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SUMMARY OBJECTIVE: Fetal vascular malperfusion is associated with poor perinatal outcomes in women with preeclampsia and gestational diabetes mellitus. The aim of this study was to determine the association between fetal vascular malperfusion score and syncytiotrophoblast basement membrane thickness and clinicopathological variables, such as developing preeclampsia in women with gestational diabetes mellitus. METHODS: This retrospective cohort study included 65 pregnant participants (34 with gestational diabetes mellitus and 31 controls) between January 2019 and January 2022. Gestational diabetes mellitus was diagnosed as ≥2 of 4 elevated values on a 3-h, 100-g oral glucose tolerance test. The fetal vascular malperfusion score was evaluated by endothelial CD34 positivity in the villous stroma of the placenta. The association between fetal vascular malperfusion score and syncytiotrophoblast basement membrane thickness with clinicopathological variables in women with gestational diabetes mellitus was evaluated. RESULTS: It was revealed that the gestational diabetes mellitus group had greater fetal vascular malperfusion scores than the control group (gestational diabetes mellitus group fetal vascular malperfusion score: 34.2±9.1 and control group fetal vascular malperfusion score: 26.5±8.7, respectively, p=0.0009). Syncytiotrophoblast basement membrane thickness was correlated with the development of preeclampsia, trophoblast proliferation, and fetal vascular malperfusions (0.3952, p=0.0129; 0.3487, p=0.0211; and 0.4331, p=0.0082, respectively). On the contrary, fetal vascular malperfusions were correlated with the development of preeclampsia, villous edema, and trophoblast proliferation (0.3154, p=0.0343; 0.2922, p=0.4123; and 0.3142, p=0.0355, respectively). CONCLUSION: The gestational diabetes mellitus group displayed significantly higher fetal vascular malperfusion scores and thickening of the syncytiotrophoblast basement membrane than the control group. There is a correlation between developing preeclampsia and the fetal vascular malperfusion scores and the syncytiotrophoblast basement membrane thickness.

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Objetivo. Evaluar la asociación del higroma quístico retronucal (HQR) y anomalías cromosómicas fetales. Métodos. Estudio observacional retrospectivo de 323 fetos del primer trimestre con riesgo para anomalías cromosómicas diagnosticados por ecografía entre las 11 y 13,6 semanas. Resultados. De 323 fetos con riesgo para anomalías cromosómicas, se encontró 132 casos de anomalías cromosómicas (40,9%). Se identificaron 145 casos de HQR; en 64 (56,6%) se realizó biopsia de vellosidades coriales y en 81 (43,5%) amniocentesis, hallándose cariotipo anómalo en 82 (56,6%). De 88 fetos con HQR aislado, 33 casos (37,5%) tuvieron alguna anomalía cromosómica; en 58 fetos con HQR asociado a otros hallazgos anormales, se encontró que en 43 fetos (74,1%) hubo anomalías cromosómicas, y de ellos 24 (41,4%) tenían onda de flujo (OVF) anormal del ductus venoso, 17 (29,3%) tenían edema generalizado, 8 casos (13,8%) con cardiopatía, 7 (12,1%) ausencia del hueso nasal. Los valores predictivos del HQR fueron: sensibilidad (S) 62,1%, especificidad (E) 67%, valor predictivo positivo (VPP) 56,6%, valor predictivo negativo (VPN) 71,9%, p<0,001, OR: 3,3. El HQR asociado a otros hallazgos anormales, tuvo los siguientes valores predictivos: S 52,4%, E 76,2%, VPP 76,2%, OR: 3,5, LR+: 2,2, p<0,000. El edema generalizado y el ductus venoso anormal tuvieron los valores predictivos más altos: VPP 88,2% y 83,3%, respectivamente. Las anomalías cromosómicas encontradas con mayor frecuencia fueron: T21 (53,7%), monosomía X (18,3%), T18 (15,9%), T13 (6,1%). Conclusiones. El higroma quístico retronucal es un marcador de riesgo con alto valor predictivo para anomalías cromosómicas, siendo mayor cuando está asociado a otros hallazgos ecográficos anormales. La identificación ecográfica del HQR en el tamizaje prenatal del primer trimestre debería ser indicación para recomendar una prueba diagnóstica para anomalías cromosómicas.

Objective: To evaluate the association of retronucal cystic hygroma (RCH) and fetal chromosomal abnormalities. Methods: Retrospective observational study of 323 first trimester fetuses at risk for chromosomal abnormalities diagnosed by ultrasound between 11 and 13.6 weeks. Results: Of 323 fetuses at risk for chromosomal abnormalities, 132 cases of chromosomal abnormalities were found (40.9%). A total of 145 cases of RCH were identified; chorionic villus biopsy was performed in 64 (56.6%) and amniocentesis in 81 (43.5%); an abnormal karyotype was found in 82 (56.6%). Of 88 fetuses with isolated RCH, 33 (37.5%) had some chromosomal abnormality. In 58 fetuses with RCH associated with other abnormal findings, chromosomal abnormalities were found in 43 fetuses (74.1%) and of these 24 (41.4%) had abnormal ductus venosus flow wave (DVF), 17 (29.3%) had generalized edema, 8 cases (13.8%) with cardiopathy, 7 (12,1%) with absent nasal bone. The predictive values of RCH were sensitivity (S) 62.1%, specificity (Sp) 67%, positive predictive value (PPV) 56.6%, negative predictive value (NPV) 71.9%, p<0.001, OR: 3.3. RCH associated with other abnormal findings were S 52.4%, Sp 76.2%, PPV 76.2%, OR: 3.5, LR+: 2.2, p<0.000. Generalized edema and abnormal ductus venosus had the highest predictive values: PPV 88.2% and 83.3%, respectively. The most frequently found chromosomal abnormalities were T21 (53.7%), monosomy X (18.3%), T18 (15.9%), T13 (6.1%). Conclusions: Retronucal cystic hygroma is a risk marker with high predictive value for chromosomal abnormalities, being higher when associated with other abnormal ultrasound findings. Ultrasonographic identification of RCH in first trimester prenatal screening should be an indication to recommend diagnostic testing for chromosomal abnormalities.

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Zika virus (ZIKV) infection has caused severe unexpected clinical outcomes in neonates and adults during the recent outbreak in Latin America, particularly in Brazil. Congenital malformations associated with ZIKV have been frequently reported; nevertheless, the mechanism of vertical transmission and the involvement of placental cells remains unclear. In this study, we applied quantitative proteomics analysis in a floating explant model of chorionic villi of human placental tissues incubated with ZIKV and with ZIKV pre-adsorbed with anti-ZIKV envelope protein. Proteomic data are available via ProteomeXchange with identifier PXD025764. Altered levels of proteins were involved in cell proliferation, apoptosis, inflammatory processes, and the integrin-cytoskeleton complex. Antibody-opsonized ZIKV particles differentially modulated the pattern of protein expression in placental cells; this phenomenon may play a pivotal role in determining the course of infection and the role of mixed infections. The expression of specific proteins was also evaluated by immunoperoxidase assays. These data fill gaps in our understanding of early events after ZIKV placental exposure and help identify infection control targets.

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ABSTRACT BACKGROUND: It is very common to offer low molecular weight heparin (LMWH) medications to women with unexplained habitual abortion, to increase the livebirth rate. Although no benefit from LMWH has been clearly demonstrated, examination of the effects of enoxaparin on placental structure is lacking. OBJECTIVE: To assess placental structural changes in pregnancies treated with enoxaparin, compared with controls. DESIGN AND SETTING: Case-control study in an obstetrics and gynecology unit of a tertiary-level university hospital in Turkey. METHODS: Forty patients who had had term pregnancies and live births but also histories of habitual abortion were recruited for this study. Placentas were sampled using a systematic random sampling method. Tissue samples were obtained, embedded and sectioned for routine histological analyses. Hematoxylin and eosin staining was used. Surface area and length estimates from placental components were evaluated by using Image J. Cell proliferation and apoptosis were also assessed via immunohistochemistry. RESULTS: There were no significant differences between the groups regarding maternal age, abortion rate, birth weight or gestational age. Comparison of the enoxaparin and control groups showed that there were no significant differences in terms of surface area and ratios of placental components. We found that Bcl-2 was generally expressed at high levels in the enoxaparin group, while there was no difference in terms of Ki-67 between the groups. CONCLUSIONS: This study demonstrates that enoxaparin did not show any significant effect on the placental structure of cases that had histories of habitual abortion.

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The most prevalent pathologies during pregnancy, such as hypertension, gestational diabetes mellitus (GDM), and intrauterine growth restriction (IUGR), can determine modifications in macro- and microscopic morphological features of the placenta and its free chorionic villi. In the fetus it may be accompanied by pathological manifestations, with the embryo's future quality of life, and even its viability, at risk. The aim of this work is to perform a review of the morphological alterations that the placenta exhibits in pregnancies with GDM. A search on the topic in the scientific literature and specialized textbooks was carried out. The terms "placenta", "diabetes mellitus gestational" and "gestational diabetes mellitus" were used to define the search. Among the morphological modifications it was found that the placental weight/fetal weight ratio is higher in GDM and is associated mainly with histological changes. The distance between maternal and fetal circulation is increased because of an increase in the chorionic villi on the surface as well as greater thickness of the syncytiotrophoblast basal membrane due to an increased type IV collagen deposition. The stroma between the villi is edematous, which modifies the metabolic and endocrinal function of these placentas. Moreover, the capillary surface is enlarged due to the phenomena of vascular neoformation and a greater penetration of these vessels within the villi. Low oxygen partial pressure (pO2) was detected, which would produce a compensatory hyperplasia of terminal chorionic villi. In GDM the placenta undergoes alterations in its formation, structure, and function. According to the review, these alterations are related to an oxygenation deficiency in the fetus and changes in the transplacental transport of nutrients and other alterations, causing fetal overgrowth by increasing their availability in addition to other consequences to the developing fetus. In the case of high blood pressure during pregnancy, this produces accelerated maturation and rapid aging of the chorionic villi, with the risk of inducing a placental abruption. In addition, placental circulation is reduced by a third, decreasing oxygen saturation in the umbilical vessels and placing the health of the fetus at risk.

Las patologías de la gestación más prevalentes, como hipertensión, diabetes mellitus gestacional (DMG) y restricción del crecimiento uterino, pueden determinar modificaciones en las características morfológicas macro y microscópicas de la placenta y sus vellosidades coriales libres,y en el feto se puede acompañar de manifestaciones patológicas, con riesgo para su calidad de vida futura, e incluso su viabilidad. El objetivo de este trabajo consiste en realizar una revisión acerca de las alteraciones morfológicas que presenta la placenta en gestaciones con DMG. Se llevó a cabo una búsqueda sobre la temática en literatura científica y libros de texto especializados. Se utilizaron los términos "placenta", "diabetes mellitus gestacional" y "gestational diabetes mellitus" para orientar la búsqueda. Entre las modificaciones morfológicas se encontró que la relación peso placentario/peso fetal está aumentado en la DMG y se asocia principalmente a cambios histológicos. La distancia entre la circulación materna y la fetal está aumentada debido a un aumento de la superficie entre las vellosidades coriales, así como al mayor grosor de la membrana basal del sincitiotrofoblasto por un depósito elevado de colágeno tipo IV. El estroma entre las vellosidades se encuentra edematoso lo que va a modificar la función metabólica y endocrina de estas placentas. También hay aumento de la superficie capilar por fenómenos de neoformación vascular y una mayor penetración de estos vasos dentro de las vellosidades. Se detectó baja presión parcial de oxígeno (pO2), que produciría una hiperplasia compensatoria de vellosidades coriónicas terminales. En la DMG la placenta experimenta alteraciones en su formación, estructura y función. Según lo revisado, estas alteraciones están relacionadas con déficit en la oxigenación del feto, cambios en el transporte transplacentario de los nutrientes y otras alteraciones, ocasionando sobrecrecimiento fetal por aumento de su disponibilidad, entre otras consecuencias al feto en desarrollo. Y en el caso de la hipertensión arterial durante la gestación produce una maduración acelerada y envejecimiento rápido de las vellosidades coriales, con el riesgo de inducir un desprendimiento prematuro de placenta. Además se reduce la circulación placentaria en un tercio, disminuyendo la saturación de oxígeno en los vasos umbilicales del, poniendo en riesgo la salud del feto.

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Early miscarriage is still a concern, and viral infections are recognised as one of the causes of this adverse outcome. The causal relationship between HPV and miscarriage remains controversial. The aim of the study was to evaluate whether HPV infection indeed may occur in both the maternal and placental tissue in cases of miscarriage. Decidual and chorionic villi fragments (n = 118) were dissected from 81 miscarriage cases, 68 spontaneous and 13 intentional. HPV DNA was detected using the consensus primers MY09/11; in eight cases (9.9%, 8/81), seven of which (10.3%) were from spontaneous miscarriages and one (7.7%), was from an intentional miscarriage. The deciduas (4/8) and chorionic villi (5/8) were both infected with HPV. A reverse line blot was used to genotype HPV positive samples and revealed HPV6, 11, 58, 66 and 82. Although the results obtained cannot infer an association between HPV and pregnancy loss, it cannot be ruled out. Impact Statement What is already known on this subject? Miscarriages are considered to be the most common complication in pregnancy. Several possible causes of miscarriage have been considered, and the role of infections as one of those is confirmed, especially during the second trimester of pregnancy. The prevalence of HPV in conception products is still questionable. However, an HPV infection should not be ignored and its association with miscarriage must be considered. What the results of this study add? The present study reveals the presence of HPV in the foetal and maternal tissues of conception. What the implications are of these findings for clinical practice and/or further research? This issue deserves further investigation aiming to clarify the role of HPV in miscarriage cases; which are mainly related to the specific type and grade of tissues' abnormalities found co-topographically with a virus presence.

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Las patologías de la gestación como la hipertensión, diabetes mellitus gestacional, o restricción del crecimiento intrauterino, pueden determinar modificaciones en las características morfológicas macro y microscópicas de la placenta y sus vellosidades coriales libres, y en el feto se puede acompañar de manifestaciones patológicas, con riesgo para su calidad de vida futura, e incluso su viabilidad. El objetivo de este trabajo consistió en describir aspectos morfométricos e histológicos de las vellosidades coriales libres en gestas normales, con diabetes e hipertensión arterial. Se utilizaron 30 placentas humanas y fueron separadas, según presencia o ausencia de patologías en el embarazo, en tres grupos: Normal (N), Síndrome Hipertensivo del Embarazo (SHE), Diabetes (D) y Restricción del Crecimiento Intrauterino (RCIU). Se usó ficha para registrar peso placentario y del recién nacido Todas las muestras fueron fijadas en formalina tamponada al 10 %. De cada una fueron extraídas 5 muestras, obteniendo 25 cortes por cada placenta. Posteriormente, fueron teñidas con H&E, Azul Alcián y Tricrómico de Masson. Además, se efectuó el análisis histológico y morfométrico (ImageJ®) de las vellosidades coriales. El análisis estadístico fue realizado utilizando ANOVA. Entre los cambios morfológicos, se encontró una relación peso placentario/peso del recién nacido aumentada en la Diabetes Mellitus Gestacional asociada a cambios histológicos. No hubo cambios morfométricos significativos entre placentas N, SHE y D. Hubo un aumento en el número de vasos coriales en placentas del grupo D (P < 0,05) y de la superficie entre las vellosidades coriales. En el grupo SHE hubo aumento moderado de nudos sinciciales y presencia de fibrina en el estroma. Las placentas con Diabetes Mellitus Gestacional experimentan alteraciones histológicas, como consecuencia de cambios estructurales y funcionales. Además, el aumento de vasos sanguíneos en placentas con diabetes se produce por neoformación vascular y mayor penetración de vasos sanguíneos dentro de las vellosidades. En el caso del SHE las alteraciones placentarias se relacionan con la gravedad de la enfermedad.

Gestational pathologies such as hypertension, gestational diabetes mellitus and restriction of intrauterine growth can determine changes in the macro and microscopic morphological characteristics of the placenta and its free chorionic villi. In the fetus it can be accompanied by pathological manifestations with risk to its viability and future quality of life. The aim of this work was to describe morphometric and histological aspects of free chorionic villi in normal pregnancies associated with diabetes, hypertension and restriction of intrauterine growth. Thirty human placentas were used and were separated into three groups: Normal (N), Hypertensive Pregnancy Syndrome (SHE), Diabetes (D), and Restriction of Intrauterine Growth (RIG) according to evident pathologies or absence thereof during pregnancy. Tab was used to record placental and newborn weight. All samples were fixed in 10 % buffered formalin. From each, 5 samples were extracted, obtaining 25 cuts for each placenta. Subsequently, they were stained with H & E, Alcian Blue and Masson's Trichrome. In addition, histological and morphometric analysis (ImageJ®) of the chorion villus was carried out. Statistical analysis was performed using ANOVA. Among the morphological changes, an increased placental weight / weight ratio of the newborn was found in Gestational Diabetes Mellitus associated with histological changes. There were no significant morphometric changes between placentas N, SHE and D. There was an increase in the number of corial vessels in placentas of group D (P <0.05) and of the surface between the chorion villi. In the SHE group there was a moderate increase in syncytial nodes and presence of fibrin in the stroma. Placentas with Gestational Diabetes Mellitus experience histological alterations, as a consequence of structural and functional changes. In addition, the increase of blood vessels in placentas D is produced by vascular neoformation and increased penetration of blood vessels into the villi. In the case of SHE, placental alterations are related to the severity of the disease.

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The aim of this report is to describe a case of marked osseous metaplasia in the placenta associated with abortion in a mare. A 19-year-old Campolina mare with a history of multiple parturitions and absence of reproductive failure, aborted a fetus with approximately six months of gestation. There were no gross changes in the fetus and the placenta. Microscopically, there was multifocal replacement of fetal connective mesenchyme of the chorionic villi with well differentiated and partially mineralized osseous tissue (confirmed by von Kossa staining). To further characterize the collagenous component of the lesion, sections of the placenta were stained with Masson's trichrome and Picrosirius red. Osseous tissue deposition had abundance of type I collagen. To the best of our knowledge, this is the first report of osseous metaplasia in the placenta of a mare associated with abortion at mid gestation, presumably due to placentary insufficiency.(AU)

O objetivo deste relato é descrever um caso de metaplasia óssea em placenta equina, associada a aborto. Uma égua da raça Campolina, com aproximadamente 19 anos de idade, após múltiplas gestações e sem histórico de alterações reprodutivas, abortou feto com idade aproximada de seis meses. Não foram observadas alterações macroscópicas no feto e na placenta. Microscopicamente, havia substituição do mesênquima de vilosidades coriônicas por tecido ósseo bem diferenciado e parcialmente mineralizado (confirmada pela coloração de von Kossa). Para caracterização do componente colagenoso, foram realizadas colorações de tricrômico de Masson e picrosirius red. O tecido ósseo tinha predominância de colágeno do tipo I. Este é o primeiro relato de metaplasia óssea na placenta equina, associada a aborto no terço médio da gestação, presumivelmente devido à insuficiência placentária.(AU)

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The aim of this report is to describe a case of marked osseous metaplasia in the placenta associated with abortion in a mare. A 19-year-old Campolina mare with a history of multiple parturitions and absence of reproductive failure, aborted a fetus with approximately six months of gestation. There were no gross changes in the fetus and the placenta. Microscopically, there was multifocal replacement of fetal connective mesenchyme of the chorionic villi with well differentiated and partially mineralized osseous tissue (confirmed by von Kossa staining). To further characterize the collagenous component of the lesion, sections of the placenta were stained with Masson's trichrome and Picrosirius red. Osseous tissue deposition had abundance of type I collagen. To the best of our knowledge, this is the first report of osseous metaplasia in the placenta of a mare associated with abortion at mid gestation, presumably due to placentary insufficiency.(AU)

O objetivo deste relato é descrever um caso de metaplasia óssea em placenta equina, associada a aborto. Uma égua da raça Campolina, com aproximadamente 19 anos de idade, após múltiplas gestações e sem histórico de alterações reprodutivas, abortou feto com idade aproximada de seis meses. Não foram observadas alterações macroscópicas no feto e na placenta. Microscopicamente, havia substituição do mesênquima de vilosidades coriônicas por tecido ósseo bem diferenciado e parcialmente mineralizado (confirmada pela coloração de von Kossa). Para caracterização do componente colagenoso, foram realizadas colorações de tricrômico de Masson e picrosirius red. O tecido ósseo tinha predominância de colágeno do tipo I. Este é o primeiro relato de metaplasia óssea na placenta equina, associada a aborto no terço médio da gestação, presumivelmente devido à insuficiência placentária.(AU)

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Complete hydatidiform mole is a common cause of gestational bleeding of the first trimester, commonly assessed by ultrasound. It represents an abnormal proliferation of trophoblastic tissue, with no fetal formation, just hydropic villi. These abnormal villi seen in ultrasound are compared to a "bunch of grapes," a classic description of this disease.

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Physical exercise has been demonstrated a positive effect on many pregnancy outcomes. Placental components are important for exchanging oxygen and nutrients between mother and fetus. This study aimed to systematic review and meta-analysis whether physical exercise could induce a morphological adjustment on placenta components. We systematically searched PubMed database until October 30th, 2014. We included randomized and non-randomized studies with control group, which aimed to investigate the effect of the physical exercise (water, aerobic and resistance) on placental components (placental weight and volume, villous volume and vascular volume, intervillous space and stem villi). Initially, we identified 222 articles, of which 9 articles were used for full text analysis. Finally, four articles were included in the systematic review and meta-analysis. Meta-analysis demonstrated that exercise appeared to affect placental weight (95% CI, 39.73g [4.66-74.80]), placental volume (95% CI, 47.11 cm3 [37.99-56.23]), intervillous space (95% CI, 16.76 cm3 [12.66-20.68]), villous volume (95% CI, 46.01 cm3 [40.21-51.81]), villous vascular volume (95% CI, 15.95 cm3 [7.83-24.07]) and stem villi (95% CI, 6.00 cm3[4.25-7.75]). Apparently, physical exercise has a positive effect on placental components. However, this conclusion is based on a limited number of studies. Clearly, it stands the necessity of larger samples and better methodology quality.

O exercício físico tem demonstrado efeito positivo nos muitos desfechos da gravidez. Componentes da placenta são importantes para a troca de oxigênio e nutrientes entre mãe e feto. O objetivo deste estudo foi revisar de forma sistemática e realizar uma meta-análise para verificar se o exercício físico pode induzir um ajuste morfológico nos componentes da placenta. A pesquisa foi feita sistematicamente no banco de dados PubMed até 30 de outubro de 2014. Foram incluídos estudos randomizados e não-randomizados com grupo controle, que tiveram como objetivo investigar o efeito do exercício físico (água, aeróbico e resistência) em componentes da placenta (peso e volume placentário, volume vascular e volume viloso, espaço interviloso e troncos vilosos). Inicialmente, identificamos 222 artigos, dos quais nove artigos foram utilizados para a análise de texto completo. Por último, quatro artigos foram incluídos na revisão sistemática e meta-análise. A meta-análise demostrou que o exercício parece afetar o peso da placenta (95% IC, 39,73g [4,66-74,80]), o volume placentário (IC 95%, 47,11 cm3 [37,99-56,23]), o espaço interviloso (IC 95%, 16,76 cm3 [12,66-20,68]), o volume viloso (IC 95%, 46,01 cm3 [40,21-51,81]), o volume vascular viloso (95% IC, 15,95 cm3 [7,83-24,07]) e o tronco viloso (95% IC, 6,00 cm3[4,25-7,75]). Aparentemente, o exercício físico tem efeito positivo sobre os componentes da placenta. No entanto, esta conclusão é baseada em um número limitado de estudos. Claramente, destaca-se a necessidade de amostras maiores e melhor qualidade de metodologia.

El ejercicio físico ha demostrado efecto positivo en los muchos resultados del embarazo. Los componentes de la placenta son importantes para el intercambio de oxígeno y nutrientes entre la madre y el feto. El objetivo de este estudio fue revisar de forma sistemática y realizar un meta-análisis para comprobar si el ejercicio físico puede inducir la adaptación morfológica en los componentes de la placenta. La encuesta se realizó sistemáticamente en la base de datos PubMed hasta 30 de octubre de 2014. Se incluyeron ensayos aleatorios y no aleatorizados con grupo control, que tenían como objetivo investigar el efecto del ejercicio físico (agua, aeróbico y de resistencia) en los componentes de la placenta (peso y volumen de la placenta, el volumen vascular y volumen velloso, espacio intervelloso y troncos vellosos). Inicialmente, se identificaron 222 artículos, de los cuales nueve artículos fueron utilizados para el análisis de texto completo. Finalmente, cuatro artículos fueron incluidos en la revisión sistemática y meta-análisis. El meta-análisis mostró que el ejercicio parece afectar el peso de la placenta (IC del 95%, 39,73g [4,66-74,80]), el volumen de la placenta (IC del 95%, 47,11 cm3 [37,99-56,23]), el espacio intervelloso (IC del 95%, 16,76 cm3 [12,66-20,68]), el volumen velloso (IC del 95%, 46,01 cm3 [40,21-51,81]), el volumen vascular velloso (95 IC%, 15,95 cm3 [7,83-24,07]) y el tronco velloso (IC 95%, 6,00 cm3 [4,25-7,75]). Aparentemente, el ejercicio físico tiene un efecto positivo sobre los componentes de la placenta. Sin embargo, esta conclusión se basa en un número limitado de estudios. Claramente, hay una necesidad para mayores tamaños de muestra y una mejor calidad de la metodología.

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Nifurtimox (Nfx) and Benznidazole (Bnz) are the only available drugs in use for the treatment of Chagas disease. These drugs are recommended but not fully validated in evidence-based medicine and reports about the differential toxicity of both drugs are controversial. Here, we evaluated the toxic and therapeutic effects of Nfx and Bnz on human placental chorionic villi explants (HPCVE) during ex vivo infection of Trypanosoma cruzi, performing histopathological, histochemical, immunohistochemical as well as immunofluorescence analysis of the tissue. Additionally, we determined the effect of both drugs on parasite load by real time PCR. Bnz prevents the parasite induced tissue damage in ex vivo infected HPCVE compared to Nfx, which is toxic per se. The presence of T. cruzi antigens and DNA in infected explants suggests that these drugs do not impair parasite invasion into the HPCVE. Additionally, our results confirm reports suggesting that Bnz is less toxic than Nfx and support the need for the development of more effective and better-tolerated drugs.

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Describir y cuantificar alteraciones morfológicas en vellosidades placentarias de embarazadas cuyo feto desarrolló malformaciones esqueléticas múltiples. MÉTODOS: se analizaron cuatro placentas de abortos terapéuticos a las 13, 16, 20 y 38 semanas de gestación. Estas se compararon con placentas normales a la misma edad de gestación de abortos electivos por indicación médico legal. Tinción de hematoxilinaeosina se aplicó a 10 láminas de 5 regiones de cada placenta utilizando un protocolo con 4 variables cuantitativas: madurez, cambios fibrinoides, edema y fibrosis estromal y una variable cualitativa: trombosis. Los resultados cuantitativos se analizaron utilizando el análisis de varianza (ANAVAR) según arreglo completamente aleatorizado y el test de Tukey. Para la variable cualitativa se aplicó la prueba de tendencia para datos correlacionados. Se empleó el software statistix 8.0 y SAS 9.0 para Windows. RESULTADOS: existen diferencias significativas (p<0,05) entre las placentas asociadas a malformaciones múltiples del sistema esquelético y las placentas control en relación a las variables cuantitativas. No se encontraron diferencias significativas (p>0,05) en relación a la variable cualitativa. CONCLUSIONES: la población de vellosidades placentarias asociadas a malformaciones múltiples del sistema esquelético presentó un alto porcentaje de alteraciones indicando que la barrera placentaria está dañada afectando el intercambio de gases, nutrientes y metabolitos durante el desarrollo del feto...

To describe and quantify morphological changes in placental villi in pregnancies with multiple fetal malformations of the skeletal system. METHODS: four placentas from fetuses of gestational ages 13, 16, 20 and 38 weeks, aborted for therapeutic reasons were examined. Normal placentas of the same gestational age, from cases where legal elective abortion had been recommended on medical grounds, were taken as the control. The hematoxilineosin stain was applied to ten slides in five regions of each placenta using a protocol with four quantitative variables: maturity of villi, fibrinoid changes, edema and stromal fibrosis and one qualitative variable: thrombosis. The quantitative results were analyzed using ANOVA in a randomized manner and the Tukey test was applied; for the qualitative variable the trend test for correlated data was used. The software used was Statistix 8.0 and SAS 9.0 for Windows. RESULTS: there were significant differences (p<0.05) between the placentas associated with multiple malformations of the skeletal system and control placentas in terms of the quantitative variables. No significant differences were found (p>0.05) in relation to the qualitative variable. CONCLUSIONS: the population of placental villi associated with multiple malformations of the skeletal system exhibited a high percentage of changes which is an indication that the placenta is damaged, thereby affecting the exchange of gases, nutrients and metabolites during the development of the fetus...

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Objetivo: determinar la proporción de las alteraciones histopatológicas en las vellosidades y en el espacio intervelloso obtenida de cuatro placentas normales del último trimestre del embarazo. Metodología: por medio de la microscopía de luz y la tinción de hematoxilina y eosina (H&E) se identificaron, en 25 láminas de 5 regiones de la placenta, 6 variables cuantitativas (p.ej. inmadurez vellosa, nódulos sincitiales, cambios fibrinoides, edema velloso, fibrosis estromal y calcificación) y 9 variables cualitativas (p.ej. depósitos de fibrina, trombosis intervellosa, infartos, trombosis vascular, cambios en la pared del vaso, calcificación intraluminal, congestión vascular,inflamaciónyhemorragia).Los resultados de las variables cuantitativas se analizaron utilizando el Análisis de Varianza (ANAVAR) de 2 vías con submuestreo y el test de Tukey. En contraste, para las variables cualitativas se aplicó la prueba de Kruskal Wallis y se estimó el porcentaje de positividad según las regiones. Dichos análisis se realizaron por medio del software Statistix® 8.0 y SAS® 9.0 para Windows®. Resultados: no se presentaron diferencias significativas (p<0,05) entre las placentas más no entre las regiones. Del mismo modo, no se observó trombosis vascular, daño de la pared de lvaso,congestión vascular, calcificación intraluminal, inflamación ni hemorragia. Conclusión: las vellosidades analizadas se mostraron homogéneas dentro de cada placenta pero no entre las mismas, indicando una variabilidad que etiológicamente podría explicarse por factores genéticosyambientalesdecuyainteracciónresultarían las diferencias individuales para cada placenta.

Objective: determining the percentage of histopathological changes in chorionic villi and intervillous space in four placentas obtained from normal women’s pregnancies at term. Methodology: six quantitative variables (i.e. immaturity, syncytial knots, fibrinoid change, oedema, fibrosis and calcification) and nine qualitative variables (i.e. fibrin deposition, intervillous fibrin, infarction, thrombosis, changes in vessel walls, intraluminal calcification, vascular congestion, inflammation and haemorrhage) were indentified on 25 slides covering 5 placental regions using light microscopy and H&E staining. Quantitative variable results were analysed using two-way variance analysis with sub-sampling and Tukey’s test; qualitative variables (the percentage of positive regions) were analysed by Kruskal-Wallis test. The software used was Statistix® 8.0 and SAS® 9.0 for Windows®. Results: there were significant differences (p<0.05) between placenta (but not between regions) regarding syncytial knots, fibrinoid change, oedema, fibrosis and calcification. Vascular thrombosis, damage to vessel walls, vascular congestion, intraluminal calcification, inflammation and/or haemorrhage were not observed. Conclusion: the population of villi analysed was homogeneous in each placenta but not amongst them, thereby indicating variability which could be etiologically explained by genetic and environmental factors whose interaction may have resulted in the individual differences observed for each placenta.

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OBJETIVO: verificar a quantidade de células CD68+ no estroma das vilosidades coriônicas na placenta de gestações submetidas ou não ao trabalho de parto. MÉTODOS: estudo transversal, com gestantes saudáveis a termo, das quais 31 placentas foram examinadas pela técnica de imunoistoquímica. Vinte placentas foram obtidas após partos vaginais (GVAG) e 11 obtidas em cesarianas eletivas (GCES). Lâminas foram preparadas com amostras de vilosidades coriônicas e submetidas à marcação com anticorpo anti-CD68, específico para macrófagos. Foram contadas as células marcadas e as não marcadas dentro das vilosidades. Testes estatísticos não-paramétricos foram utilizados para a análise. RESULTADOS: entre 6.424 células contadas no estroma das vilosidades das 31 placentas, 1.135 células (17,6%) foram marcadas pelo CD68+. Em cada amostra placentária, a média de células coradas pelo anticorpo anti-CD68 foi de 22±18 para o grupo GVAG e de 20±16 para o grupo GCES. CONCLUSÕES: não houve diferenças significantes no percentual de macrófagos (CD68+) em associação com o trabalho de parto.

PURPOSE: to verify the amount of CD68+ cells in chorionic villosities in placentae from gestations submitted or not to labor. METHODS: transversal study with healthy near-term pregnant women, among whose placentae, 31 have been examined by immunohistochemical technique. Twenty placentae were obtained after vaginal delivery (VAGG) and eleven after elective cesarean sections (CESG). Slides were prepared with chorionic villosities samples and labeled with anti-CD68 antibody, specific for macrophages. Labeled and nonlabeled cells were counted inside the villosities. Non-parametric statistical tests were used for the analysis. RESULTS: among the 6,424 cells counted in the villosities' stroma from the 31 placentae, 1,135 cells (17.6%) were stained by the CD68+. The mean of cells labeled by the anti-CD68 was 22±18 for the VAGG group and 20±16 for the CESG, in each placentary sample. CONCLUSIONS: there were no significant differences in the percentage of macrophages (CD68+) in association with labor.

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The aim of this study was observe differences in the immunological distribution of the placental lactogene and IGF-1 receptor on free-chorionic villi, between studied groups and to relate the neonatal diagnosis of PEG with morphometric and immunohystochemical characteristics of the placenta. A total of, twelve placentas from AEG newborn and twelve from PEG newborn were obtained from the Maternity Ward of Temuco, Chile. H&E, Alcian blue and Masson's trichromic stains, as well as Hematoxilyn-PAS. In the immunoperoxidase technique, were used: 1) placental lactogen (polyclonal, dilution 1:200, NCL-PLP, Novocastra) 2) Insuline-1 like growth factor (monoclonal, dilution 1:200, NCL-GHR, Novocastra). Differences between PEG and AEG placentae in the immnunostaing for placental lactogen and IGF-1 receptor in the sincitial throphoblast were not observed.

El objetivo de este estudio fue observar diferencias en la distribución del lactogeno placentario y receptor del factor de crecimiento similar a la insulina, entre placentas de recién nacidos normales para la edad gestacional AEG y pequeños para la edad gestacional PEG. Un total de 12 placentas de recién nacidos AEG y 12 PEG obtenidas de la maternidad del Hospital de Temuco, Chile fueron procesadas con técnicas histológicas H&E, azul de Alcián y un método de tinción tricrómico. La técnica de inmunoperoxidasa utilizada fue: 1) lactogeno placentario (pohclonal, dilución 1:200, NCL-PLP, Novocastra) 2) Factor de crecimiento similar a la insulina (monoclonal, dilución 1:200, NCL-GHR, Novocastra). No se observaron diferencias en la distribución de lactogeno placentario ni factor de crecimiento similar a la insulina entre las placentas provenientes de recién nacidos pequeños para la edad gestacional y adecuados para la edad gestacional.

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O diagnóstico pré-natal está indicado para algumas genodermatoses graves, como a epidermólise bolhosa distrófica recessiva e a epidermólise bolhosa juncional. A biópsia de pele fetal foi introduzida em 1980, mas não pode ser realizada antes da 15a semana de gestação. A análise do DNA fetal é método preciso e pode ser realizado mais precocemente na gestação. No entanto, deve-se conhecer a base molecular da genodermatose, e é essencial determinar a mutação e/ou marcadores informativos nas famílias com criança previamente afetada. O DNA fetal pode ser obtido pela biópsia da vilosidade coriônica ou amniocentese. O diagnóstico genético pré-implantação tem surgido como alternativa que dispensa a interrupção da gestação. Essa técnica, que envolve fertilização in vitro e teste genético do embrião. vem sendo realizada para genodermatoses em poucos centros de referência. A ultra-sonografia é exame não invasivo, mas tem uso limitado no diagnóstico pré-natal de genodermatoses. A ultrasonografia tridimensional geralmente estabelece o diagnóstico tardiamente na gestação, e há apenas relatos anedóticos de diagnóstico pré-natal de genodermatoses usando esse método.

Prenatal diagnostic testing is indicated for some severe genodermatoses, such as recessive dystrophic epidermolysis bullosa and junctional epidermolysis bullosa. Fetal skin biopsy was introduced in 1980, but it cannot be performed before 15th gestational week. Fetal DNA analysis is a precise method and can be performed earlier in pregnancy. However, the molecular basis of the genodermatoses must be known and it is essential to determine the gene mutations and/or informative markers in the families with a previously affected child. Fetal DNA can be obtained by chorionic villus sampling or amniocentesis. Preimplantation genetic diagnosis is an alternative approach obviating the need for termination of pregnancy. It involves in vitro fertilization and genetic testing of embryos. However, this technique has been performed for genodermatoses in only a few reference centers. Ultrasonography is a non-invasive test, but has a limited use in prenatal diagnosis of genodermatoses. Tridimensional ultrasonography usually establishes diagnosis late in pregnancy and there are only anecdotal reports of prenatal diagnosis of genodermatoses using this method.

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El síndrome de la rubéola (SRC) o rubéola congénita se refiere a un grupo de anomalías físicas tales como cataratas, sordera, defectos del corazón, y retraso mental que el bebé manifiesta como resultado de la infección materna y posterior infección fetal con el virus de la rubéola. Lo más probable es que la rubéola materna provoque en la fase de viremia una infección de las vellosidades coriales o de la placenta y produzca una viremia fetal generalizada. El diagnostico se confirma por hallazgos de Ac. Ig M específicos en el suero del recién nacido o mediante cultivos del virus en muestras del lactante. El virus se puede eliminar por la orina durante al menos 1 año. El diagnóstico prenatal se puede establecer mediante aislamiento del virus en el líquido amniótico o por identificación de Ig.M en la sangre del cordón umbilical. Los efectos del virus sobre el feto dependen del momento de la infección; cuanto más joven es el feto, más severa es la enfermedad.

Congenital rubella syndrome (CRS) or congenital rubella refers to a group of physical anomalies such as cataract, deafness, heart conditions, mental retardation that the baby manifests as a result of a maternal infection and posterior fetus infection with rubella virus. It’s most probable that maternal rubella provoke an infection of chorionic villi or placenta in the viremic phase producing a generalized fetus viremia. Diagnosis is confirmed with IgM specific antibodies in newborns serum or culture samples of the virus on infants. Virus can be eliminated through urine at least in one year. Prenatal diagnosis can be established when isolating the virus from amniotic fluid or identification of IgM in umbilical cords blood. The effects the virus produce to the fetus depend of the moment of infection; while younger the fetus, the more severe will the disease be.

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OBJETIVO: avaliar complicações maternas e fetais após realização de biópsia de vilo corial (BVC) para diagnóstico pré-natal de alterações genéticas, na cidade de Salvador (BA). MÉTODOS: série de 958 gestantes de risco para cromossomopatias, submetidas à BVC realizada entre a nona e a 24ª semanas de gestação, por via transabdominal, utilizando agulha espinhal 18G 3½, guiada por ultra-sonografia, entre 1990 e 2006. As variáveis para a análise de complicações imediatas foram cólicas uterinas, hematoma subcoriônico, punção acidental da cavidade amniótica, dor no local da punção, amniorrexe, desconforto abdominal, bradicardia fetal e sangramento vaginal, e para complicações tardias, dor abdominal, sangramento vaginal, amniorrexe, infecção e abortamento espontâneo. Complicações obstétricas e fetais (parto prematuro, descolamento prematuro de placenta, placenta prévia e malformações anatômicas fetais) foram também estudadas. Para análise estatística, utilizaram-se o chi² e o teste t de Student ou Mann-Whitney; o nível de significância foi 5 por cento. RESULTADOS: a média de idade das gestantes foi 36,3±4,9 anos. Complicações imediatas foram encontradas em 182 (19 por cento) casos (cólica uterina em 14 por cento, hematoma subcoriônico em 1,8 por cento e punção amniótica acidental em 1,3 por cento) e tardias em 32 (3,3 por cento) casos (sangramento vaginal em 1,6 por cento, dor abdominal em 1,4 por cento, amniorrexe em 0,3 por cento e aborto espontâneo em 1,6 por cento). Não foi observado descolamento prematuro de placenta, placenta prévia ou malformação fetal. CONCLUSÕES: a BVC revelou-se procedimento simples e seguro. A BVC pode ser utilizada em gestantes que necessitam de diagnóstico pré-natal devido ao risco de anomalias genéticas.

PURPOSE: to evaluate fetal maternal complications after chorionic villus sampling (CVS) for prenatal diagnosis of genetic disorders in pregnant women of Salvador (BA), Brazil. METHODS: case-series study of 958 pregnancies with high risk for chromosomal abnormality submitted to CVS transabdominal between the ninth to the 24th week of gestation, using an ultrasound-guided 18G 3½ spinal needle, from 1990 to 2006. The variables for the analysis of immediate complications were uterine cramps, subchorionic hematoma, accidental amniotic cavity punction, pain in the punction area, amniotic fluid leakage, abdominal discomfort, fetal arrhythmias and vaginal bleeding, and of late complication, abdominal pain, vaginal bleeding, amniotic fluid leakage, infection and spontaneous miscarriage. Premature labor, obstetrical complications (abruption placenta and placenta previa) and newborn malformation were also studied. Qui-square, Student’s "t" or Mann-Whitney tests were used for the statistical analysis; the significance level was 5 percent. RESULTS: maternal mean age was 36.3±4.9 years old. Immediate complications ware found in 182 (19 percent) cases (uterine cramp in 14 percent, subchorionic hematoma in 1.8 percent and accidental amniotic cavity punction in 1.3 percent). Late complications were found in 32 (3.3 percent) cases (vaginal bleeding in 1.6 percent, abdominal pain in 1.4 percent, amniotic fluid leakage in 0.3 percent and spontaneous miscarriage in 1.6 percent cases). There was no case of abruption placentae, placenta previa or fetal malformation. CONCLUSIONS: CVS is a simple and safe procedure. CVS should be performed in high risk pregnant patients who need prenatal diagnosis of fetal chromosomal abnormalities.

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