Cardiopulmonary Collapse during Labour

Cardiopulmonary collapse during labour is a catastrophic event caused by various medical, surgical and obstetrical conditions. It is an emergency that threatens the life of the mother and her unborn child. We present a case of a pregnant woman who suffered from preeclampsia and underwent induction of labour. Severe lung edema occurred early in labour that caused cardiopulmonary collapse. Advanced heart-lung resuscitation was established immediately and continued until an emergency cesarean section was performed few minutes later. The outcome was favourable for both mother and child. We further discuss some aspects of the pathophysiology and appropriate treatment of cardiorespiratory arrest during labour, which involves the coordinated action of the obstetric, pediatric and surgical ward personnel

Laeverin Protein Expression in Normal and Preeclamptic Placentas using Tissue Microarray Analysis

This is the peer reviewed version of the following article: Nystad, M., Sitras, V.S., Nordbakken, C., Pedersen, M.I. & Acharya, G. (2018). Laeverin Protein Expression in Normal and Preeclamptic Placentas using Tissue Microarray Analysis. Acta Obstetricia et Gynecologica Scandinavica, 97(5), 536-544, which has been published in final form at https://doi.org/10.1111/aogs.13304. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Introduction - Laeverin is a placenta‐specific protein that is normally expressed in the plasma membrane of human trophoblasts. In previous studies, we showed higher expression levels of laeverin gene in preeclamptic compared with normal placentas and found that laeverin protein was ectopically expressed in the cytoplasm of the preeclamptic placentas. Our objective was to investigate laeverin protein expression in normal and preeclamptic placentas combining immunohistochemistry and immunofluorescence. Material and methods - Tissue microarray analysis of 72 placentas, obtained from 33 preeclamptic and 39 uncomplicated pregnancies, was performed. Laeverin was labeled with a specific antibody for immunohistochemistry and immunofluorescence studies. Results - Immunohistochemistry showed that laeverin was expressed in syncytiotrophoblasts, cytotrophoblasts and extravillous trophoblasts in all placentas examined. In preeclamptic placentas (n = 33) compared with normal placentas (n = 39), laeverin was expressed in the cell membrane in 21 (64%) vs. 21 (54%) samples (p = 0.726), in the cytoplasm in 3 (9%) vs. 2 (5%) samples (p = 0.795) and in both the cytoplasm and membrane in 9 (27%) vs. 16 (41%) samples (p = 0.0522). All placental samples that showed cytoplasmic expression of laeverin were obtained from women who delivered before 34 weeks of gestation (early‐onset preeclampsia). Further, immunofluorescence studies showed laeverin expression in the cytoplasm of six preeclamptic (three early‐onset and three late‐onset) and one normal placenta but did not reveal any simultaneous cell membrane and cytoplasmic expression of laeverin. Conclusion - Laeverin is expressed in all trophoblast cell types of normal and preeclamptic placentas. Expression pattern of laeverin in trophoblast cells is heterogeneous and not necessarily membrane‐bound

Paraoxonase 2 protein is spatially expressed in the human placenta and selectively reduced in labour

Humans parturition involves interaction of hormonal, neurological, mechanical stretch and inflammatory pathways and the placenta plays a crucial role. The paraoxonases (PONs 1–3) protect against oxidative damage and lipid peroxidation, modulation of endoplasmic reticulum stress and regulation of apoptosis. Nothing is known about the role of PON2 in the placenta and labour. Since PON2 plays a role in oxidative stress and inflammation, both features of labour, we hypothesised that placental PON2 expression would alter during labour. PON2 was examined in placentas obtained from women who delivered by cesarean section and were not in labour and compared to the equivalent zone of placentas obtained from women who delivered vaginally following an uncomplicated labour. Samples were obtained from 12 sites within each placenta: 4 equally spaced apart pieces were sampled from the inner, middle and outer placental regions. PON2 expression was investigated by Western blotting and real time PCR. Two PON2 forms, one at 62 kDa and one at 43 kDa were found in all samples. No difference in protein expression of either isoform was found between the three sites in either the labour or non-labour group. At the middle site there was a highly significant decrease in PON2 expression in the labour group when compared to the non-labour group for both the 62 kDa form (p = 0.02) and the 43 kDa form (p = 0.006). No spatial differences were found within placentas at the mRNA level in either labour or non-labour. There was, paradoxically, an increase in PON2 mRNA in the labour group at the middle site only. This is the first report to describe changes in PON2 in the placenta in labour. The physiological and pathological significance of these remains to be elucidated but since PON2 is anti-inflammatory further studies are warranted to understand its role

Differences in Gene Expression between First and Third Trimester Human Placenta: A Microarray Study

BACKGROUND: The human placenta is a rapidly developing organ that undergoes structural and functional changes throughout the pregnancy. Our objectives were to investigate the differences in global gene expression profile, the expression of imprinted genes and the effect of smoking in first and third trimester normal human placentas. MATERIALS AND METHODS: Placental samples were collected from 21 women with uncomplicated pregnancies delivered at term and 16 healthy women undergoing termination of pregnancy at 9-12 weeks gestation. Placental gene expression profile was evaluated by Human Genome Survey Microarray v.2.0 (Applied Biosystems) and real-time polymerase chain reaction. RESULTS: Almost 25% of the genes spotted on the array (n = 7519) were differentially expressed between first and third trimester placentas. Genes regulating biological processes involved in cell proliferation, cell differentiation and angiogenesis were up-regulated in the first trimester; whereas cell surface receptor mediated signal transduction, G-protein mediated signalling, ion transport, neuronal activities and chemosensory perception were up-regulated in the third trimester. Pathway analysis showed that brain and placenta might share common developmental routes. Principal component analysis based on the expression of 17 imprinted genes showed a clear separation of first and third trimester placentas, indicating that epigenetic modifications occur throughout pregnancy. In smokers, a set of genes encoding oxidoreductases were differentially expressed in both trimesters. CONCLUSIONS: Differences in global gene expression profile between first and third trimester human placenta reflect temporal changes in placental structure and function. Epigenetic rearrangements in the human placenta seem to occur across gestation, indicating the importance of environmental influence in the developing feto-placental unit

Placental Protein 13 (PP13) – a placental immunoregulatory galectin protecting pregnancy

Galectins are glycan-binding proteins that regulate innate and adaptive immune responses, and some confer maternal-fetal immune tolerance in eutherian mammals. A chromosome 19 cluster of galectins has emerged in anthropoid primates, species with deep placentation and long gestation. Three of the five human cluster galectins are solely expressed in the placenta, where they may confer additional immunoregulatory functions to enable deep placentation. One of these is galectin-13, also known as Placental Protein 13 (PP13). It has a jelly-roll fold, carbohydrate-recognition domain and sugar-binding preference resembling to other mammalian galectins. PP13 is predominantly expressed by the syncytiotrophoblast and released from the placenta into the maternal circulation. Its ability to induce apoptosis of activated T cells in vitro, and to divert and kill T cells as well as macrophages in the maternal decidua in situ suggests important immune functions. Indeed, mutations in the promoter and an exon of LGALS13 presumably leading to altered or non-functional protein expression are associated with a higher frequency of preeclampsia and other obstetrical syndromes, which involve immune dysregulation. Moreover, decreased placental expression of PP13 and its low first trimester maternal serum concentrations are associated with elevated risk of preeclampsia. Indeed, PP13 turned to be a good early biomarker to assess maternal risk for the subsequent development of pregnancy complications caused by impaired placentation. Due to the ischemic placental stress in preterm preeclampsia, there is an increased trophoblastic shedding of PP13 immunopositive microvesicles starting in the second trimester, which leads to high maternal blood PP13 concentrations. Our meta-analysis suggests that this phenomenon may enable the potential use of PP13 in directing patient management near to or at the time of delivery. Recent findings on the beneficial effects of PP13 on decreasing blood pressure d

Gene expression profile of normal and compromised placentas

Objective Placenta has an important function of sustaining life in utero. Role of placental gene expression in the physiology of parturition and pathogenesis of pregnancy disorders are poorly understood. The aims of this thesis were to: 1. Investigate the effect of labor on global gene expression profile of normal placentas 2. Compare placental gene expression profile of uncomplicated pregnancies with that of pregnancies complicated by severe preeclampsia and intrauterine growth restriction (IUGR) Materials and Methods Hemodynamic assessment of the maternal uterine and feto-placental circulations was performed ≤72 hours before delivery using Doppler ultrasonography. Global gene expression profile was investigated using microarrays in placental samples collected after delivery from women with normal pregnancies (n=34), and pregnancies complicated by preeclampsia (n=16) and IUGR (n=8). The effect of parturition on gene expression was studied comparing placentas obtained from healthy women after normal delivery (n=17) with placentas obtained from women delivered by elective cesarean section (n=17). Placental gene expression profiles of women with severe preeclampsia (i.e. BP≥160/110 mmHg and proteinuria ≥2+ in dipstick) and IUGR due to placental insufficiency (i.e. estimated fetal weight <5th percentile for the gestational age with hemodynamic signs of redistribution of blood flow to the fetal brain) were compared with healthy controls. Microarray results were validated at the transcript and protein level by real-time reverse-transcriptase polymerase chain reaction (RT-PCR), placental immunofluorescence and urinary electrochemiluminescence immunoassay. Results Gene expression profile was similar in healthy placentas obtained following normal delivery and elective cesarean section. Placental genes were differentially expressed in preeclampsia and IUGR compared to normal controls indicating a central role of the placenta in the pathogenesis of these pregnancy-specific disorders. In particular, 16 genes were able to differentiate preeclamptic from normal placentas in our samples after supervised clustering. Several known (leptin, Flt-1, endoglin) and some novel genes (laeverin) and pathways (angiogenesis, hypoxia, Alzheimer, Notch) were found to be involved in the pathogenesis of preeclampsia. Subgroup analysis comparing early- (i.e. ≤34 weeks) with late-onset preeclamptic placentas showed different genetic signatures with oxidative stress, inflammation and endothelin signaling pathways mainly involved in early-onset disease. In IUGR, genes involved in glucocorticoid-metabolism and inflammation mediated by chemokine and cytokine signaling pathway were differentially expressed compared with controls. None of the known imprinted placental genes were differentially expressed. Conclusion Labor does not significantly alter the global gene expression profile in near term placenta. Placental gene expression profile is altered in severe preeclampsia and IUGR. Early-onset preeclampsia has a different genetic signature compared with late-onset preeclampsia supporting the possibility of different pathogeneses. Genes involved in inflammatory pathways are up-regulated both in early-onset preeclampsia as well as in IUGR, indicating that they might share common pathogenetic features

Obstetric and psychological characteristics of women choosing epidural analgesia during labour: A cohort study

Objectives: To investigate the obstetric and psychological characteristics of women who opt to use epidural analgesia (EDA) during labour and the impact of participating in labour preparation courses on women’s decisions to use EDA. Methods: Data were collected using two self-completed questionnaires at pregnancy weeks 17 and 32. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and depression by the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and socio-demographic information was retrieved from birth records at the maternity ward. Main outcome measure: Preference for EDA was indicated by the questionnaire item “I would prefer an epidural regardless” on a 4-point scale (1 = highly agree, 4 = highly disagree) at pregnancy week 32. Results: Twenty-one percent of the women (540/2596) answered that they would choose EDA as the only alternative method of analgesia during labour. Counselling for fear of childbirth [OR 3.23 (95%CI 2.12; 4.92)] and W-DEQ sum score ≥ 85 [OR 2.95 (95%CI 2.06; 4.23)] were significantly (p<0.001) associated with choice of EDA. Participation in labour preparation courses was significantly (p = 0.008) associated with a reduction of intended use of EDA during labour [OR 0.67 (95%CI 0.49; 0.90)]. Conclusion: Fear of childbirth is significantly associated with women’s choice of EDA during labour. On the other hand, women that participate in labour preparation courses would rather consider other methods of analgesia during labour