Abstracts / Placenta 35 (2014) A1eA23
Material and Method: I examined 47 MD twin placenta cases using an injection method, in which I injected white colored dye through the artery of the smaller baby into the placental surface. And I injected black ink through the veins of the bigger baby into the placental surface. Plus I examined them under the microscope. Results: There were 12 cases in which the difference between the two baby’s weights was greater than 25%. In 10 of those 12 cases, the babies’ umbilical cord insertion was velamentaous or marginal. From the 49 MD cases, there were 4 cases of TTTS and 2 cases of FLP (fetoscopic laser coagulation). All TTTS cases had artery to artery anastomosis. Discussion: My research showed MD twins present 2 potential problems, and here I offer 2 possible solutions. The weight difference between MD twins is well known. My research showed the cause is umbilical cord insertion. So this needs to be checked during pregnancy by ultrasound. All TTTS cases have anastomosis. FLP that blocks blood flow, is effective for TTTS. However, my research number is small. I intend to continue this placental examination. I only examined a relatively small number of cases. We need to continue this method of placenta examinations.
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pregnant woman. 28 years old. Untreated diabetes mellitus. Restroom delivery. She was admitted to our hospital. Unfortunately, the baby was small for gestational dates and was admitted to GCU. The placenta had ischemic villi and stem villous vascular lesions. Case 2 was also an unexamined pregnant woman. The baby was born at home. The baby was born around the 37th week of gestation. The baby had a GBS meningitis. The placenta examination showed high grade CAM with GBS. Conclusion: The ability of doctors to help these mothers is complicated by the fact that unexamined pregnant women do not accurately know their week of gestation and we have no prior medical history for either the mother or baby. My placenta examination showed that this group of mothers is more susceptible to complications during pregnancy. Going forward we need to think about education and support for the mother, along with greater communication between hospitals. My placental examination showed vascular lesions from Case 1, and GBS infection from Case 2.
O-090. PLACENTA PATHOLOGY AND BIRTH ASPHYXIA O-088. THE CAUSES OF GESTATIONAL DIABETES AND PLACENTAL PATHOLOGY Masayoshi Arizawa. Tokyo Metropolitan Ohtsuka Hospital Department of Laboratory Medicine, Japan Purpose: It is said that most gestational diabetes (GDM) is an indicator of diabetes (DM) or impaired glucose tolerance (IGT). If a woman shows GDM, this is usually considered to be an indicator of future DM. I often think that there may be other causes when I examine placenta under the microscope. The reason is because the number of VUE (villitis of unknown etiology) at onset of GDM is double the usual rate. As for the onset of VUE, this is caused by the immunological problems or the possibility of an unknown viral infection. Both are possible. An antiGAD antibody is known, and the onset of DM develops in some kind of antigen-antibody reaction in pancreas. I examined many cases this time and I clarified placenta pathology of GDM, how it relate to VUE. Method: The definition of GDM is one point or more over 92 mg/dL, 180 mg/dL and 153mg/dL of the blood glucose levels at 0, 60 and 120 minutes after 75g glucose load. Result: Using this new definition, I found 170 GDM cases from lab data and clinical records. I reexamined 170 placentas under microscope. There were 15 cases of VUE (8.8%). Consideration: In our hospital, the rate of VUE is 4-5% from all placental examinations. The rate of VUE with GDM is around double. There is the possibility that some GDM is rerated to virus infection and immunological problems. It is well known that some DM is rerated to anti-GAD antibody and pancreatitis or by some virus. I predicted that some GDM is caused by the VUE related to virus and immunologic reaction. I examined over 250 cases to check my prediction and I clarified the placental pathology of GDM and tried to establish the relation between GDM and VUE.
Masayoshi Arizawa. Tokyo Metropolitan Ohtsuka Hospital Department of Laboratory Medicine, Japan Purpose: Birth asphyxia is a big problem for both mother and newborn. It is caused by intrauterine lack of oxygen before delivery. In this study I will examine how placental pathological problems relate to birth asphyxia. And also the relationship between birth asphyxia and fetal cardiac monitoring during labor. Method: I examined 20 normal cases from no risk selective cesarean sections. And I examined 100 placentas from emergency cesarean sections prompted by Non reassuring fetal status (NRFS) diagnosed by monitor. I selected birth asphyxia cases from 100 cesarean sections. Results: Out of 20 normal cases, just 2 cases presented slight chorioamnionitis (CAM). From 100 emergency caesarian section cases, 17 were complicated with ischemic villi, 14 with CAM, and 8 with VUE. There were 16 cases of abruptio placentae, however these were maternal floor disease and not within this study. Out of 39 cases with CAM or ischemic villi or VUE, there were 11 birth aspixia cases. 9 cases had vasculer problems such as fibrin cushion, occlusion, recanalization and hemorrhagic endovasculitis of the stem villous vessels. Discussion: The NRFS and neonatal asphyxia caused by Abruptio, villous ischemia, CAM, and VUE were totally as expected. In contrast to NRFS without Birth asphyxia, which mostly showed variable deceleration and late deceleration only, NRFS with birth asphyxia mostly showed prolonged deceleration and loss of variability. In terms of pathological pictures NRFS without birth asphyxia showed slight ischemic villi or slight CAM, whereas NRFS with birth asphyxia mostly showed severe ischemic villi and CAM with stem villous vascular lesions. Before birth, the clinical perspective focuses on the fetal cardiac monitor. On the other hand, the pathological concern is, with stem villous vessel problems. Ideally stem villi vessel problems should be identified before labor. If we are aware of this fact, rats of birth asphyxia will diminish.
O-089. PLACENTA OF UNEXAMINED PREGNANT WOMEN Masayoshi Arizawa. Tokyo Metropolitan Ohtsuka Hospital Department of Laboratory Medicine, Japan
O-092. PROSPECTIVE RISK OF STILLBIRTH IN WOMEN WITH PLACENTAL MESENCHYMAL DYSPLASIA
Purpose: On December 27, 2011, the Tokyo Metropolitan Bureau of social welfare and public health reported to us that 1 in 4 unexamined pregnant women delivered small babies. In addition, approximately 40% of those babies were admitted to NICU or GCU. In this article I examine the placenta of unexamined pregnant women to try to discover other issues which we are unaware of. Material: There were 25 cases requests for placenta examination for unexamined pregnant women.
Satoshi Ishikawa, Takahiro Yamada, Takeshi Umadume, Koyama, Rina Akaishi, Mamoru Morikawa, Minakami. Department of Obstetrics, Hokkaido University, Japan
Takahiro Hisanori
Results: Out of the 25 cases, 8 had chorioamnionitis (CAM), 4 had immature villi, and 6 had meconium stain. This paper details two cases of typical unexamined pregnant women. Case 1 was an unexamined
Methods: We reviewed the outcomes of 109 PMD pregnancies with gestational week (GW). 24 abstracted from 63 reports in the English literature, including 2 cases that we encountered recently. The prospective
Purpose: To provide better counsel to pregnant women who are suspected to have placental mesenchymal dysplasia (PMD) regarding the risks of preterm birth and intrauterine foetal death (IUFD).