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Histological features of placenta diagnosed with twin anemia-polycythemia sequence
Abstracts / Placenta 35 (2014) A1eA23
Methods: BeWo choriocarcinoma cells were pretreated with Ca2+ channel blockers (nifedipine or verapamil), an inhibitor of Ca2+ release from endoplasmic reticulum (dantrolene), or a peptide ionophore that stimulates intracellular Ca2+ influx (alamethicin) for 1 h, and then incubated with dibutyryl cAMP for 48 h. The expression of hCG-alpha and beta subunits, cholesterol side-chain cleavage enzyme (P450scc), and 3-betahydroxysteroid dehydrogenase 1 (3-beta-HSD1) was analyzed by real-time RT-PCR. The level of hCG-beta protein in culture media was determined by immunoblotting. Results: Treatment with nifedipine, verapamil, or dantrolene significantly increased dibutyryl cAMP-stimulated hCG-alpha, hCG-beta, P450scc and 3-beta;-HSD1 expression as well as hCGb secretion. Conversely, treatment with alamethicin repressed dibutyryl cAMP-induced hCG-beta and 3-betaHSD1 expression and hCG-beta secretion. Conclusion: These results suggest that intracellular Ca2+ may negatively regulate cAMP-mediated hCG and P4 production in human trophoblasts.
O-065. HISTOLOGICAL FEATURES OF PLACENTA DIAGNOSED WITH TWIN ANEMIA-POLYCYTHEMIA SEQUENCE Makoto Takeuchi b, Keisuke Ishii a, Nobuaki Aki Mabuchi a, Mitsuda a. a Osaka Medical Center and Research Institute for Maternal and Child Health, Japan; b Osaka Medical Cener and Research Institute for Maternal and Child Health, Japans Objective: To evaluate the histological features of placenta diagnosed with twin anemia-polycythemia sequence (TAPS). Methods: This was a retrospective study of placenta diagnosed with TAPS delivered at our center between 2003 and 2013. Cases of abortion, acardiac twins, or intrauterine death were excluded in this study. According to postnatal criteria of TAPS described by E. Lopriore et al, cases were diagnosed with TAPS when the intertwin Hgb difference was above 8g/dl as well as the intertwin reticulocyte count ratio (RCR) was above 1.7. After delivery, all placentas were examined grossly and histologically. Placental injection with colored dye was performed to record the vascular anastomoses. Furthermore, two sections of placental membrane roll, umbilical cord, and at least two paracentral full-thickness chorionic disc sections were routinely obtained as a part of the placental examination. Result: During the study period, 469 out of a total of 575 MD twins born at our hospital were analyzed. There were 9 (1.9%) cases diagnosed with TAPS. The median gestational age at birth was 33 weeks (range, 23-38 weeks), and all cases were delivered by cesarean section (CS). The median birth weight of the recipient twin was 1894g (554-2820), whereas that of the donor twin was 1748g (424-2868). The maternal side of all placentas with TAPS showed a white pale part for the anemic twin and a congestive part for the polycythemic twin. In eight of nine cases (89%), minuscule arterio-venous (AV) anastomoses were present. Moreover, in eight of nine cases (89%), delayed villous maturation was seen in placenta of donor. No cases showed CAM. Conclusion: Although there were small number of cases with TAPS, placentas with TAPS were characterized by not only the placental difference in color but the delayed villous maturation of donor twin.
O-066. CASE OF FETOMATERNAL ERYTHROBLASTOSIS
HEMORRHAGE
WITH
PLACENTAL
Hisanobu Saakata a, Maki Inoue a, Takashi Kameda a, Takashi Minegishi a, Yu Hayashi b, Shinichi Shimizu c. a Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Japan; b Department of Pediatrics, Gunma University Graduate School of medicine, Japan; c Department of Diagnostic Pathology, Gunma University Graduate School of medicine, Japan Placental erythroblastosis suggests a response to fetal hypoxia or anemia due to various causes including fetomaternal hemorrhage (FMH). Case, A 36-yaer-old woman, gravid 1 para 1 was diagnosed as placenta previa
A17
and fetal growth restriction. She was referred to our hospital for diminished fetal movement at 36 weeks and 0 day of her pregnancy. Ultrasonography revealed elevated middle cerebral artery peak systolic velocity of the fetus. The CTG showed diminished variability. Emergency cesarean section was performed, and a female baby weighing 1602g was delivered with Apgar scores of 1 and 3 at 1 and 5 minutes, respectively. The infant presented severe edema and cardiomegaly, and had significant anemia with a hemoglobin level of 1.8g/dL. The level of hemoglobin F (HbF) in the maternal blood was 6.3% and was indicative of the presence of FMH. Microscopic examination of the placenta revealed erythroblastosis. Presence of severe edema and cardiomegaly of the infant and erythroblastosis of the placenta was thought to suggest chronic process of FHM.
O-067. A CASE OF PREGNANT WOMAN COMPLICATED WITH SLE AND PLACENTA INCREATA Yukiko Hazama a, Mika Sugihara a, Rikiya Sano b, Takahito Miyake a, Takuya Takuji Tomimatu a, Yuichiro Nakai a, Takafumi Murata a, Mitsuru Shiota b, Daisuke Yorimitsu c, Souhati Nakamura a, Fujimoto c, Naoki Kashihara c, Hirotake Nishimura d, Takuya Moriya e, Koichiro Shimoya a. a Department of Obstetrics and Gynecology 1 Kawasaki Medical School, Japan; b Department of Gynecologic Oncology, Kawasaki Medical School, Japan; c Department of Nephrology, Kawasaki Medical School, Japan; d Department of Pathology 1, Kawasaki Medical School, Japan; e Department of Pathology 2, Kawasaki Medical School, Japan € gren's synA 32-years-old nulligravid woman was diagnosed SLE and Sjo drome five years ago, and lupus nephritis was treated three years ago. She was treated with PSL (12.5mg). She became pregnant by IVF-ET and visited our hospital at 9 weeks and 6 days of gestation. She was treated by aspirin (100mg) since 11 gestational weeks. She suffered joint pain, worse photosensitivity and admitted to our hospital at 18 gestational weeks. She was treated by dose-up of PRL (12.5mg to 30mg). The fetal growth and amniotic fluid volume were normal. At 33 gestational weeks her platelet count and serum complement level were reduced and proteinuria became worse. She was treated by dose-up of PRL (30mg to 40mg). At 35 gestational weeks her blood pressure became 160/84 mmHg. She was terminated pregnancy at 35 gestational weeks. Despite of the administration of the maximum dose of oxytocin, the uterine contraction was not observed. We diagnosed the arrest of labor and performed the emergent cesarean section. Her baby was delivered without complication. The placenta accreta was suspected and we performed supra-cervical hysterectomy. The pathological analysis revealed the placenta increta. Previously eight cases of placenta accreta with pregnant women complicated with SLE were reported in Japan. Further studies would be necessary to investigate the association between the immunological aspects of SLE and the placental formation.
O-068. TARGETING IKKb SIGNALING PREVENTS PRETERM DELIVERY THROUGH INHIBITION OF INTERLEUKIN-6 PRODUCTION FROM AMNIOTIC MESENCHYMAL CELLS. Kenjiro Sawada a, Tomoyuki Fujikawa b, Kae Aska Toda a, a a a Hashimoto , Ikuko Sawada , Yasuto Kinose , Akiko Itai b, Tadashi Kimura a. a Department of Obstetrics and Gynecology, Osaka Graduate School of Medicine, Suita, Osaka, Japan; b IMMD Inc., Japan Background: Preterm delivery (PTD) remains a serious challenge in perinatology, as no effective therapy is available other than tocolytic agents; however, tocolysis with these agents is rarely successful beyond 24-48 hours and has not been shown to improve neonatal outcomes. Intrauterine infection and/or inflammation, represented by chorioamnionitis (CAM), is the most firmly established trigger of early PTD. Proinflammatory cytokines in response to bacteria or bacterial products (e.g., lipopolysaccharide (LPS)) are considered to play pivotal roles in the pathology of PTD. Among these cytokines, IL-6 is assumed to be a key player. In this study, we
Methods: BeWo choriocarcinoma cells were pretreated with Ca2+ channel blockers (nifedipine or verapamil), an inhibitor of Ca2+ release from endoplasmic reticulum (dantrolene), or a peptide ionophore that stimulates intracellular Ca2+ influx (alamethicin) for 1 h, and then incubated with dibutyryl cAMP for 48 h. The expression of hCG-alpha and beta subunits, cholesterol side-chain cleavage enzyme (P450scc), and 3-betahydroxysteroid dehydrogenase 1 (3-beta-HSD1) was analyzed by real-time RT-PCR. The level of hCG-beta protein in culture media was determined by immunoblotting. Results: Treatment with nifedipine, verapamil, or dantrolene significantly increased dibutyryl cAMP-stimulated hCG-alpha, hCG-beta, P450scc and 3-beta;-HSD1 expression as well as hCGb secretion. Conversely, treatment with alamethicin repressed dibutyryl cAMP-induced hCG-beta and 3-betaHSD1 expression and hCG-beta secretion. Conclusion: These results suggest that intracellular Ca2+ may negatively regulate cAMP-mediated hCG and P4 production in human trophoblasts.
O-065. HISTOLOGICAL FEATURES OF PLACENTA DIAGNOSED WITH TWIN ANEMIA-POLYCYTHEMIA SEQUENCE Makoto Takeuchi b, Keisuke Ishii a, Nobuaki Aki Mabuchi a, Mitsuda a. a Osaka Medical Center and Research Institute for Maternal and Child Health, Japan; b Osaka Medical Cener and Research Institute for Maternal and Child Health, Japans Objective: To evaluate the histological features of placenta diagnosed with twin anemia-polycythemia sequence (TAPS). Methods: This was a retrospective study of placenta diagnosed with TAPS delivered at our center between 2003 and 2013. Cases of abortion, acardiac twins, or intrauterine death were excluded in this study. According to postnatal criteria of TAPS described by E. Lopriore et al, cases were diagnosed with TAPS when the intertwin Hgb difference was above 8g/dl as well as the intertwin reticulocyte count ratio (RCR) was above 1.7. After delivery, all placentas were examined grossly and histologically. Placental injection with colored dye was performed to record the vascular anastomoses. Furthermore, two sections of placental membrane roll, umbilical cord, and at least two paracentral full-thickness chorionic disc sections were routinely obtained as a part of the placental examination. Result: During the study period, 469 out of a total of 575 MD twins born at our hospital were analyzed. There were 9 (1.9%) cases diagnosed with TAPS. The median gestational age at birth was 33 weeks (range, 23-38 weeks), and all cases were delivered by cesarean section (CS). The median birth weight of the recipient twin was 1894g (554-2820), whereas that of the donor twin was 1748g (424-2868). The maternal side of all placentas with TAPS showed a white pale part for the anemic twin and a congestive part for the polycythemic twin. In eight of nine cases (89%), minuscule arterio-venous (AV) anastomoses were present. Moreover, in eight of nine cases (89%), delayed villous maturation was seen in placenta of donor. No cases showed CAM. Conclusion: Although there were small number of cases with TAPS, placentas with TAPS were characterized by not only the placental difference in color but the delayed villous maturation of donor twin.
O-066. CASE OF FETOMATERNAL ERYTHROBLASTOSIS
HEMORRHAGE
WITH
PLACENTAL
Hisanobu Saakata a, Maki Inoue a, Takashi Kameda a, Takashi Minegishi a, Yu Hayashi b, Shinichi Shimizu c. a Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Japan; b Department of Pediatrics, Gunma University Graduate School of medicine, Japan; c Department of Diagnostic Pathology, Gunma University Graduate School of medicine, Japan Placental erythroblastosis suggests a response to fetal hypoxia or anemia due to various causes including fetomaternal hemorrhage (FMH). Case, A 36-yaer-old woman, gravid 1 para 1 was diagnosed as placenta previa
A17
and fetal growth restriction. She was referred to our hospital for diminished fetal movement at 36 weeks and 0 day of her pregnancy. Ultrasonography revealed elevated middle cerebral artery peak systolic velocity of the fetus. The CTG showed diminished variability. Emergency cesarean section was performed, and a female baby weighing 1602g was delivered with Apgar scores of 1 and 3 at 1 and 5 minutes, respectively. The infant presented severe edema and cardiomegaly, and had significant anemia with a hemoglobin level of 1.8g/dL. The level of hemoglobin F (HbF) in the maternal blood was 6.3% and was indicative of the presence of FMH. Microscopic examination of the placenta revealed erythroblastosis. Presence of severe edema and cardiomegaly of the infant and erythroblastosis of the placenta was thought to suggest chronic process of FHM.
O-067. A CASE OF PREGNANT WOMAN COMPLICATED WITH SLE AND PLACENTA INCREATA Yukiko Hazama a, Mika Sugihara a, Rikiya Sano b, Takahito Miyake a, Takuya Takuji Tomimatu a, Yuichiro Nakai a, Takafumi Murata a, Mitsuru Shiota b, Daisuke Yorimitsu c, Souhati Nakamura a, Fujimoto c, Naoki Kashihara c, Hirotake Nishimura d, Takuya Moriya e, Koichiro Shimoya a. a Department of Obstetrics and Gynecology 1 Kawasaki Medical School, Japan; b Department of Gynecologic Oncology, Kawasaki Medical School, Japan; c Department of Nephrology, Kawasaki Medical School, Japan; d Department of Pathology 1, Kawasaki Medical School, Japan; e Department of Pathology 2, Kawasaki Medical School, Japan € gren's synA 32-years-old nulligravid woman was diagnosed SLE and Sjo drome five years ago, and lupus nephritis was treated three years ago. She was treated with PSL (12.5mg). She became pregnant by IVF-ET and visited our hospital at 9 weeks and 6 days of gestation. She was treated by aspirin (100mg) since 11 gestational weeks. She suffered joint pain, worse photosensitivity and admitted to our hospital at 18 gestational weeks. She was treated by dose-up of PRL (12.5mg to 30mg). The fetal growth and amniotic fluid volume were normal. At 33 gestational weeks her platelet count and serum complement level were reduced and proteinuria became worse. She was treated by dose-up of PRL (30mg to 40mg). At 35 gestational weeks her blood pressure became 160/84 mmHg. She was terminated pregnancy at 35 gestational weeks. Despite of the administration of the maximum dose of oxytocin, the uterine contraction was not observed. We diagnosed the arrest of labor and performed the emergent cesarean section. Her baby was delivered without complication. The placenta accreta was suspected and we performed supra-cervical hysterectomy. The pathological analysis revealed the placenta increta. Previously eight cases of placenta accreta with pregnant women complicated with SLE were reported in Japan. Further studies would be necessary to investigate the association between the immunological aspects of SLE and the placental formation.
O-068. TARGETING IKKb SIGNALING PREVENTS PRETERM DELIVERY THROUGH INHIBITION OF INTERLEUKIN-6 PRODUCTION FROM AMNIOTIC MESENCHYMAL CELLS. Kenjiro Sawada a, Tomoyuki Fujikawa b, Kae Aska Toda a, a a a Hashimoto , Ikuko Sawada , Yasuto Kinose , Akiko Itai b, Tadashi Kimura a. a Department of Obstetrics and Gynecology, Osaka Graduate School of Medicine, Suita, Osaka, Japan; b IMMD Inc., Japan Background: Preterm delivery (PTD) remains a serious challenge in perinatology, as no effective therapy is available other than tocolytic agents; however, tocolysis with these agents is rarely successful beyond 24-48 hours and has not been shown to improve neonatal outcomes. Intrauterine infection and/or inflammation, represented by chorioamnionitis (CAM), is the most firmly established trigger of early PTD. Proinflammatory cytokines in response to bacteria or bacterial products (e.g., lipopolysaccharide (LPS)) are considered to play pivotal roles in the pathology of PTD. Among these cytokines, IL-6 is assumed to be a key player. In this study, we