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154 Maternal age and placental pathology
290
SPO Abstracts
[53 TRANSFER OF ASPIRIN ACROSS THE PERFUSED HUMAN PLACENTAL COTYLEDON: R. L. Jacobson, M,D,', A. Brewer, B.S.', TA Siddiqi, M.D., L.Myatt, Ph.D.' University of Cincinnati Medical Center, Cincinnati, OH Pregnancy-induced hypertension (PIH) is associated with a reduction in prostacyclin (PGI,) synthesis relative to normotensive pregnancy whereas thromboxane (TXA,) synthesis is unchanged or increased. The net effect is a decreased PGI/TXA2 ratio which may result in the reduced fetal-placental blood flow seen in PIH as TXA2 is known to constrict this circulation. Low-dose aspirin used to treat PIH selectively inhibits TXA2 synthesis and therefore may alter fetal-placental blood flow. We have investigated the transfer of ASA in the perfused human placental cotyledon and its effects on fetal-placental perfusion pressure. Human placental cotyledons were perfused with tissue culture medium 199 plus 5% polyvinyl-pyrrolidone gassed with 95%O,.l5%C0 2 at flow rates of 10mVmin (maternaQ and 4ml/min (fetaQ. ASA was added to the maternal circuit to a final concentration of 10"'M. Cotyledons were perfused for one hour with aliquots taken from the fetal side every 2.5 minutes (first 10 minutes) then every 5 minutes (remaining 50 minutes). ASA was assayed by spectrofluorometry at 306/412nm. Our data indicate an initial rapid trar,sfer of ASA over the first ten minutes into the fetal placental circulation, the concentration then decreasing to a steady state. Resting perfusion pressure of both maternal and fetal circulation did not change after addition of ASA to maternal perfusate and transfer to the fetal-circulation. Supported in part by NIH HL 40029
54 MATERNAL AGE AND PLACENTAL PATHOLOGY S Rotmensch, K Hsieh' C Salafia', C Vogel·, K Belanger·, JC Hobbins, Dept Ob/Gyn, Yale; Lab Med, Danbury Hosp, CT. Advancing maternal age is associated with an increase In maternal and perinatal complications. The magnitude of added risk is the subject of much recent controversy. The biologic mediators of this association are largely unknown. Since many of the maternal and fetal complications are suggestive of impaired utero-placental function, we hypothesized that the effect of maternal aging on pregnancy might be mediated by, or reflected in, morphological alterations of placental histology. We examined the morphology, weight, and fetal/placental weight ratio of 341 placentas from healthy, non-smoking, primiparous parturients between the age of 20-25 (control group, n=255) and age 35 and over (study group, n=86). Specimens were examined for the presence of a variety of decidual, vascular and villous parenchymal lesions. Assuming that a two-fold increase in any of the pathologic categories would likely be biologically meaningful, the sample size was chosen to detect such a difference with 99% power. Res u Its: No statistically significant differences were found for any of the pathologic parameters. Mean fetal and placental weights were similar. Conclusion: No significant placental or decidual vascular changes, or villous parenchymal lesions, seem to occur with advancing maternal age.
Januar~
1991
Am J Obstet Gynecol
155 NONIMMUNE
HYDROPS FETALIS IN ASSOCIATION WITH HEMORRHAGIC ENDOVASCUUTIS OF THE PLACENTA: REPORT OF 12 CASES
PM Novakri , CM SandeP, SS Yan,!!,l, PT von Oeyenl ,2, William Beaumont Hospitall , Wayne State Universiry2, Royal Oak, MI 48073 and Michigan State Universiry3, East Lansing, Michigan 48823 Hemorrhagic endovasculitis (HEY) of the placenta is a distinct vasodestructive process of unknown etiology. It has been associated with otherwise unexplained intrauterine fetal death or growth retardation, and longterm developmental abnormalities in surviving infants. A relationship between nonimmune hydrops fetalis (NIHF) and HEY has not been previously described. At a large teaching hospital, 4 cases of NIHF were identified out of 57 cases of HEV, for an incidence of 7%. Conversely, these same 4 cases of HEV represented 21 % of the 19 identifiable cases of NIHF where the placentas were examined. An additional 8 cases of associated NIHF were found among the 2064 cases of HEV in the files of the Michigan Placental Tissue Registry. The low incidence from this registry is probably due to the highly selective nature of the cases submitted. In 7 of the total 12 cases, after excluding congenital malformations (Trisomy 21, Turner Syndrome, and cystic adenomatoid malformation) and cytomegalovirus infections (2 cases), HEV was the only pathologic finding. Of the total, there were 6 stillbirths and 4 neonatal deaths. One infant survived and one is lost to follow-up. The significance of this association of HEY and NIHF, and the possibility of placental ischaemia or fetal-placental hemorrhage as an etiology of NIHF, remains to be determined.
156 PLACENTAS OF COCAINE ADDICTED MOTHERS. Salih Y. Yasin, M.D., Gene Burkett, Diana Palow, RN ,x Alfred Abuhamad, University of Miami, Miami, Florida.
Ivl.D. , M.D.~
This is a descriptive study of 69 parturients with history of cocaine use during pregnancy, confirmed by maternal and neonatal toxicology studies. Their demographic characteristics are similar to published data. The gross pathologic findings showed smaller placentas (weight and mass) in comparison to published means for different gestational ages • Five major categories of histopathologic findings were found: obliteration of intervillous space, 29%; membrane abnormality, 16%; inflammatory/infectious, 41%; other ischemic changes, 29%; abruption, 25%. These findings suggest that placentas in these mothers sustain chronic hypoxic lnJury and vasospastic abnormalities suggestive of acute ischemia. The picture is probably similar to chronic hypertension/preeclampsia with infection.
SPO Abstracts
[53 TRANSFER OF ASPIRIN ACROSS THE PERFUSED HUMAN PLACENTAL COTYLEDON: R. L. Jacobson, M,D,', A. Brewer, B.S.', TA Siddiqi, M.D., L.Myatt, Ph.D.' University of Cincinnati Medical Center, Cincinnati, OH Pregnancy-induced hypertension (PIH) is associated with a reduction in prostacyclin (PGI,) synthesis relative to normotensive pregnancy whereas thromboxane (TXA,) synthesis is unchanged or increased. The net effect is a decreased PGI/TXA2 ratio which may result in the reduced fetal-placental blood flow seen in PIH as TXA2 is known to constrict this circulation. Low-dose aspirin used to treat PIH selectively inhibits TXA2 synthesis and therefore may alter fetal-placental blood flow. We have investigated the transfer of ASA in the perfused human placental cotyledon and its effects on fetal-placental perfusion pressure. Human placental cotyledons were perfused with tissue culture medium 199 plus 5% polyvinyl-pyrrolidone gassed with 95%O,.l5%C0 2 at flow rates of 10mVmin (maternaQ and 4ml/min (fetaQ. ASA was added to the maternal circuit to a final concentration of 10"'M. Cotyledons were perfused for one hour with aliquots taken from the fetal side every 2.5 minutes (first 10 minutes) then every 5 minutes (remaining 50 minutes). ASA was assayed by spectrofluorometry at 306/412nm. Our data indicate an initial rapid trar,sfer of ASA over the first ten minutes into the fetal placental circulation, the concentration then decreasing to a steady state. Resting perfusion pressure of both maternal and fetal circulation did not change after addition of ASA to maternal perfusate and transfer to the fetal-circulation. Supported in part by NIH HL 40029
54 MATERNAL AGE AND PLACENTAL PATHOLOGY S Rotmensch, K Hsieh' C Salafia', C Vogel·, K Belanger·, JC Hobbins, Dept Ob/Gyn, Yale; Lab Med, Danbury Hosp, CT. Advancing maternal age is associated with an increase In maternal and perinatal complications. The magnitude of added risk is the subject of much recent controversy. The biologic mediators of this association are largely unknown. Since many of the maternal and fetal complications are suggestive of impaired utero-placental function, we hypothesized that the effect of maternal aging on pregnancy might be mediated by, or reflected in, morphological alterations of placental histology. We examined the morphology, weight, and fetal/placental weight ratio of 341 placentas from healthy, non-smoking, primiparous parturients between the age of 20-25 (control group, n=255) and age 35 and over (study group, n=86). Specimens were examined for the presence of a variety of decidual, vascular and villous parenchymal lesions. Assuming that a two-fold increase in any of the pathologic categories would likely be biologically meaningful, the sample size was chosen to detect such a difference with 99% power. Res u Its: No statistically significant differences were found for any of the pathologic parameters. Mean fetal and placental weights were similar. Conclusion: No significant placental or decidual vascular changes, or villous parenchymal lesions, seem to occur with advancing maternal age.
Januar~
1991
Am J Obstet Gynecol
155 NONIMMUNE
HYDROPS FETALIS IN ASSOCIATION WITH HEMORRHAGIC ENDOVASCUUTIS OF THE PLACENTA: REPORT OF 12 CASES
PM Novakri , CM SandeP, SS Yan,!!,l, PT von Oeyenl ,2, William Beaumont Hospitall , Wayne State Universiry2, Royal Oak, MI 48073 and Michigan State Universiry3, East Lansing, Michigan 48823 Hemorrhagic endovasculitis (HEY) of the placenta is a distinct vasodestructive process of unknown etiology. It has been associated with otherwise unexplained intrauterine fetal death or growth retardation, and longterm developmental abnormalities in surviving infants. A relationship between nonimmune hydrops fetalis (NIHF) and HEY has not been previously described. At a large teaching hospital, 4 cases of NIHF were identified out of 57 cases of HEV, for an incidence of 7%. Conversely, these same 4 cases of HEV represented 21 % of the 19 identifiable cases of NIHF where the placentas were examined. An additional 8 cases of associated NIHF were found among the 2064 cases of HEV in the files of the Michigan Placental Tissue Registry. The low incidence from this registry is probably due to the highly selective nature of the cases submitted. In 7 of the total 12 cases, after excluding congenital malformations (Trisomy 21, Turner Syndrome, and cystic adenomatoid malformation) and cytomegalovirus infections (2 cases), HEV was the only pathologic finding. Of the total, there were 6 stillbirths and 4 neonatal deaths. One infant survived and one is lost to follow-up. The significance of this association of HEY and NIHF, and the possibility of placental ischaemia or fetal-placental hemorrhage as an etiology of NIHF, remains to be determined.
156 PLACENTAS OF COCAINE ADDICTED MOTHERS. Salih Y. Yasin, M.D., Gene Burkett, Diana Palow, RN ,x Alfred Abuhamad, University of Miami, Miami, Florida.
Ivl.D. , M.D.~
This is a descriptive study of 69 parturients with history of cocaine use during pregnancy, confirmed by maternal and neonatal toxicology studies. Their demographic characteristics are similar to published data. The gross pathologic findings showed smaller placentas (weight and mass) in comparison to published means for different gestational ages • Five major categories of histopathologic findings were found: obliteration of intervillous space, 29%; membrane abnormality, 16%; inflammatory/infectious, 41%; other ischemic changes, 29%; abruption, 25%. These findings suggest that placentas in these mothers sustain chronic hypoxic lnJury and vasospastic abnormalities suggestive of acute ischemia. The picture is probably similar to chronic hypertension/preeclampsia with infection.