Analysis of pathomorphological characteristics of the placental structure in cases of prenatally diagnosed fetal congenital heart disease

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective: The purpose of the study was to determine placental pathologic changes associated with live-born premature and small-for-gestational-age (SGA) infants in cases of prenatally diagnosed fetal congenital heart disease (CHD).

Materials and methods: A comparative retrospective analysis of the results of pathologic examination of placentas was carried out in the cohort of 115 cases with fetal CHD, that was formed prenatally and divided into groups depending on the gestational age at delivery and birth weight of newborns. Group 1 consisted of 15 cases with premature and/or SGA infants. Group 2 consisted of 100 newborns with birth weight ≥ the 10th percentile.

Results: Examination of placentas in the general cohort showed small for gestational age in 59.1% of cases, abnormal shape in 53%, infarctions in 15.6%, delayed maturation of the vascular tree in 13.3%, meconium staining of the membranes in 8 .7%, massive fibrin deposition in 7.8%, multiple calcifications in 2.6% of cases. There were differences in the placental weight between the groups: the values less that the 3rd percentile and the 10th percentile were in 80% vs 40%, 93.3% vs 54%, in group 1 and group 2, respectively (p<0.01). It was found that the odds ratio for giving birth to premature and/or SGA babies with CHD, when placental weight was less that the 3rd and the 10th percentile, was 6.0 and 11.9, respectively.

Conclusion: According to the results of the pathologic examination of the placenta in cases of congenital heart disease, multiple macro- and microscopic signs of pathological changes were found in the fetus. A significant association between small placental weight and the birth of SGA or premature infant with cardiac pathology indicates the need to expand the scope of prenatal ultrasound examination for searching the markers of placental dysfunction in the diagnosis of fetal cardiac anomalies.

Full Text

Restricted Access

About the authors

Tamara A. Yarygina

Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky; A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of Russia; Peoples' Friendship University of Russia named after Patrice Lumumba

Author for correspondence.
Email: tamarayarygina@gmail.com
ORCID iD: 0000-0001-6140-1930

PhD, Head of the Ultrasound Diagnostics Department; Researcher at the Perinatal Cardiology Center; Associated Professor at the Department of Ultrasound Diagnostics of the Faculty of Continuing Medical Education of the Medical Institute

Russian Federation, Moscow; Moscow; Moscow

Rena M. Gasanova

A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of Russia; Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: rmgasanova@bakulev.ru
ORCID iD: 0000-0003-3318-1074

Dr. Med. Sci., Head of the Perinatal Cardiology Center; Physician of Ultrasound Diagnostics, Department of Ultrasound and Functional Diagnostics

Russian Federation, Moscow; Moscow

Olga V. Marzoeva

A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of Russia

Email: ovmarzoeva@bakulev.ru
ORCID iD: 0000-0003-4475-0105

PhD, Doctor of Ultrasound Diagnostics, Researcher at the Perinatal Cardiology Center

Russian Federation, Moscow

Elena V. Sypchenko

A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of Russia

Email: evsypchenko@bakulev.ru
ORCID iD: 0000-0002-8809-7913

PhD, Doctor of Ultrasound Diagnostics at Perinatal Cardiology Center

Russian Federation, Moscow

Elena I. Leonova

A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of Russia

Email: eileonova@bakulev.ru
ORCID iD: 0000-0002-6140-7950

Doctor of Ultrasound Diagnostics at Perinatal Cardiology Center

Russian Federation, Moscow

Vyacheslav M. Lyapin

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_lyapin@oparina4.ru

Pathologist of the Pathology Department

Russian Federation, Moscow

Alexander I. Shchegolev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: ashegolev@oparina4.ru
ORCID iD: 0000-0002-2111-1530

Dr. Med. Sci., Professor, Head of the 2nd Pathoanatomical Department

Russian Federation, Moscow

Alexander I. Gus

Peoples' Friendship University of Russia named after Patrice Lumumba; Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_gus@oparina4.ru
ORCID iD: 0000-0003-1377-3128

Dr. Med. Sci., Professor, Chief Researcher at the Department of Ultrasound and Functional Diagnostics; Head of the Department of Ultrasound Diagnostics of the Faculty of Continuing Medical Education of the Medical Institute

Russian Federation, Moscow; Moscow

References

  1. Burton G.J., Fowden A.L., Thornburg K.L. Placental origins of chronic disease. Physiol. Rev. 2016; 96(4): 1509-65. https://dx.doi.org/10.1152/physrev.00029.2015.
  2. Barker D.J., Thornburg K.L. Placental programming of chronic diseases, cancer and lifespan: a review. Placenta. 2013; 34(10): 841-5. https://dx.doi.org/10.1016/j.placenta.2013.07.063.
  3. Ярыгина Т.А., Гасанова Р.М., Марзоева О.В., Сыпченко Е.В., Леонова Е.И. Ишемическая болезнь сердца как следствие эпигенетических модификаций и фетального программирования при задержке роста плода. Креативная кардиология. 2023; 17(2): 189-202. [Yarygina T.A., Gasanova R.M., Marzoeva O.V., Sypchenko E.V., Leonova E.I. Ischemic heart disease as a consequence of epigenetic modifications and fetal programming in fetal growth retardation. Creative Cardiology. 2023; 17(2): 189-202. (in Russian)]. https://dx.doi.org/10.24022/1997-3187-2023-17-2-189-202.
  4. Maslen C.L. Recent advances in placenta-heart interactions. Front. Physiol. 2018; 9: 735. https://dx.doi.org/10.3389/fphys.2018.00735.
  5. Liu H.J., Liu P.C., Hua J., Zhao Y., Cao J. Placental weight and size in relation to fetal growth restriction: a case-control study. J. Matern. Fetal Neonatal Med. 2021; 34(9): 1356-60. https://dx.doi.org/10.1080/14767058.2019.1636371.
  6. Salavati N., Smies M., Ganzevoort W., Charles A.K., Erwich J.J., Plösch T. et al. The possible role of placental morphometry in the detection of fetal growth restriction. Front. Physiol. 2019; 9: 1884. https://dx.doi.org/10.3389/fphys.2018.01884.
  7. Albalawi A., Brancusi F., Askin F., Ehsanipoor R., Wang J., Burd I. et al. Pla-cental characteristics of fetuses with congenital heart disease. J. Ultrasound Med. 2017; 36(5): 965-72. https://dx.doi.org/10.7863/ultra.16.04023.
  8. Aliasi M., Snoep M.C., van Geloven N., Haak M.C. Birthweight and isolated congenital heart defects - a systematic review and meta-analysis. BJOG. 2022; 129(11): 1805-16. https://dx.doi.org/10.1111/1471-0528.17164.
  9. Matthiesen N.B., Henriksen T.B., Agergaard P., Gaynor J.W., Bach C.C., Hjortdal V.E. et al. Congenital heart defects and indices of placental and fetal growth in a nationwide study of 924 422 liveborn infants. Circulation. 2016; 134(20): 1546-56. https://dx.doi.org/10.1161/CIRCULATIONAHA.116.021793.
  10. Best K.E., Tennant P.W.G., Rankin J. Survival, by birth weight and gestational age, in individuals with congenital heart disease: a population-based study. J. Am. Heart Assoc. 2017; 6(7): e005213. https://dx.doi.org/10.1161/JAHA.116.005213.
  11. Yoshida T., Hiraiwa A., Ibuki K., Makimoto M., Inomata S., Tamura K. et al. Neurodevelopmental outcomes at 3 years for infants with congenital heart disease and very-low birthweight. Pediatr. Int. 2020; 62(7): 797-803. https://dx.doi.org/10.1111/ped.14160.
  12. Gimeno L., Brown K., Harron K., Peppa M., Gilbert R., Blackburn R. Trends in survival of children with severe congenital heart defects by gestational age at birth: a population-based study using administrative hospital data for England. Paediatr. Perinat. Epidemiol. 2023; 37(5): 390-400. https://dx.doi.org/10.1111/ppe.12959.
  13. Rychik J., Goff D., McKay E., Mott A., Tian Z., Licht D.J. et al. Characterization of the placenta in the newborn with congenital heart disease: distinctions based on type of cardiac malformation. Pediatr. Cardiol. 2018; 39(6): 1165-71. https://dx.doi.org/10.1007/s00246-018-1876-x.
  14. O'Hare C.B., Mangin-Heimos K.S., Gu H., Edmunds M., Bebbington M., Lee C.K. et al. Placental delayed villous maturation is associated with fetal congeni-tal heart disease. Am. J. Obstet. Gynecol. 2023; 228(2): 231.e1-231.e11. https://dx.doi.org/10.1016/j.ajog.2022.08.013.
  15. Щеголев А.И., Туманова У.Н., Шувалова М.П., Фролова О.Г. Сравнительный анализ мертворождаемости в Российской Федерации в 2010 и 2012 гг. Российский вестник перинатологии и педиатрии. 2015; 60(3): 58-62. [Shchegolev A.I., Tumanova U.N., Shuvalova M.P., Frolova O.G. Comparative analysis of stillbirth rates in the Russian Federation in 2010 and 2012. Russian Bulletin of Perinatology and Pediatrics. 2015; (3): 58-62. (in Russian)].
  16. Щеголев А.И., Туманова У.Н., Чаусов А.А., Шувалова М.П. Мертворожде-ние в Российской Федерации в 2020 году (год пандемии COVID-19). Акушерство и гинекология. 2022; 11: 131-40. [Shchegolev A.I., Tumanova U.N., Chausov A.A., Shuvalova M.P. Stillbirths in the Russian Federation in 2020 (COVID-19 pandemic year). Obstetrics and Gynecology. 2022; (11): 131-40. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.11.131-140.
  17. Щеголев А.И., Туманова У.Н., Серов В.Н. Роль плаценты в развитии поражений головного мозга новорожденного. Акушерство и гинекология. 2023; 8: 38-47. [Shchegolev A.I., Tumanova U.N., Serov V.N. The role of the placenta in the development of neonatal brain lesions. Obstetrics and Gynecology. 2023; (8): 38-47. (in Russian)]. https://dx.doi.org/10.18565/aig.2023.185.
  18. Nijman M., van der Meeren L.E., Nikkels P.G.J., Stegeman R., Breur J.M.P.J., Jansen N.J.G. et al.; CHD LifeSpan Study Group. Placental pathology con-tributes to impaired volumetric brain development in neonates with congenital heart disease. J. Am. Heart Assoc. 2024; 13(5): e033189. https://dx.doi.org/10.1161/JAHA.123.033189.
  19. Цибизова В.И., Первунина Т.М., Артеменко В.А., Бицадзе В.О., Гоциридзе К.Э., Аверкин И.И., Блинов Д.В., Новикова Н.Ю. Ключевая функция плаценты в формировании врожденного порока сердца плода. Акушерство, гинекология и репродукция. 2022; 16(1): 66-72. [Tsibizova V.I., Pervunina T.M., Artemenko V.A., Bitsadze V.O., Gotsiridze K.E., Averkin I.I., Blinov D.V., Novikova N.Yu. Placenta crucially affects formation of fetal congenital heart disease. Obstetrics, Gynecology and Reproduction. 2022; 16(1): 66-72. (in Russian)]. https://dx.doi.org/10.17749/2313-7347/ ob.gyn.rep.2022.262.
  20. Ярыгина Т.А., Гасанова Р.М., Марзоева О.В., Леонова Е.И., Малоземова О.Г., Сыпченко Е.В. Особенности развития и функции плаценты при врожденном пороке сердца у плода. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. Сердечно-сосудистые заболевания. 2023; 24(S6): 192. [Yarygina T.A., Gasanova R.M., Marzoeva O.V., Leonova E.I., Malozemova O.G., Sypchenko E.V. Features of the development and function of the placenta in congenital heart disease in the fetus. Bulletin of Bakoulev Center. Cardiovascular Diseases. 2023; 24(S6): 192. (in Russian)].
  21. Кравченко Е.Н., Коломбет Е.В., Любавина А.Е. Исследование плода и плаценты при врожденных пороках развития, несовместимых с жизнью. Лечащий врач. 2017; 10: 62. [Kravchenko E.N., Colombet E.V., Lyubavina A.E. Study of the fetus and placenta in congenital malformations incompatible with life. Lechaschi Vrach. 2017; (10): 62. (in Russian)].
  22. Щеголев А.И., Павлов К.А., Дубова Е.А., Фролова О.Г. Ранняя неонатальная смертность в Российской Федерации в 2010 г. Архив патологии. 2013; 75(4): 15-9. [Shchegolev A.I., Pavlov K.A., Dubova E.A., Frolova O.G. Early neonatal mortality in the Russian Federation in 2010. Russian Journal of Archive of Pathology. 2013; 75(4): 15-9. (in Russian)].
  23. Туманова У.Н., Шувалова М.П., Щеголев А.И. Анализ статистических показателей врожденных аномалий как причины ранней неонатальной смерти в Российской Федерации. Российский вестник перинатологии и педиатрии. 2018; 63(6): 60-7. [Tumanova U.N., Shuvalova M.P., Shchegolev A.I. Analysis of statistical indicators of congenital anomalies as causes of early neonatal death in the Russian Federation. Russian Bulletin of Perinatology and Pediatrics. 2018; 63(6): 60-7. (in Russian)]. https://dx.doi.org/10.21508/10274065-2018-63-5-60-67.
  24. Villar J., Cheikh Ismail L., Victora C.G., Ohuma E.O., Bertino E., Altman D.G. et al.; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014; 384(9946): 857-68. https://dx.doi.org/10.1016/S0140-6736(14)60932-6.
  25. Щеголев А.И. Современная морфологическая классификация повреждений плаценты. Акушерство и гинекология. 2016; 4: 16-23. [Shchegolev A.I. Current morphological classification of damages to the placenta. Obstetrics and Gynecology. 2016; (4): 16-23. (in Russian)]. https://dx.doi.org/10.18565/aig.2016.4.16-23.
  26. Flatley C., Sole-Navais P., Vaudel M., Helgeland Ø., Modzelewska D., Johansson S. et al. Placental weight centiles adjusted for age, parity and fetal sex. Placenta. 2022; 117: 87-94. https://dx.doi.org/10.1016/j.placenta.2021.10.011.
  27. Здравоохранение в России. 2023. Статистический сборник. М.: Росстат; 2023. 181с. [Healthcare in Russia. 2023. Statistical collection. Moscow: Rosstat; 2023. 181p. (in Russian)].
  28. Щеголев А.И., Серов В.Н. Клиническая значимость поражений плаценты. Акушерство и гинекология. 2019; 3: 54-62. [Shchegolev A.I., Serov V.N. Clinical significance of placental lesions. Obstetrics and Gynecology. 2019; (3): 54-62. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.3.54-62.
  29. Туманова У.Н., Щеголев А.И. Поражения плаценты в генезе мертворождения (обзор литературы). Международный журнал прикладных и фундаментальных исследований. 2017; (3-1): 77-81. [Tumanova U.N., Shchegolev A.I. Placental lesions as the cause of stillbirth (review). International Journal of Applied and Basic Research. 2017; (3-1): 77-81. (in Russian)]. https://dx.doi.org/10.17513/mjpfi.11403.
  30. Leon R.L., Sharma K., Mir I.N., Herrera C.L., Brown S.L., Spong C.Y. et al. Placental vascular malperfusion lesions in fetal congenital heart disease. Am. J. Obstet. Gynecol. 2022; 227(4): 620.e1-620.e8. https://dx.doi.org/10.1016/ j.ajog.2022.05.038.
  31. Ortinau C.M., Newburger J.W. Placenta-heart-brain connection in congenital heart disease. J. Am. Heart Assoc. 2024; 13(5): e033875. https://dx.doi.org/10.1161/JAHA.124.033875.
  32. Carvalho J.S., Axt-Fliedner R., Chaoui R., Copel J.A., Cuneo B.F., Goff D. et al. ISUOG Practice Guidelines (updated): fetal cardiac screening. Ultrasound Obstet. Gynecol. 2023; 61(6): 788-803. https://dx.doi.org/10.1002/uog.26224.
  33. Rychik J., Donaghue D.D., Levy S., Fajardo C., Combs J., Zhang X. et al. Maternal psychological stress after prenatal diagnosis of congenital heart disease. J. Pediatr. 2013; 162(2): 302-7.e1. https://dx.doi.org/10.1016/j.jpeds.2012.07.023.
  34. Williams A., Saizy S., Mendola P., Grobman W., Subramaniam A., Stevens D.R. et al. Prenatal exposure to perceived stress, maternal asthma, and placental size. Placenta. 2023; 139: 127-33. https://dx.doi.org/10.1016/j.placenta.2023.06.012.
  35. Rajagopalan V., Schmithorst V., El-Ali A., Reynolds W., Lee V., Wallace J. et al. Associations between maternal risk factors and intrinsic placental and fetal brain functional properties in congenital heart disease. Int. J. Mol. Sci. 2022; 23(23): 15178. https://dx.doi.org/10.3390/ijms232315178.
  36. Приказ Министерства здравоохранения РФ от 20.10.2020 N1130н "Об утверждении Порядка оказания медицинской помощи по профилю "акушерство и гинекология". 611 с. [Order of the Ministry of Health of Russian Federation dated October 20, 2020 N1130n "On approval of the Procedure for the provision of medical care in the field of obstetrics and gynecology". 611p. (in Russian)].
  37. Josowitz R., Linn R., Rychik J. The placenta in congenital heart disease: form, function and outcomes. Neoreviews. 2023; 24(9): e569-e582. https://dx.doi.org/10.1542/neo.24-9-e569.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2024 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies