Jean-Pierre Schaaps

Echocardiograhic and anatomic studies of the maternotrophoblastic border during the first trimester of pregnancy

The initiation of uteroplacental circulation was investigated in early pregnancy with the following material: contact ultrasonography, 250 cases; direct-vision chorionic biopsy, 10 cases; products from voluntary interruption of pregnancy, 60 cases; and hysterectomy with the pregnancy in situ, three cases. Using all of these techniques, we were unable to demonstrate a true intervillous blood flow during the first 12 weeks. We suggest that during this period the intervillous space is bathed by an acellular fluid that could be plasma filtered by the trophoblastic shell and its endovascular cone. If this is the case, the physiology of early pregnancy must be reconsidered.

Histological study of the materno-embryonic interface in spontaneous abortion

In a histological study of 184 specimens of complete spontaneous abortion, the following points were delineated. In cases of anomaly or death of the conceptus, there was a reduced trophoblastic penetration into the decidua and into the spiral arteries where physiological changes were limited or absent. Trophoblastic proliferation within the columns and the outer shell was limited with frequent disruption or even disappearance of the shell. These findings seem to be related to the untimely initiation of blood flow in the intervillous space which in turn is associated with arrest of pregnancy and eventual expulsion.

Dysregulation of anti-angiogenic agents (sFlt-1, PLGF, and sEndoglin) in preeclampsia—a step forward but not the definitive answer

Preeclampsia (PE) is a pregnancy-specific syndrome characterized by hypertension, proteinuria and edema, which resolves on placental delivery. It is thought to be the consequence of impaired placentation due to inadequate trophoblastic invasion of the maternal spiral arteries. In PE the maternal plasma concentration of free vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) is decreased whereas the concentration of soluble fms-like tyrosine kinase-1 (sFlt-1) and of soluble endoglin (sEng) is increased. These soluble receptors may bind VEGF, PLGF and TGFbeta1 and TGFbeta3 in the maternal circulation, causing endothelial dysfunction in many maternal tissues. Hence there is a view that the pathogenesis is more or less clarified. According to the vascular theory, poor placentation leads to poor uteroplacental perfusion and hypoxia, which stimulates sFlt-1 and sEng production causing the maternal syndrome. This assumption has been recently challenged. The role of hypoxia as the main stimulus for release of sFlt-1 has been questioned and the role of inflammatory mechanisms has been emphasized. According to this inflammatory theory, poor placentation may predispose more to placental oxidative stress than hypoxia and endothelial dysfunction may be part of a broader disorder of systemic inflammation. Finally, the recent demonstration of activating auto-antibodies to the angiotensin 1 receptor that experimentally play a major pathogenic role in PE further suggests a pleiotropism of aetiologies for this condition. The purpose of this review is to critically evaluate the recent hypotheses and their possible insights on early diagnosis, prevention and treatment.

Individual decisions in placenta increta and percreta: a case series.

Abstract Objective: Placenta increta or percreta is an uncommon pathology, sometimes associated with high maternal morbidity. Its prevalence increases proportionally to the number of cesarean sections. This study analyzed the changes of our management strategy to devise treatment guidelines for this uncommon disorder. Materials and methodology: Between 2005 and 2011, 10 cases of placenta increta or percreta were managed at our university hospital maternity department. Results: Among the 10 cases, seven were diagnosed prenatally. Two patients were diagnosed early, at 14 and 17 weeks of gestational age, and their pregnancies were terminated. Five had hysterectomies during the intrapartum period, and despite attempted conservative treatment for the two others, hysterectomy proved necessary 2 months postpartum because of intrauterine infections. Seven of the 10 women had hysterectomies. Conclusion: Prenatal diagnosis of placenta increta or percreta is essential to plan the delivery in a competent tertiary care center. The decision to perform a cesarean hysterectomy or leave the placenta in situ for spontaneous delivery is based on the extent of infiltration, the patient’s hemodynamic status, and her desire to remain fertile. The high-risk of infection and severe hemorrhage must not be overlooked should conservative treatment be chosen. This situation requires prolonged close monitoring.

Utilisation en routine clinique du genotypage foetal RHD sur plasma maternel: bilan de deux ans d'activite

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° 5 - p. 448-453

Fetal renal artery flow and renal echogenicity in the chronically hypoxic state.

The object of this study was to investigate the fetal renal arterial blood flow in normal and hyperechogenic kidneys during the third trimester of gestation. The pregnancies screened were all chronically hypoxic. Depending on the etiology of the intrauterine chronic hypoxia, the cases were divided into two study groups. Group I comprised 120 pregnant women with pregnancy-associated hypertension and/or proteinuria. Group II consisted of 87 pregnancies with intrauterine growth retardation. Both study groups included pregnant women from the third trimester. Hyperechogenic renal medullae were detected in 15 out of 120 cases with pregnancy-associated hypertension and/or proteinuria, and in 22 fetuses of the 87 pregnancies involving intrauterine growth retardation. Fetal renal hyperechogenicity appears to be an indicator of fetal arterial circulatory depression, correlated with pathological changes in the resistance index for the fetal renal arteries. The fetal renal arterial blood flow resistance index was significantly lower in hyperechogenic cases. This may also be an in utero indication of subsequent intrauterine and neonatal complications, such as cesarean section because of fetal distress (43%), treatment in a neonatal intensive care unit (51%) or increased perinatal mortality (5.4%, as compared with 0.8–1.0% in the normal population). Detailed ultrasound and Doppler examinations of renal parenchyma and arteries appear to be useful methods in the prenatal diagnosis of reduced renal perfusion and of intrauterine hypoxia to detect possible pathological fetal conditions in utero.

An unusual false-positive fetal RHD typing result using DNA derived from maternal plasma from a solid organ transplant recipient

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Circadian and circannual variations in cord blood hematopoietic cell composition

Several previous studies have demonstrated that cord blood unit composition is an important factor that may predict outcomes after cord blood transplantation, with higher doses of transplanted nucleated cells and hematopoietic stem and progenitor cells being associated with faster engraftment and better overall survival. In the setting of this study involving 3 University centers, we analyzed factors potentially influencing cord blood cell composition. In accordance with the results of several previous publications, we observed that gestational age, birth weight and babys gender impacted concentrations of nucleated and hematopoietic progenitor cells in cord blood. We also showed that uses of epidural anesthesia and of oxytocin were associated with higher concentrations of hematopoietic progenitor cells. Interestingly, we observed that nucleated cell and progenitor cell concentrations were also determined by time of day and month of delivery. Recent studies have suggested chronological rhythmic egress of hematopoietic stem and progenitor cells from the bone marrow to the peripheral blood in adult individuals. Our findings suggest that such physiological rhythm may not be restricted to post-natal life. We think our study may have practical implications for cord blood banking strategies and also raises questions about chronological rhythm in hematopoietic cell trafficking during fetal life.

Association rare d’un choriangiome et d’une hémangiomatose néonatale diffuse

Placental chorioangioma is a benign vascular tumor. Lesions larger than 4 cm may cause fetal and maternal complications. Its association with disseminated neonatal hemangiomatosis is rarely described. We report a case of a large chorioangioma associated with an hydrops foetalis and disseminated neonatal hemangiomatosis. The relationship between placental chorioangioma and hemangioma is briefly discussed.

A rare case of placental chorioangioma associated with neonatal disseminated hemangiomatosis

Placental chorioangioma is a benign vascular tumor. Lesions larger than 4 cm may cause fetal and maternal complications. Its association with disseminated neonatal hemangiomatosis is rarely described. We report a case of a large chorioangioma associated with an hydrops foetalis and disseminated neonatal hemangiomatosis. The relationship between placental chorioangioma and hemangioma is briefly discussed.