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Chronic intervillositis

Lawrence Koby, Sarah Keating, Ann Kinga Malinowski, Rohan D'Souza
INTRODUCTION: Chronic histiocytic intervillositis (CHI) of the placenta although rare, has a high recurrence rate, is associated with serious adverse pregnancy outcomes and has no available treatment. This study aims to determine clinical, biochemical and radiological factors associated with CHI, to guide management of subsequent pregnancies. METHODS: This retrospective observational study included consecutive cases with a histopathologic diagnosis of CHI after 18 weeks of gestation, between 2001 and 2014, and no controls...
April 2018: Placenta
M Bos, P G J Nikkels, D Cohen, J W Schoones, K W M Bloemenkamp, J A Bruijn, H J Baelde, M L P van der Hoorn, R J Turner
Chronic intervillositis of unknown etiology (CIUE) is a poorly understood, relatively rare condition characterized histologically by the intervillous infiltration of mononuclear cells in the placenta. Clinically, CIUE is associated with poor pregnancy outcome (e.g., impaired fetal growth, preterm birth, fetal death) and high risk of recurrence in subsequent pregnancies. Because CIUE is not defined consistently, it is essential to clearly define this condition. We therefore review the published definitions of CIUE...
January 2018: Placenta
Sahar Abdulghani, Felipe Moretti, Peter Gj Nikkels, Suonavy Khung-Savatovsky, Julie Hurteau-Miller, David Grynspan
We describe a case of a pregnancy complicated by early onset asymmetric growth restriction with anhydramnios with termination occurring at 21 weeks. Fetal autopsy showed demineralization of bones and renal tubular dysgenesis. Placental pathology showed features of massive perivillous fibrin deposition and chronic histiocytic intervillositis. We review prior documentation of this association and briefly discuss potential pathogenesis.
January 2018: Pediatric and Developmental Pathology
A Mekinian, N Costedoat-Chalumeau, L Carbillon, A Coulomb-L'Hermine, V Le Guern, A Masseau, E Lazaro, J Cohen, M Bornes, G Kayem, O Fain
Chronic intervillositis is a rare condition, which is associated with severe obstetrical outcome and high recurrence rate. Obstetrical adverse events are intrauterine growth restriction, recurrent early miscarriages, intrauterine deaths and prematurity by placental insufficiency. The determination of the extension and the intensity of the chronic intervillositis are not currently standardized. High rates of recurrence have been described, but actually there is no reliable predictive biomarker. No treatment is currently validated, but the use of immunomodulatory drugs could be justified by the possible autoimmune or allo-immune origin...
February 2018: La Revue de Médecine Interne
Nobuaki Ozawa, Koushi Yamaguchi, Megumi Shibata, Rika Sugibayashi, Hiroya Yagi, Haruhiko Sago, Kentaro Matsuoka
Chronic histiocytic intervillositis (CHI) is an extremely rare pathological condition but is strongly associated with severe obstetric complications and has a high recurrence rate. The management of this condition has not yet been established. We describe herein the occurrence of CHI in the late second-third trimester in each of three consecutive pregnancies in a single patient with four previous consecutive early miscarriages. In this patient, each of the three complicated pregnancies was managed with one of the following, respectively: low-dose aspirin; heparin plus low-dose aspirin; and prednisolone plus low-dose aspirin...
September 2017: Journal of Obstetrics and Gynaecology Research
Sahar Abdulghani, Felipe Moretti, Andree Gruslin, David Grynspan
BACKGROUND: Massive perivillous fibrin deposition (MPVFD) and chronic intervillositis (CI) are related rare pathological correlates of severe intrauterine growth restriction (IUGR) and fetal loss with high recurrence rates. No standard management has been established. CASE: A patient underwent termination of pregnancy at 21 weeks for severe early onset IUGR. Placental histology showed mixed CI with MPVFD. Several months later, the patient became pregnant and was managed with prednisone and aspirin (ASA) but miscarried at 16 weeks...
August 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
David A Clark, Jennifer M Dmetrichuk, Elizabeth McCready, Sukhbinder Dhesy-Thind, Jorge L Arredondo
PROBLEM: Expression of CD200 at the feto-maternal interface is associated with successful murine and human pregnancy. CD200 binding to CD200 receptors on lymphomyeloid cells suppresses inflammation and induces Tregs. CD200 receptors are also expressed on mouse and human placental trophoblast cells. What is the expression of CD200 and CD200R in human missed abortions which have preserved Treg levels and in chronic histiocytic intervillositis (CHI) where maternal inflammatory cells cause IUGR? METHODS: Immunohistiochemistry for CD200, CD200R, and Ki67 using human placental sections from missed abortions, term placenta, and CHI...
July 2017: American Journal of Reproductive Immunology: AJRI
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...
November 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...
April 2017: 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...
July 2017: 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
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