal UAD prior to delivery. Cases with ≥ 1 UtAD record(s) after 18(+0) weeks' gestation and placental pathology were included...
September 20, 2016: American Journal of Perinatology
Christel Nowak, Madeleine Joubert, Frederique Jossic, Agathe Masseau, Mohamed Hamidou, Henri-Jean Philippe, Claudine Le Vaillant
INTRODUCTION: The objective of this work was to evaluate and compare perinatal outcomes of pregnancies complicated by placental chronic intervillositis (CIUE) or villitis (CVUE) of unknown etiology and combined lesions. METHODS: Retrospective study of all cases of significant CVUE and CIUE occurring during a 12-year period in a university tertiary hospital center. Multiple pregnancies, infectious and medical termination of pregnancies (TOP) without intra-uterine growth restriction (IUGR) were excluded...
August 2016: Placenta
H Feist, C von Kaisenberg, K Hussein
BACKGROUND: Prematurely born children show a clearly elevated risk for perinatal morbidity, long-term pediatric morbidities and development of chronic diseases in adulthood compared to babies born at term. The pathoanatomical investigation of placentas from preterm births is useful for assessing the etiology, the risk of recurrence and the prognosis for the child. AIMS: The focus is on presenting the clinical and pathoanatomical characteristics of acute chorioamnionitis as a frequent cause of preterm induction of labor and pregnancy-induced hypertension, in particular preeclampsia as a frequent reason for elective cesarean section...
June 2, 2016: Der Pathologe
Kais Hussein, Angelika Stucki-Koch, Hans Kreipe, Henning Feist
Chronic histiocytic intervillositis of the placenta (CHI) shows monocytic/histiocytic infiltration of the intervillous space. Placental malaria has a CHI-like histopathology and induces an aberrant expression of Toll-like receptors (TLR) 3, 7-9. We hypothesized that, similar to placental malaria, CHI could be associated with increased TLR expression. TLR1-10 and other inflammation-associated factors were analyzed by real-time PCR and immunohistochemistry. A total of 31 formalin-fixed and paraffin-embedded placenta samples were evaluated: CHI (n = 9), and for control purposes, villitis of unknown etiology (VUE, n = 8) and placentas without inflammation (n = 14)...
2015: Fetal and Pediatric Pathology
Robert W Bendon, Susan Coventry, Matthew Thompson, Erin R Rudzinski, Elizabeth M Williams, Assaf P Oron
Deposition of the complement split product C4d is a phenomenon studied extensively as a marker for complement activation in antibody-mediated transplant rejection. C4d also is observed in placental disease processes including spontaneous abortion, infarct, and villitis of unknown origins. Massive chronic intervillositis is a rare placental abnormality associated with increased risk of growth restriction, fetal death, and recurrent fetal loss. In this study, we evaluated C4d immunostaining in placentas with accumulation of intervillous monocytes with and without villitis...
September 2015: Pediatric and Developmental Pathology
C A Labarrere, J W Hardin, D M Haas, G S Kassab
INTRODUCTION: Chronic villitis of unknown etiology (CVUE) and massive chronic intervillositis (MCI) are placental lesions associated with infiltration of mononuclear cells in the chorionic villi and the intervillous spaces, respectively. It is not well known whether immune cells in CVUE and MCI have similar phenotypic characteristics. METHODS: A cross-sectional study of third trimester placentas was conducted to identify immune cell subpopulations in CVUE and MCI (n = 17/group)...
June 2015: Placenta
Duygu İskender-Mazman, Zuhal Akçören, Şule Yiğit, Gülsev Kale, Ayşe Korkmaz, Murat Yurdakök, Tekin Durukan
This study aims to define the placental findings in intrauterine growth restriction (IUGR). The study group consisted of 40 neonates without IUGR and 24 neonates with IUGR, including their placentas. The cases were separated into three groups according to gestational age. Group A (n=21): 37 ≤ weeks, Group B (n=27): 32≤ - <37 weeks, Group C (n=16): < 32 weeks. Each group had two subgroups, IUGR and non-IUGR. The placentas from the non-IUGR subgroup were heavier than the IUGR subgroup placentas in the term group (p<0...
July 2014: Turkish Journal of Pediatrics
Chelsea Elwood, Dena Bloomenthal, Susan Purkiss
OBJECTIVES: Fever in the antepartum period without the presence of ruptured membranes is unusual. A 37 y.o. Vietnamese G5T1P3SA1L3 presented with fever in her fourth pregnancy at 25 weeks gestation. She had an extensive evaluation, including laboratory, microbiological and imaging which found no localizing source of her fever. Her bloodwork revealed elevated liver enzymes and an elevated platelet count. She required delivery for fetal distress at 29 weeks after 4 weeks of fevers. Her fever of unknown origin (FUO) resolved after delivery and did not recur...
January 2015: Pregnancy Hypertension
H Feist, T Blöcker, K Hussein
BACKGROUND: Maternal floor infarction/massive perivillous fibrin deposition (MFI/MFD), chronic histiocytic intervillositis (CHIV) and villitis of unknown etiology (VUE) are lesions of the placenta which are characterized morphologically. The cause is thought to be pathological immunotolerance/rejection reaction at the fetomaternal interface. The risk of recurrence is elevated and the lesions can lead to severe pediatric diseases. AIM: This article provides an overview of the pathological and anatomical characteristics of each of these lesions, including diagnostic criteria, suspected etiology, clinical relevance and suggested therapy options...
July 2015: Der Pathologe
Philip J Katzman
The chronic inflammatory lesions of the placenta often run in the shadows of the better-known acute inflammatory processes of the placenta, such as acute chorioamnionitis and acute funisitis. A heterogeneous population of T-cell lymphocytes, plasma cells, and macrophages is the primary player in chronic villitis, chronic chorioamnionitis, chronic deciduitis, and chronic intervillositis, and eosinophils are an added component of eosinophilic/T-cell chorionic vasculitis. The histologic appearance, sites of occurrence in the placenta, and pathogeneses of these entities are reviewed...
February 2015: Seminars in Perinatology
Aurélie Revaux, Arsène Mekinian, Pascale Nicaise, Martine Bucourt, Françoise Cornelis, Eric Lachassinne, Sylvie Chollet-Martin, Olivier Fain, Lionel Carbillon
OBJECTIVES: Chronic intervillositis of unknown etiology (CIUE) is characterized by an intervillous infiltrate of mononuclear cells and a high recurrence rate of adverse obstetrical outcomes. The aim was to describe obstetrical history in patients with at least one event characterized by CIUE, and the possible impact of systematic investigation of an underlying autoimmune disease on the obstetrical outcome of subsequent pregnancies. METHODS: We retrospectively reviewed all pregnancies in patients having experienced at least one adverse obstetric outcome associated with chronic intervillositis of unknown etiology diagnosed by placental histological analysis between 2004 and 2011 in our university hospital...
June 2015: Archives of Gynecology and Obstetrics
A N Drobinskaia, A P Nadeeva, V A Zhukova, N M Pasman, M A Karpov, N V Teliatnikova
OBJECTIVE: To study placental morphological changes in inherited thrombophilia. SUBJECT AND METHODS: A morphometric method was used to examine placentas from 37 patients divided into 3 groups: 1) 13 pregnant women with verified inherited thrombophilia; 2) 14 pregnant women with inherited thrombophilia and signs of placental inflammatory manifestations (basal deciduitis, intervillositis, placentitis); 3) 10 women with normal pregnancy (a control group). RESULTS: In inherited thrombophilia, the placentas exhibited morphological manifestations of chronic placental insufficiency as pathological immaturity with a predominance of intermediate differentiated villi and as dissociated maturity of cotyledones, with a substantial reduction in the specialized terminal villi, excessive intervillous fibrinoid formation and villous immuring, evolving pseudoinfarctions, fewer capillaries in the terminal villi, and their increased stromal proportion...
May 2014: Arkhiv Patologii
Jane E Dahlstrom, Christopher J Nolan, Rebecca McCormack, Andrew Gordan
A 26-year-old Indian lady G2P0 presented at 33 weeks gestation complaining of itch. Liver function tests revealed an elevated alkaline phosphatase (ALKP) of 2983 U/L (normal range 20-110) which on fractionation was a placental or placental-like isoenzyme. All other investigations, including fetal ultrasound, were normal. Labour was induced at 37 weeks due to continued ALKP rise (peak level 4082 U/L). The baby and placental disc weighed 2740 g and 380 g, respectively. The ALKP level returned to normal over 8 weeks...
October 2014: Pathology
Arsène Mekinian, Nathalie Costedoat-Chalumeau, Agathe Masseau, Angela Botta, Anastasia Chudzinski, Arnaud Theulin, Virginie Emmanuelli, Eric Hachulla, Sara De Carolis, Aurélie Revaux, Pascale Nicaise, Françoise Cornelis, Damien Subtil, Francois Montestruc, Martine Bucourt, Sylvie Chollet-Martin, Lionel Carbillon, Olivier Fain
UNLABELLED: Introduction: In this prospective multicenter study, we aimed to describe (1) the outcome of pregnancy in the case of previous chronic histiocytic intervillositis (CHI), (2) the immunological findings and associated diseases, (3) the treatments, and (4) the factors associated with pregnancy loss. METHODS: We prospectively included all patients with a prior CHI with ongoing pregnancy between 2011 and 2013. RESULTS: Twenty-four women (age 34±5 years) were included in this study...
February 2015: Autoimmunity
C A Labarrere, E Bammerlin, J W Hardin, H L Dicarlo
INTRODUCTION: Massive chronic intervillositis (MCI), also known as chronic intervillositis of unknown etiology, is a placental lesion associated with massive infiltration of mononuclear cells in the intervillous space, poor perinatal outcome, and high rate of recurrence. Our previous demonstration of increased syncytiotrophoblast (st) intercellular adhesion molecule-1 (ICAM-1) expression in villitis lesions and the finding of extensive monocyte/macrophagic cells in the maternal intervillous space in MCI, led us to further investigate stICAM-1 in MCI...
May 2014: Placenta
P Marcorelles
OBJECTIVE: To evaluate the placental pathological patterns in intrauterine growth restriction (IUGR) in order to determinate which placental lesions are linked to clinically significant anomalies and to predict the child outcome and the mother risk of recurrence. METHODS: Bibliographic review using the Medline and PubMed databases. RESULTS: Placental studies designed in order to provide macroscopic and microscopic information about the mechanism of IUGR are not numerous and retrospective; files are most of the time very small...
December 2013: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
Lukas Freitag, Constantin von Kaisenberg, Hans Kreipe, Kais Hussein
UNLABELLED: Chronic histiocytic intervillositis of the placenta (CHI) is a rare and potentially recurrent disease. Characteristically it shows accumulation of CD68+ cells in the intervillous space but no destructive tissue infiltration. An immunopathological background is likely but it is unknown what attracts circulating monocytes to the placenta. METHODS: We analysed the expression profile of 102 inflammation- and angiogenesis-associated genes with real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in 16 placentas: CHI (n = 5) and, as controls, villitis of unknown aetiology (VUE, n = 4) and normal placenta (n = 7)...
2013: International Journal of Clinical and Experimental Pathology
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