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Discordant karyotype in monochorionic diamniotic twins: two cases report
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Abstracts / Placenta 59 (2017) 169e184
each 3 siblings in the both side of the uterus without placentation. The uterus contained large amount of milk and egg-shells. Methods: The uterine specimens were investigated by histochemically and electron-microscopically methods. Results: 1) The uterine endometrium of a great white shark showed thickend endometrium stained histochemically well with PAS, hPL, SP1 in addition to GLUT 1 and GLUT 3. 2) By surface-ultrastructural observations, the surface of the uterine endothelium showed mosaic sheets patterns. 3) In the endometrial gland surface of uterine epithelium, we can see very active protein secretion released, by which milk-like secretions have been produced here and released from the uterine epithelium within the uterine cavity for nourishment of the fetuses. Conclusions: It is concluded that uterine endometrium has replaced placentation as nutritious works within the pregnant uterus of a great white shark.
Slc2a1 and/or DBA-positive cells was divided by number of DAPI nuclei in the same area to normalize the data. Results: In the maternal decidua and MLAp at E10.5, DBA and Slc2a1double positive cells, DBA-positive and Slc2a1-negative cells, and DBAnegative and Slc2a1-positive cells were 23.9%, 2.7%, and 1.6%, respectively. In other words, 93.8% of Slc2a1 positive cells were DBA-positive NK cells and 89.8% of DBA-positive NK cells were Slc2a1-positive. DBA-positive NK cells gradually decreased toward late gestation. Conclusion: We found that most of the DBA-positive dNK cells expressed Slc2a1 in the maternal decidua and MLAp.
22. PPAP SCORING SYSTEM PREDICTS ADHERENT PLACENTA IN WOMEN WITH PLACENTA PREVIA Kenji Tanimura. Kobe University Hospital Center for Perinatal Care, Japan
20. DISCORDANT KARYOTYPE IN MONOCHORIONIC DIAMNIOTIC TWINS: TWO CASES REPORT Atsuko Hichijo. Department of Obstetrics and Gynecology, Tokushima University Hospital, Japan Monochorionic diamniotic (MD) twins are usually monozygotic twins, that is, their karyotype is match. Nevertheless, some discordant karyotype of MD twins have been reported. As the reasons there are such as twins generated via binovular follicle fertilization (dizygotic) and trisomy rescue. Case 1 was conceived MD twins spontaneously. But ultrasound showed the fetuses were discordant for gender. Delivery in pregnancy 38 weeks, they seemed normal girl and boy. The karyotype of umbilical cord blood was 46,XX[15]/46,XY[15] in the girl and 46,XY[21]/46,XX[9] in the boy. So we investigated their karyotype of buccal mucosa when 1-year-old. That was respectively 46,XX and 46,XY, was determined to be dizygotic MD twins.Case 2 was conceived MD twins by single embryo transfer with a frozen embryo in hormone replacement therapy cycles. In early pregnancy, nuchal translucency was found in one of the twins. The infant had multiple malformation such as both sides cleft lip and palate, double outlet right ventricle, single umbilical artery. However, the other had no obvious abnormalities. Delivery in pregnancy 33 weeks, the first baby without abnormality was healthy, the second died in even 1.5 hours after birth because of respiratory failure. Cytogenetic analysis of umbilical cord blood and the villi showed 46,XY in the first and 47,XY+18 in the second.We experienced discordant karyotype in MD twins. As the causes, dizygotic MD twins in case 1, trisomy rescue in case 2, were considered. We need to take into account the karyotype do not match in some of MD twins.
21. DECIDUAL NATURAL KILLER CELLS EXPRESS GLUCOSE TRANSPORTER TYPE 1 (SLC2A1) DURING MOUSE PREGNANCY Chaw Kyi-Tha-Thu, Toshihiro Takizawa. Department of Molecular Medicine and Anatomy, Nippon Medical School, Tokyo, Japan Objective: Decidual natural killer (dNK) cells transiently appear in the mid gestation and play an important role in placenta formation. Glucose transporter type 1 (Slc2a1) is a main glucose transporter isoform in the mouse placenta. We previously reported that Slc2a1 was present not only in the syncytiotrophoblast of the placental labyrinth zone but also in the cells of maternal decidua and mesometrial lymphoid aggregate of pregnancy (MLAp). In this study, we performed quantitative analysis of Slc2a1positive cells. Methods: Formalin-fixed paraffin sections of the B6D2F1 mouse placenta (from E10.5 to E18.5) were prepared. Sections were double-stained with anti-Slc2a1 and Dolichos Biflorus Agglutinin (DBA) lectin (a marker of dNK cells). We manually counted the individual cells of the decidua and MLAp in the images taken by fluorescence light microscopy. The number of
Objective: Adherent placenta (AP) is a life-threatening condition, and is often complicated with placenta previa (PP). We have devised an original scoring system for predicting AP complicated with PP, and conducted a prospective cohort study to evaluate the diagnostic accuracy of our scoring system (Placenta Previa with Adherent Placenta score: PPAP score). Methods: PPAP score is composed of the following two components; 1) past history of previous cesarean section, dilation and curettage, or other uterine surgery; and 2) imaging findings of ultrasonography and MRI. Each item is graded either 0, 1, 2, or 4 points, and then added up to yield a number between 0 and 24. From January 2011, we have used the PPAP scoring system for predicting AP complicated by PP. If patients with PP had score 8 or more, we suspected them to have AP, and the patients received preoperative internal iliac artery occlusion balloon catheters (IIAOBC) placement. The diagnostic accuracy of PPAP score were evaluated. Results: This prospective cohort study included 175 pregnant women with PP who had delivered after PPAP scoring at Kobe University Hospital from January 2011 to June 2017. Twenty-four of them had PPAP score 8 or more. Twenty-one of the 24 actually had AP. However, two women with AP were overlooked at cut-off of 8. PPAP score yielded 91% sensitivity, 98% specificity, 88% positive predictive value, 99% negative predictive value, and 97% accuracy. In addition, it was also found that there was a modest positive association between PPAP score and the amount of intraoperative blood loss (r¼0.43, p<0.01). Conclusion: This prospective cohort study demonstrated that the PPAP scoring system may be useful for predicting AP complicated by PP. The higher PPAP score might be associated with an increased amount of intraoperative blood loss, regardless of the preoperative placement of IIAOBC.
23. A CASE OF PREGNANCY WITH PLACENTA PREVIA ACCRETA TERMINATED AT 16TH WEEKS OF GESTATION, AND PLACENTAL PROTEOMIC ANALYSIS Yoshinori Moriyama. Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Japan Introduction: Placenta accreta is one of fatal obstetric complications, while its pathophysiology remains unestablished, and prediction of its onset is usually difficult. We experienced a case of placenta previa accreta where we successfully suspected it, and performed placental proteomic analysis of the case. Case: The patient was a 40-year-old 3 gravida 3 para pregnant woman with a history of 2 prior Cesarean sections (CS). She was diagnosed with MD twin pregnancy at 14th weeks of gestation and referred to a general hospital. Just after that she had bloody vaginal discharge, and placenta previa accreta was suspected, so she was referred to our hospital. Her placenta was located on the scar of previous CS. Her situation was getting improved. However, placenta accreta was highly suspected, and her life could be
Abstracts / Placenta 59 (2017) 169e184
each 3 siblings in the both side of the uterus without placentation. The uterus contained large amount of milk and egg-shells. Methods: The uterine specimens were investigated by histochemically and electron-microscopically methods. Results: 1) The uterine endometrium of a great white shark showed thickend endometrium stained histochemically well with PAS, hPL, SP1 in addition to GLUT 1 and GLUT 3. 2) By surface-ultrastructural observations, the surface of the uterine endothelium showed mosaic sheets patterns. 3) In the endometrial gland surface of uterine epithelium, we can see very active protein secretion released, by which milk-like secretions have been produced here and released from the uterine epithelium within the uterine cavity for nourishment of the fetuses. Conclusions: It is concluded that uterine endometrium has replaced placentation as nutritious works within the pregnant uterus of a great white shark.
Slc2a1 and/or DBA-positive cells was divided by number of DAPI nuclei in the same area to normalize the data. Results: In the maternal decidua and MLAp at E10.5, DBA and Slc2a1double positive cells, DBA-positive and Slc2a1-negative cells, and DBAnegative and Slc2a1-positive cells were 23.9%, 2.7%, and 1.6%, respectively. In other words, 93.8% of Slc2a1 positive cells were DBA-positive NK cells and 89.8% of DBA-positive NK cells were Slc2a1-positive. DBA-positive NK cells gradually decreased toward late gestation. Conclusion: We found that most of the DBA-positive dNK cells expressed Slc2a1 in the maternal decidua and MLAp.
22. PPAP SCORING SYSTEM PREDICTS ADHERENT PLACENTA IN WOMEN WITH PLACENTA PREVIA Kenji Tanimura. Kobe University Hospital Center for Perinatal Care, Japan
20. DISCORDANT KARYOTYPE IN MONOCHORIONIC DIAMNIOTIC TWINS: TWO CASES REPORT Atsuko Hichijo. Department of Obstetrics and Gynecology, Tokushima University Hospital, Japan Monochorionic diamniotic (MD) twins are usually monozygotic twins, that is, their karyotype is match. Nevertheless, some discordant karyotype of MD twins have been reported. As the reasons there are such as twins generated via binovular follicle fertilization (dizygotic) and trisomy rescue. Case 1 was conceived MD twins spontaneously. But ultrasound showed the fetuses were discordant for gender. Delivery in pregnancy 38 weeks, they seemed normal girl and boy. The karyotype of umbilical cord blood was 46,XX[15]/46,XY[15] in the girl and 46,XY[21]/46,XX[9] in the boy. So we investigated their karyotype of buccal mucosa when 1-year-old. That was respectively 46,XX and 46,XY, was determined to be dizygotic MD twins.Case 2 was conceived MD twins by single embryo transfer with a frozen embryo in hormone replacement therapy cycles. In early pregnancy, nuchal translucency was found in one of the twins. The infant had multiple malformation such as both sides cleft lip and palate, double outlet right ventricle, single umbilical artery. However, the other had no obvious abnormalities. Delivery in pregnancy 33 weeks, the first baby without abnormality was healthy, the second died in even 1.5 hours after birth because of respiratory failure. Cytogenetic analysis of umbilical cord blood and the villi showed 46,XY in the first and 47,XY+18 in the second.We experienced discordant karyotype in MD twins. As the causes, dizygotic MD twins in case 1, trisomy rescue in case 2, were considered. We need to take into account the karyotype do not match in some of MD twins.
21. DECIDUAL NATURAL KILLER CELLS EXPRESS GLUCOSE TRANSPORTER TYPE 1 (SLC2A1) DURING MOUSE PREGNANCY Chaw Kyi-Tha-Thu, Toshihiro Takizawa. Department of Molecular Medicine and Anatomy, Nippon Medical School, Tokyo, Japan Objective: Decidual natural killer (dNK) cells transiently appear in the mid gestation and play an important role in placenta formation. Glucose transporter type 1 (Slc2a1) is a main glucose transporter isoform in the mouse placenta. We previously reported that Slc2a1 was present not only in the syncytiotrophoblast of the placental labyrinth zone but also in the cells of maternal decidua and mesometrial lymphoid aggregate of pregnancy (MLAp). In this study, we performed quantitative analysis of Slc2a1positive cells. Methods: Formalin-fixed paraffin sections of the B6D2F1 mouse placenta (from E10.5 to E18.5) were prepared. Sections were double-stained with anti-Slc2a1 and Dolichos Biflorus Agglutinin (DBA) lectin (a marker of dNK cells). We manually counted the individual cells of the decidua and MLAp in the images taken by fluorescence light microscopy. The number of
Objective: Adherent placenta (AP) is a life-threatening condition, and is often complicated with placenta previa (PP). We have devised an original scoring system for predicting AP complicated with PP, and conducted a prospective cohort study to evaluate the diagnostic accuracy of our scoring system (Placenta Previa with Adherent Placenta score: PPAP score). Methods: PPAP score is composed of the following two components; 1) past history of previous cesarean section, dilation and curettage, or other uterine surgery; and 2) imaging findings of ultrasonography and MRI. Each item is graded either 0, 1, 2, or 4 points, and then added up to yield a number between 0 and 24. From January 2011, we have used the PPAP scoring system for predicting AP complicated by PP. If patients with PP had score 8 or more, we suspected them to have AP, and the patients received preoperative internal iliac artery occlusion balloon catheters (IIAOBC) placement. The diagnostic accuracy of PPAP score were evaluated. Results: This prospective cohort study included 175 pregnant women with PP who had delivered after PPAP scoring at Kobe University Hospital from January 2011 to June 2017. Twenty-four of them had PPAP score 8 or more. Twenty-one of the 24 actually had AP. However, two women with AP were overlooked at cut-off of 8. PPAP score yielded 91% sensitivity, 98% specificity, 88% positive predictive value, 99% negative predictive value, and 97% accuracy. In addition, it was also found that there was a modest positive association between PPAP score and the amount of intraoperative blood loss (r¼0.43, p<0.01). Conclusion: This prospective cohort study demonstrated that the PPAP scoring system may be useful for predicting AP complicated by PP. The higher PPAP score might be associated with an increased amount of intraoperative blood loss, regardless of the preoperative placement of IIAOBC.
23. A CASE OF PREGNANCY WITH PLACENTA PREVIA ACCRETA TERMINATED AT 16TH WEEKS OF GESTATION, AND PLACENTAL PROTEOMIC ANALYSIS Yoshinori Moriyama. Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Japan Introduction: Placenta accreta is one of fatal obstetric complications, while its pathophysiology remains unestablished, and prediction of its onset is usually difficult. We experienced a case of placenta previa accreta where we successfully suspected it, and performed placental proteomic analysis of the case. Case: The patient was a 40-year-old 3 gravida 3 para pregnant woman with a history of 2 prior Cesarean sections (CS). She was diagnosed with MD twin pregnancy at 14th weeks of gestation and referred to a general hospital. Just after that she had bloody vaginal discharge, and placenta previa accreta was suspected, so she was referred to our hospital. Her placenta was located on the scar of previous CS. Her situation was getting improved. However, placenta accreta was highly suspected, and her life could be