Debora Kidron

Placental aetiologies of foetal growth restriction: Clinical and pathological differences

BACKGROUND Placental morphology and pregnancy outcome differ between normal pregnancies and those with foetal growth restriction (FGR). Most reports do not differentiate among different placental injury patterns related to foetal growth restriction. AIMS To evaluate placental and perinatal findings in growth restricted pregnancies based on three placental injury patterns: maternal and foetal blood supply abnormalities, and villitis of unknown aetiology, compared to those of preeclampsia (PE) and normal pregnancies. STUDY DESIGN Retrospective review. SUBJECTS 65 growth restricted newborns and their placentas. OUTCOME MEASURES Comparison of the clinical perinatal characteristics and outcomes, placental pathology and the number of syncytiocapillary membranes in the terminal villi, of the 65 FGR cases with 13 pregnancies complicated with preeclampsia (PE), and 25 uncomplicated pregnancies as controls, at 34-40weeks gestation. RESULTS The most common injury patterns of FGR placentas were maternal underperfusion (66%) (group 1), foetal blood supply abnormality (17%) (group 2), and villitis of unknown aetiology (17%) (group 3). The rate of induced labours was the highest in group 1 but the rate of operative deliveries due to suspected foetal asphyxia was the highest in group 2 (p<0.05). In the FGR cases, inverse relationship was found between birth weight and the number of syncytiocapillary membranes (r=-0.31, p<.05) in the maternal underperfusion FGR cases (group 1) only. CONCLUSIONS The different injury patterns in placentas of FGR patients may be correlated to different clinical outcomes. Placental examination in FGR pregnancies can provide a specific pathophysiologic explanation that may recur in subsequent pregnancies and lead to changes in follow-up and management.

Prenatal diagnosis of fetal cerebellar lesions: a case report and review of the literature.

The fetal cerebellar structure, size and consistency are looked at in every system survey. Among the acquired cerebellar events that might change the cerebellar consistency are haemorrhage, infections in utero and neoplasia. Additional fetal malformations, if present, assist in making the final diagnosis. We present a case of an isolated echogenic mass in one of the cerebellar hemispheres along with the differential diagnosis. Copyright

In utero congestive heart failure due to maternal indomethacin treatment for polyhydramnios and premature labour in a fetus with antenatal closure of the foramen ovale

A case of severe fetal congestive heart failure due to occlusion of the ductus arteriosus in a mother treated with indomethacin for polyhydramnios and premature contractions is described. Closure of the fetal foramen ovale that escaped detection by prenatal echocardiography was later demonstrated at neonatal autopsy. This case suggests that indomethacin treatment in a ductus‐dependent fetus may be hazardous. Therefore, careful surveillance of the fetus exposed to indomethacin in utero is warranted.

Congenital deficiency of alpha-fetoprotein and associated chromosomal abnormality in the placenta.

In this study we describe two patients with congenital absence of alpha‐fetoprotein (AFP). The pathological examination results, including an immunohistochemical stain, which define qualitatively the levels of AFP detected by the biochemical studies and the comparative genomic hybridization (CGH) are enclosed. A description of the suggested functions of AFP and the means of its production are set forth. An explanation is suggested for the lack of symptoms in a newborn with undetectable levels of AFP and the mechanism by which this condition might occur.

Is the ratio of maternal serum to amniotic fluid AFP superior to serum levels as a predictor of pregnancy complications

PurposeThe use of maternal serum alpha fetoprotein (MSAFP) levels as a predictor of pregnancy complications (PC) is well established. We hypothesized that the ratio between the MSAFP/AFAFP levels (RATIO) will more accurately predict PC than MSAFP levels alone.MethodsWomen who had a MSAFP test followed by amniocentesis were divided into two groups: those who had PC comprised the study group and those who had an uneventful pregnancy served as the control group. Data regarding pregnancy and delivery course were collected. The RATIO between the study and the control groups was compared.Results166 women were included in the study, of which 24 had PC. A significant correlation was found between the RATIO and intrauterine growth restriction (IUGR) and week of delivery. Six pregnancies had elevated MSAFP levels; two with RATIO below 2 had uneventful pregnancies. Among the other four pregnancies with RATIO above two, one had IUGR and the other, placental abruption.ConclusionOur data suggest that the RATIO might serve as a predictor of IUGR and week of delivery. Although the number of patients in the current study was relatively small, the novelty of the proposed simple marker implies that a larger scale study is warranted. Such studies may confirm this finding and a possible advantage of using this RATIO instead of or in addition to MSAFP values for better prediction of pregnancies at risk for PC.

Morphometric characteristics of the umbilical cord and vessels in fetal growth restriction and pre-eclampsia

BACKGROUND Reports on the morphometric analysis of umbilical cord (UC) and its vessels have been inconsistent due to varying inclusion criteria and methodology. The current study tried to overcome the limitations of previous studies by comparing the UC in pregnancies complicated by fetal growth restriction (FGR), preeclampsia (PE) and FGR+PE, to healthy controls. AIMS Analyze the morphometric attributes of the UC in pregnancies complicated by FGR and PE. STUDY DESIGN Case-control. SUBJECTS The study groups consisted of 36 patients with FGR+PE, 72 with FGR (without PE) and 15 with PE (without FGR). They were compared to 50 patients without FGR or PE. OUTCOME MEASURES Histological cross-sections of the UC were photographed and measured. The following variables were recorded: cross-section area of UC, thickness and surface area of umbilical vessel walls, shortest distance between cord surface and nearest artery (DSA), distance between the arteries (DBA) and placental weight and measurements. The area of the Whartons jelly (WJ) area was calculated. RESULTS UC and WJ cross-section areas were significantly smaller in FGR+PE and FGR, but not in PE. The umbilical vessel wall area was decreased in FGR+PE, but the thickness was not significantly decreased in all three study groups, compared to controls. DSA was smaller in all three groups, whereas DBA was not significantly different, compared to controls. CONCLUSIONS Smaller UC cross-section areas were seen in FGR and FGR+PE, but not in PE without FGR. However, there is no evidence to determine whether this reduction is a cause or consequence of FGR. Reduced DSA in PE, whose UC cross-section area was not smaller as in FGR and FGR+PE, might reflect alterations in UC induced by PE.

Diagnostic Aspects of Fine Needle Aspiration for Lung Lesions: Series of 245 Cases

BACKGROUND Transthoracic fine needle aspiration (FNA) is one of several methods for establishing tissue diagnosis of lung lesions. Other tissue or cell sources for diagnosis include sputum, endobronchial biopsy, washing and brushing, endobronchial FNA, transthoracic core needle biopsy, biopsy from thoracoscopy or thoracotomy. The purpose of this study was to compare the sensitivity and specificity of FNA and other diagnostic tests in diagnosing lung lesions. MATERIALS AND METHODS The population included all patients undergoing FNA for lung lesions at Meir Medical Center from 2006 through 2010. Information regarding additional tissue tests was derived from the electronic archives of the Department of Pathology, patient records and files from the Department of Oncology. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculated for each test. RESULTS FNA was carried out in 245 patients. Malignant tumors were diagnosed in 190 cases (78%). They included adenocarcinoma (43%), squamous cell carcinoma (15%), non-small cell carcinoma, not otherwise specified (19%), neurondocrine tumors (7%), metastases (9%) and lymphoma (3%). The specificity of FNA for lung neoplasms was 100%; sensitivity and diagnostic accuracy were 87%. CONCLUSIONS FNA is the most sensitive procedure for establishing tissue diagnoses of lung cancer. Combination with core needle biopsy increases the sensitivity. Factors related to the lesion (nature, degenerative changes, location) and to performance of all stages of test affect the ability to establish a diagnosis.

The association between maternal serum first trimester free βhCG, second trimester intact hCG levels and foetal growth restriction and preeclampsia

Abstract The purpose of this study was to analyse the association between free beta hCG (fβhCG) increased levels and pregnancy complications (PC), foetal growth restriction (FGR) and preeclampsia (PE). This connection was evaluated in two stages (i) investigating the association between those PC with first trimester fβhCG and second trimester intact hCG (ihCG), and (ii) studying the association between these two analytes in the same pregnancy. This was a retrospective study in two settings: medical centre that provided data on fβhCG and ihCG levels in pregnancies with FGR and PE, and central laboratory that provided fβhCG and ihCG levels that were compared in the same pregnancy. No association was found between those PC and the hCG analytes, except for elevated ihCG levels and FGR. Elevated fβhCG (>3.00 MoM) was found in 570/16,849 (3.4%) women. However, only 14% of whom had elevated second trimester ihCG. A positive correlation was found between the magnitude of first trimester fβhCG levels and the percentage of women who had elevated second trimester ihCG. This association was determined by the magnitude of the elevation of fβhCG levels. Impact statement What is already known on this subject: The two analytes, first trimester fβhCG and second trimester ihCG, are independently produced and parameters of the biochemical screening during pregnancy. What the results of this study add: Referring to 3.00 MoM as cut-off levels, most pregnancies with elevated levels of first trimester fβhCG will have normal ihCG second trimester levels. What the implications are of these findings for clinical practice and/or further research: The risk of developing pregnancy complications, FGR and PE should be associated with second trimester ihCG levels. About 3.5% of women had high fβhCG levels during the first trimester. However, only 14% also had increased ihCG levels, defined as >3.00 MoM; additional studies are needed to explore the association between increased first trimester fβhCG levels and the risk of developing pregnancy complications, independent of ihCG levels in the second trimester.