Placental surface shape, function, and effects of maternal and fetal vascular pathology
| Autor: | John M. Thorp, Oleksander Shlakhter, Dawn P. Misra, Barbara Eucker, Michael Yampolsky, Carolyn Salafia, Danielle Haas |
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| Rok vydání: | 2010 |
| Předmět: |
Pathology
medicine.medical_specialty Term Birth Placenta Biology Umbilical cord Severity of Illness Index Article Umbilical Cord Cohort Studies Pregnancy medicine Image Processing Computer-Assisted Photography Humans Placental Circulation Vascular Diseases Prospective cohort study Fetus Obstetrics Obstetrics and Gynecology Placentation Chorion Organ Size medicine.disease medicine.anatomical_structure Reproductive Medicine Fetal Weight Velamentous cord insertion Gestation Female Algorithms Developmental Biology |
| Zdroj: | Placenta. 31(11) |
| ISSN: | 1532-3102 |
| Popis: | Goal In clinical practice, variability of placental surface shape is common. We measure the average placental shape in a birth cohort and the effect deviations from the average have on placental functional efficiency. We test whether altered placental shape improves the specificity of histopathology diagnoses of maternal uteroplacental and fetoplacental vascular pathology for clinical outcomes. Materials and methods 1225 Placentas from a prospective cohort had chorionic plate digital photographs with perimeters marked at 1–2 cm intervals. After exclusions of pre-term (n = 202) and velamentous cord insertion (n = 44), 979 (95.7%) placentas were analyzed. Median shape and mean perimeter were estimated. The relationship of fetal and placental weight was used as an index of placental efficiency termed “β”. The principal placental histopathology diagnoses of maternal uteroplacental and fetoplacental vascular pathologies were coded by review of individual lesion scores. Acute fetal inflammation was scored as a “negative control” pathology not expected to affect shape. ANOVA with Bonferroni tests for subgroup comparisons were used. Results The mean placental chorionic shape at term was round with a radius estimated at 9.1 cm. Increased variability of the placental shape was associated with lower placental functional efficiency. After stratifying on placental shape, the presence of either maternal uteroplacental or fetoplacental vascular pathology was significantly associated with lower placental efficiency only when shape was abnormal. Conclusions Quantifying abnormality of placental shape is a meaningful clinical tool. Abnormal shapes are associated with reduced placental efficiency. We hypothesize that such shapes reflect deformations of placental vascular architecture, and that an abnormal placental shape serves as a marker of maternal uteroplacental and/or fetoplacental vascular pathology of sufficiently long standing to impact placental (and by extension, potentially fetal) development. |
| Databáze: | OpenAIRE |
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