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Twin Anemia Polycythemia Sequence: Knowledge and Insights After 15 Years of Research

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Maternal-Fetal Medicine 2021年第1期3卷 33-41页

作者： Lisanne S.A.Tollenaar Enrico Lopriore Dick Oepkes Monique C.Haak Frans J.C.M.Klumper Johanna M.Middeldorp Jeanine M.M.Van Klink Femke Slaghekke Department of Obstetrics Division of Fetal therapyLeiden University Medical CenterLeiden 2333 ZAThe Netherlands Department of Pediatrics Division of NeonatologyLeiden University Medical CenterLeiden 2333 ZAThe Netherlands

Twin anemia polycythemia sequence (TAPS) is a chronic form of unbalanced feto-fetal transfusion through minuscule placental anastomoses in monochorionic twin pregnancies, leading to anemia in the donor twin and polycythemia in the recipient twin. TAPS can occur spontaneously in up to 5% of monochorionic twins or can arise in 2%-16% of cases after incomplete laser surgery for twin-twin transfusion syndrome. TAPS can develop across the entire second and third trimester. Antenatal diagnosis for TAPS is reached via Doppler measurement of the fetal middle cerebral artery peak systolic velocity, showing an increased velocity in the donor, combined with a decreased velocity in the recipient. Treatment options for TAPS include expectant management, preterm delivery, intrauterine blood transfusion with or without a partial exchange transfusion, fetoscopic laser surgery and selective feticide. The best treatment option is unclear and is currently being investigated in an international multicenter randomized trial (the TAPS trial). Spontaneous fetal demise occurs in 5%-11% of TAPS twins, more often in donors (8%-18%) than in recipients (2%-5%). Severe long-term neurodevelopmental impairment is seen in 9% of TAPS twins, with donors having an increased risk for cognitive impairment and hearing problems (15%).

关键词： Polycythemia Anemia Twin anemia polycythemia sequence Monochorionic twins Twin-twin transfusion syndrome placenta

Embryonic-like stem cells derived from postpartum placenta delivered after spotaneous labor emerging as universal prophylactic cancer vaccine

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Stem Cell Discovery 2013年第4期3卷 240-250页

作者： Manole Corocleanu Private Brasov Romania

In the eighth decade of the last century extensive clinical delayed-type hypersensitivity (DTH) skin tests to an intradermal injection of a pharmaceutical allogeneic human placenta Suspension (phPS) performed in obstetrical, gynecological and control group patients have shown positive reaction in 239 patients with clinical conditions having been as histopatrhological substratum, a hypoxia-induced adaptive/reactive epithelial cell proliferation, e.g. syncytiotrophoblastic cell hyperplasia, endometrial cell hyperplasia, or different gynecological cancers. Because the immune response against phPS has shown antigenc similarities between normal placental and endometrial hyperplastic cells and different kinds of cancer cells and because many cancers adopt an embryonic stem-like gene expression pattern, it is suggested that the profile of hypoxia-promoting placental and endometrial stem cell proliferation is more embryonic-like, and that the immune respose against phPS is expected to cross-react with tumor cells in vivo. In the process of persistent growth and accelerated oxygen consumption by hyperplastic cytotrophoblastic cells and neoplastic cells in a hypoxic microenvironment, a basic shift in energy metabolism is accompanied by appearance of heat shock proteins (HSPs), of fetal isoenzymes and of membrane glycoproteins (reappearance of oncofetal antigens, OFAs), which, as result of their overexpression/amplification may induce a host immunological response. Thus, it is assumed that phPS prepared from full-term human placentas delivered after a spontaneous labor comprises stem/progenitor cells reverted to a proliferative embryonic stem cell-like-state upon exposure to labor-inducing intrmittent placental hypoxia and that by expressing HSP/OFAs could immunize to generate immune response againjst a variety of antigens that are shared by different kinds of epithelial cancers. This immunological feature of phPS qualifies is as a vaccine-related product that may be used for a preventive cancer vaccine when mixed with a po

关键词： placenta Embryonic-Like Stem Cells Preventive Cancer Vaccine

Isolation and partial molecular characterization of heat-stable growth factor from human placenta

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Science China(Life Sciences) 1998年第6期41卷 628-635页

作者：方云南王希成罗利群周海梦

A heat\|stable growth factor has been purified to homogeneity from human placenta. Purification procedure involved extraction with acidic medium, precipitation using ethanol, DE\|52 ion\|exchange chromatography, and reversed\|phase HPLC. The purified preparation has been named human placental growth factor\|1 (HPGF\|1), which simulates the proliferation of some cell lines, such as human amniotic cell, mouse marrow tumor cell, and mouse fibroblast cell. The growth factor has an approximate molecular weight of 1 900. It is a glycopeptide which contains a polypeptide chain consisting of 10 amino acid residues with molecular weight of 1 195. The N\|terminal residue of the polypeptide chain part is phenylalanine. The molecular weight of non\|peptide part is 682. The isoelectric point of the growth factor is pI 6.8.

关键词： human placenta growth factor active polypeptide purification.

Surgical Excision of placenta with Lower Uterine Segment as a Conservative Management in a Case of placenta Accreta: A Case Report

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Open Journal of Obstetrics and Gynecology 2018年第1期8卷 63-68页

作者： Ahmed Sherif Abdel Hamid Abdel Wahab Mohamed Mohamed Yaseen Department of Obstetrics & Gynecology Ain-Shams University Cairo Egypt Department of Urology Ain-Shams University Cairo Egypt

Introduction: placenta accreta is due to invasive placental implantation. It is diagnosed when there is failure of delivery of a retained placenta. This is usually complicated by massive intrapartum hemorrhage that ends by hysterectomy. Case: We report a case of conservative management in a case of placenta accreta involving an elliptical shape incision of the lower segment with removal of placenta with underlying lower uterine segment in a stable patient desiring future fertility. Conclusion: Conservative management may be valid in carefully selected cases of placenta accreta diagnosed pre-operatively in tertiary hospitals with availability of blood-bank and multi-disciplinary approach.

关键词： placenta Accreta Conservative Management Elliptical Incision Cystostomy

Syncytiotrophoblast Derived Extracellular Vesicles in Relation to Preeclampsia

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Maternal-Fetal Medicine 2021年第2期3卷 151-160页

作者： William R.Cooke Gabriel D.Jones Christopher W.G.Redman Manu Vatish Nuffield Department of Women’s and Reproductive Health University of OxfordOxfordOX39DUUK

The syncytiotrophoblast,a fused single-cell layer between mother and fetus,constitutively releases extracellular vesicles(STBEV)directly into the maternal circulation.STBEV contain a variety of proteins and RNA which can be targeted to specific cells.In preeclampsia,asymptomatic placental oxidative stress is a precursor to later multi-organ dysfunction in the mother.Increased STBEV release in preeclampsia is considered a manifestation of syncytiotrophoblast stress,which may play a key role in signaling between fetus and mother.STBEV release in preeclampsia changes,both in terms of volume and content.In this review,we outline the latest advances in STBEV isolation and detection.We consider evidence for differential STBEV release,protein cargo and RNA content in preeclampsia,highlighting common pitfalls in study design.We summarise studies to date demonstrating STBEV actions on target cells.Ultimately,we consider how STBEV fit into the pathophysiology of the heterogeneous syndrome of preeclampsia.The key unifying concept in early-and late-onset preeclampsia is syncytiotrophoblast stress.We submit that STBEV are the key stress signal in preeclampsia.We believe that further investigation of STBEV release,content,and actions may offer valuable insights into preeclampsia pathophysiology and potential new clinical diagnostics and therapeutic targets.

关键词： Biomarkers Diagnostics Extracellular vesicles placenta Preeclampsia Signalling Stress Syncytiotrophoblast

Outcome of Patients with placenta Accreta at El Shatby Maternity University Hospital

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Open Journal of Obstetrics and Gynecology 2017年第7期7卷 725-733页

作者： Eman Ali AbdElfatah Elsayed Elbadwy Mohamed Awad Tamer Mamdouh Abd-Eldaym Zynab Hassan Ali Department of Obstetrics and Gynecology Faculty of Medicine Alexandria University Alexandria Egypt

Objective: The aim of this study was to determine the incidence, risk factors, and outcomes of management of patients with placenta accreta. Background placenta accreta occurs when the placental implantation is abnormal. The marked increase in incidence has been attributed to the increasing prevalence of cesarean delivery in recent years. The most common theory is defective decidualization. The most important risk factor for placenta accreta is placenta previa after a prior cesarean delivery. The first clinical manifestation of placenta accreta is usually profuse, life-threatening hemorrhage. The recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ. Patients and methods: It’s a study of all cases of placenta accreta at El-Shatby Maternity University Hospital starting from 1/4/2016 till 1/10/2016. Selection of the cases will only be dependent upon their pregnancy gestational age above 28 weeks of gestation. Results: The incidence of placenta accreta was 1/75 cesarean deliveries. The ultrasonography and doppler had a false negative rate of 54.6% and a sensitivity of 45.2% in diagnosis of placenta accreta. The rate of blood transfusion was 79.6%. Uterine preserving procedures performed in 66%. Cesarean hysterectomy performed in 34%. Intensive care unit admission occurred in 27.3%. The mean gestational age at delivery was 33.8 ± 4.6 weeks’ gestation. 31.8% admitted to the neonatal intensive care unit. Conclusion: The incidence of placenta accreta increased due to the increasing rate of cesarean deliveries, prenatal diagnosis of placenta accreta is paramount, as most women are asymptomatic. Prenatal diagnosis allows time for a multidisciplinary team to make delivery plans, which will help decrease surgical complications.

关键词： Pregnancy Cesarean Deliveries placenta Accreta Postpartum Haemorrhage Blood Transfusion Hysterectomy

Clinical Analysis on the Effectiveness of Conservative Compression Suture Technique to Conserve Fertility on Pernicious placenta Previa

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Open Journal of Obstetrics and Gynecology 2019年第1期9卷 62-72页

作者： Krishna Pyari Duguju Jin He Shuxin Li Ashu Shrestha Nasrat Rahim Yanhong Shan Department of Obstetrics and Gynecology The First Hospital of Jilin University Changchun China Department of Radiology China-Japan Union Hospital of Jilin University Changchun China

Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.

关键词： Pernicious placenta Previa Conservative Compression Suture Techniques Cesarean Section Hysterectomy Fertility

Frequency of placenta Previa and Maternal Morbidity Associated with Previous Cesarean Delivery

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Open Journal of Obstetrics and Gynecology 2014年第14期4卷 903-908页

作者： Anisodowleh Nankali Farahnaz Keshavarzi Atefeh Shajari Sara Daeichin Kermanshah University of Medical Sciences Kermanshah Iran MSc Student in Obstetrics Students Research Committee School of Nursing and Midwifery Kermanshah University of Medical Sciences Kermanshah Iran

Background: placenta previa (P.P) is a rare pregnancy complication where a placenta particularly or completely covers the internal cervical os thereby preventing normal vaginal delivery. This study was conducted to evaluate the relationship between repeated cesarean deliveries and subsequent development of placenta previa. Methods & Materials: This cross-sectional study was held in Imam Reza Hospital Kermanshah-Iran during 2008-2011. This study included all pregnant women with repeated cesarean sections while nullipara and patients with placenta previa without previous surgery were excluded. Diagnosis was made on ultrasound and at surgery. Results: among 2696 Women, 98 cases had P.P (3.63%). The mean age was 30 years, 76.5% (75 cases) had gravidity 2 and 3 and 87.8% (86 cases) had parity 1 - 3. Anterior location of placenta was 44.9% while posterior was 55.1%. 48% were complete P.P, 32.7% low lying P.P, 13.3% marginal P.P, and 6% Partial P.P. 26.5% of patients had history of abortion. 55.1% of patients had male fetus. There was an increase in frequency of placenta previa with just one previous C-section (74.5%). Frequency of accreta P.P 32% (n = 7), increta (14.3%, n = 3) and percreta 28% (n = 6). Among those who underwent emergency hysterectomy (21 cases) 23.8% cases had no abnormal placentation. 30.6% of newborns had birth weight placenta previa and need to hysterectomy were more than those with history of 2 and 3 previous cesarean delivery. The most common type of abnormal placentation was accreta, percreta and increta respectively.

关键词： placenta Previa Cesarean Maternal Morbidity

Mechanisms of calcium transport across the placenta: Review

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Open Journal of Animal Sciences 2013年第1期3卷 13-20页

作者： Catarina Tivane Marcio Nogueira Rodrigues Phelipe Oliveira Favaron Antonio Chaves de Assis Neto Eduardo Harry Birgel Júnior Maria Angelica Miglino Faculty of Food Engineering and Animal Science University of Sao Paulo Sao Paulo Brazil Faculty of Veterinary Medicine and Animal Science University of Sao Paulo Sao Paulo Brazil Faculty of Veterinary Medicine and Animal Science University of Sao Paulo Sao Paulo Brazil

Studies of calcium transfer across the placenta have been reviewed because of the physiological and nutritional importance of this mineral during pregnancy, especially in order to better understand its contribution to development of the fetal skeleton. The placental transfer of maternal calcium to the fetus represents a vital mechanism for fetal development and breast-milk production, yet little meaningful information is currently available regarding the biochemical mechanisms involved in this process. Once again, the use of different animal models as rodents, rabbit, sheep and bovine have demonstrate different mechanisms of calcium transport across the placenta and contribute to better understand its effects in both fetus and mother during the gestation. In relation to the transfer of calcium from the mother to fetus data suggest it occur via an active mechanism;thus calcium concentration is higher in fetus than in maternal blood. Despite conflicting reports, several investigators agreed that calcium concentration in the fetal blood is mainly regulated by fetal parathyroid hormone and plasma concentration of vitamin D3, a metabolite that plays a key role in calcium transport through the syncytial cells.

关键词： Calcium Transplacental Homeostasis Transport placenta