Paula Zozzaro-Smith

Whole mount immunofluorescence analysis of placentas from normotensive versus preeclamptic pregnancies.

INTRODUCTION Defects in placental angiogenesis and spiral artery remodeling have been proposed to play essential roles in the development of preeclampsia. However, the specific molecular mechanism(s) responsible for aberrant placental angiogenesis in preeclampsia are incompletely understood. The vascular endothelial growth factor receptors (VEGFR1, R2, R3) and STAT3 have critical functions in normal blood vessel development, but their potential roles in preeclampsia are currently unclear. In this study, we utilized a novel whole mount immunofluorescence (WMIF) method to compare expression of VEGFR1, R2, R3 and activated, phosphorylated STAT3 (pSTAT3) in placentas of preeclamptic (PE) versus normotensive (NT) pregnancies. METHODS Placental biopsies collected from NT and PE pregnant women were fixed and stained with fluorochrome-conjugated antibodies to identify specific cell populations as follows: CD31 for blood vessel endothelial cells, cytokeratin-7 for trophoblast cells, and CD45 for immune cells. Expression of the VEGFRs and pSTAT3 were subsequently characterized by WMIF in conjunction with confocal microscopy. RESULTS A total of 18 PE and 18 NT placentas were evaluated. No significant differences in the cell type-specific expression patterns or expression levels of VEGFR1, VEGFR2 or VEGFR3 were detected between NT and PE placentas. In contrast, statistically significant increases in pSTAT3 staining were detected in endothelial cells of PE placentas versus NT controls. DISCUSSION Our study demonstrates that increased pSTAT3 expression in placental endothelial cells is associated with PE. We speculate that elevated pSTAT3 expression in the blood vessels of PE placentas may be due to aberrant angiogenesis, increased pro-inflammatory cytokine expression, and/or placental stress.

Limitations of Aneuploidy and Anomaly Detection in the Obese Patient

Obesity is a worldwide epidemic and can have a profound effect on pregnancy risks. Obese patients tend to be older and are at increased risk for structural fetal anomalies and aneuploidy, making screening options critically important for these women. Failure rates for first-trimester nuchal translucency (NT) screening increase with obesity, while the ability to detect soft-markers declines, limiting ultrasound-based screening options. Obesity also decreases the chances of completing the anatomy survey and increases the residual risk of undetected anomalies. Additionally, non-invasive prenatal testing (NIPT) is less likely to provide an informative result in obese patients. Understanding the limitations and diagnostic accuracy of aneuploidy and anomaly screening in obese patients can help guide clinicians in counseling patients on the screening options.

Loeys-Dietz syndrome in pregnancy

Abstract Loeys-Dietz syndrome results from mutations in genes encoding the transforming growth factor-β receptor. Women with similar syndromes are at risk of obstetrical complications, including vessel and uterine rupture during labor. There are few reports regarding the safety of pregnancy in women with Loeys-Dietz syndrome, and the available literature recommends early cesarean delivery. We report a case of a successful vaginal delivery at 36 weeks of gestation in a primigravid woman. Prenatal imaging revealed no vascular abnormalities and echocardiogram demonstrated normal cardiac anatomy. Her pregnancy and delivery were uneventful, and the baby was also found to have the mutation on postnatal molecular testing. In a low-risk individual, vaginal delivery at term may be considered a reasonable approach in this group of women.

Enlargement of hepatic hemangioma in successive pregnancies

Abstract Hemangiomas are the most common benign tumor of the liver and are commonly seen as incidental findings on abdominal imaging. Little is known regarding the natural course and pathogenesis of hepatic hemangiomas during pregnancy. It is believed estrogen may play a role in their growth; however, the precise mechanism remains undefined. Here we describe a patient with hepatic hemangioma enlargement in consecutive pregnancies suggesting a hormonal role in their growth.

Association between obesity during pregnancy and the use of prenatal services.

INTRODUCTION: Approximately 25% of women in the United States are obese (body mass index greater than 30 kg/m2). Obese women are at risk for poor perinatal outcomes, and studies imply that inadequate, late onset, or both of prenatal care are contributing factors in this population. We previously demonstrated that maternal obesity is actually associated with improved adequacy of prenatal care as measured by the Kotelchuck index and now further examine the use of specific prenatal services by otherwise uncomplicated obese women. METHODS: Retrospective cohort study of medically uncomplicated women who initiated prenatal care and delivered at our institution from January 2009 to December 2011. Maternal history and delivery information were obtained through chart abstraction. Use of specific prenatal care services including diabetic screening, ultrasound examinations, and hospitalization was compared between nonobese and obese women. RESULTS: A total of 320 women were evaluated, of whom 38% were obese. Mean (±standard error) length of hospital stay for combined intrapartum and postpartum care was 3.0±0.1 days in obese women compared with 2.9±0.1 days in nonobese women (P=.4). Both populations had similar diabetic screening compliance of 86.4% for nonobese and 86.8% for obese women (P=.9). However, obesity was significantly associated with more obstetrical ultrasonographic examinations with 48% obese women having five or more ultrasound scans compared with only 25% of nonobese women (P<.05). CONCLUSION: In our population, obesity in otherwise uncomplicated pregnant women is associated with increased use of obstetric ultrasound services, but there were no differences in use of other prenatal services.