In-vitro study of the effect of anti-hypertensive drugs on placental hormones and angiogenic proteins synthesis in pre-eclampsia

Antihypertensive drugs lower the maternal blood pressure in pre-eclampsia (PE) by direct or central vasodilatory mechanisms but little is known about the direct effects of these drugs on placental functions

Pro- and anti-inflammatory cytokines in threatened miscarriages

OBJECTIVE: The purpose of this study was to evaluate circulating and intracellular levels of Th1 and Th2 cytokines in women with threatenedmiscarriage (TM) and subsequent outcome. STUDY DESIGN: Plasma levels of tumor necrosis factor (TNF)-receptors 1 and 2, TNF , interferon gamma (IFN ), and interleukins (IL) -6 and -10 were measured by flow cytometric bead assays in 80 women with TM: 53 women with normal outcome and 27 women who miscarried. Fluorescent antibody labeling was also performed on whole blood in a subgroup of 27 women of TM: 16 women with normal outcome and 11 women who miscarried. RESULTS: Monocyte expression of TNF and circulating levels of TNF , IFN , IL-10, IL-6, and TNF-R1 were significantly lower, whereas circulating levels of TNF /IL-10, IFN /IL-10, and TNF /IL-6 ratios were significantly higher, in women with TM who subsequently miscarried, compared with the women with normal outcome. CONCLUSION: An increased Th1 type of immune response, which was similar to that observed in preterm delivery, was found in TM cases that were complicated by a subsequent miscarriage.peer-reviewe

Ultrasound and endocrinological markers of first trimester placentation and subsequent fetal size

INTRODUCTION: To study the relationship between 2-dimensional placental ultrasound measurements and maternal serum (MS) levels of biomarkers of placentation and in pregnancies presenting with an isolated abnormally high or low birthweight at term, without evidence of placental insufficiency. METHOD: We performed a population based cohort study of 306 pregnancies delivered at term including 30 presenting with large-for-gestational age (LGA, birthweight > 90th centile) and 17 small-for-gestational age (SGA; birthweight < 10th centile). Antenatal measurements included placental thickness and 2D-volume and MS levels of pregnancy-associated plasma protein A (PAPP-A) and free-beta human chorionic gonadotrophin (fβhCG) at 11-13(+6) weeks of gestation and mid-trimester MS α-fetoprotein (AFP), unconjugated estriol (uE3) and inhibin A levels. RESULTS: In the subgroup with a normal birthweight (10th-90th centile), there was a significant positive correlation between birthweight and the basal plate surface area (p < 0.001) and 2D placental volume (p < 0.01). In the LGA subgroup, MS PAPP-A was significantly (p < 0.05) higher than in normal controls and there was a significant (p < 0.01) positive correlation with birthweight. There was no significant difference for any of the ultrasound and biomarkers parameters between SGA and the normally grown controls. DISCUSSION: In uncomplicated singleton pregnancies with a normal birthweight, 2D measurements of placentation are related with fetal size but are not related to subsequent excessive or slow fetal growth. LGA at birth is associated with increased MS PAPP-A at 11-14 weeks of gestation supporting the association between PAPP-A synthesis and early placental growth and development

Pathologie des infections par les morbillivirus chez les mammifères marins

Morbillivirus infections were described since 1988 in marine mammals including pinnipeds and cetaceans. Since, numerous outbreaks, responsible for thousands marine mammals death, as well as sporadic cases, have occurred in various populations from North Atlantic, Mediterranean Sea, Baikal Lake, Caspian Sea, and recently from northern Pacific. Clinical signs and macroscopic lesions are similar between species infected by morbillivirus and are close to those reported in dog with canine distemper. Under microscope, characteristic les ions are interstitial bronchopneumonia, lymphoid depletion and subacute encephalitis. Syncytia and inclusion bodies are frequently observed in lesions and epithelia. Lymphoid depletion promotes secondary infections by opportunistic pathogens, responsible in many cases of the animals death. Various parameters explain the high sensibility of certain population such as the species, the naive immunological status and vectors intervention for the disease

Rethinking Prenatal Screening for Anomalies of Placental and Umbilical Cord Implantation

The most common anomalies of implantation of the placenta and umbilical cord include placenta previa, placenta accreta spectrum, and vasa previa, and are associated with considerable perinatal and maternal morbidity and mortality. There is moderate quality evidence that prenatal diagnosis of these conditions improves perinatal outcomes and the performance of ultrasound imaging in diagnosing them is considered excellent. The epidemiology of placenta previa is well known, and it is standard clinical practice to assess placental location at the routine screening second-trimester detailed fetal anatomy ultrasound examination. In contrast, the prevalence of placenta accreta spectrum and vasa previa in the general population is more difficult to evaluate because detailed confirmatory histopathologic data are not available in most studies. The sensitivity and specificity of ultrasonography for the diagnosis of these anomalies is also difficult to assess. Recent epidemiologic studies show an increase in the incidence of placental and umbilical cord implantation anomalies, which may be the result of increased use of assisted reproductive technology and cesarean delivery. There is good evidence to support targeted standardized protocols for women at high risk and that screening and diagnosing placenta accreta spectrum and vasa previa should be integrated into obstetric ultrasound training programs

The cytotrophoblastic shell and complications of pregnancy

Many complications of pregnancy have their pathophysiological roots in the early stages of placentation. Impaired trophoblast invasion and deficient remodelling of the maternal spiral arteries are a common feature. While malperfusion of the placenta may underpin cases of fetal growth restriction and early-onset pre-eclampsia, the mechanistic links to spontaneous miscarriage, pre-term labour and premature rupture of the membranes are less obvious. Here, we speculate that formation of a well-developed cytotrophoblastic shell at the maternal-fetal interface is crucial for pregnancy success. Initially, extravillous trophoblast cells differentiate from the outer layer of the shell in contact with the endometrium. Impaired development may thus contribute to reduced invasion and deficient remodelling. In addition, the extent of the shell influences the timing and spatial configuration of onset of the maternal arterial circulation. A thin and fragmentary shell results in premature and disorganised onset, leading to spontaneous miscarriage. In less severe cases it may predispose to haemorrhage at the interface and formation of intrauterine haematomas. If pregnancy continues, these haematomas may act as a source of oxidative stress, promoting senescence and weakening of the membranes, and stimulating inflammation in the uterine wall and premature contractions. Formation of the shell is dependent on proliferation of cytotrophoblast progenitor cells during the first weeks after implantation, when the developing placenta is supported by histotrophic nutrition from endometrial glands. Hence, we propose the fitness of the endometrium prior to conception, and the peri-conceptional dialogue between the endometrium and the trophoblast is critical for avoidance of later complications of pregnancy.The Global Pregnancy Collaboration is part of the Pre-eclampsia-Eclampsia Monitoring, Prevention & Treatment (PRE-EMPT) initiative funded by the University of British Columbia, a grantee of the Bill & Melinda Gates Foundation