Skip to main content

Advertisement

SpringerLink
Log in

None, One, or Both Placentas Involved with Malperfusion Lesions in Twin Pregnancies Complicated by Preeclampsia—Does It Matter?

  • Original Article
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

We aimed to study the association between the number of placentas with vascular malperfusion lesions in dichorionic twin pregnancies complicated by preeclampsia and the severity of the disease and pregnancy outcomes. Dichorionic twin pregnancies with preeclampsia (n = 125), from January 2007–June 2018, were reviewed. Affected placenta was defined as the presence of maternal/fetal vascular malperfusion lesions. Maternal demographics, pregnancy characteristics, and neonatal outcomes were compared between three groups: no pathological placentas, one pathological placenta, and two pathological placentas. Composite adverse neonatal outcome was defined as ≥ 1 early neonatal complication. Regression analysis models were used to recognize independent associations with the number of involved placentas. The two pathological placenta group (n = 57 pregnancies), the one pathological placenta group (n = 40 pregnancies), and the no pathological placenta group (n = 28 pregnancies) differed in terms of gestational age (GA) at delivery (p < 0.001, p = 0.008) and the rates of severe features (p = 0.028, p = 0.047). Neonates born to the two pathological placenta group (n = 114), the one pathological placenta group (n = 80), and the no pathological placenta group (n = 56) were characterized by lower birth weights (p < 0.001, p = 0.031), higher rates of small for gestational age (SGA) (p = 0.017, p = 0.748), neonatal intensive care unit admission (p = 0.004, p = 0.013), and composite adverse neonatal outcome (p < 0.001, p = 0.025). By regression analyses, the presence of two pathological placentas was found to be independently associated with severe features (aOR = 5.1), GA at delivery < 32 weeks (aOR = 2.0), SGA (aOR = 2.5), and composite adverse neonatal outcome (aOR = 2.7). In dichorionic twin pregnancies, there is an association between the presences of placental vascular malperfusion lesions in none, one, or both placentas and the development of early and severe preeclampsia, as well as with SGA and adverse neonatal outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980–2010: age-period-cohort analysis. BMJ. 2013;347:f6564.

    Article  Google Scholar 

  2. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785–99.

    Article  Google Scholar 

  3. Bellamy L, et al. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.

    Article  Google Scholar 

  4. McDonald SD, et al. Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. Am Heart J. 2008;156(5):918–30.

    Article  Google Scholar 

  5. Simmons RA. Developmental origins of adult disease. Pediatr Clin N Am. 2009;56(3):449–66 Table of Contents.

    Article  Google Scholar 

  6. Hakim J, Senterman MK, Hakim AM. Preeclampsia is a biomarker for vascular disease in both mother and child: the need for a medical alert system. Int J Pediatr. 2013;2013:953150.

    Article  Google Scholar 

  7. Grace T, et al. Maternal hypertensive diseases negatively affect offspring motor development. Pregnancy Hypertens. 2014;4(3):209–14.

    Article  Google Scholar 

  8. Khong Y, Brosens I. Defective deep placentation. Best Pract Res Clin Obstet Gynaecol. 2011;25(3):301–11.

    Article  Google Scholar 

  9. Bustamante Helfrich B, et al. Maternal vascular malperfusion of the placental bed associated with hypertensive disorders in the Boston Birth Cohort. Placenta. 2017;52:106–13.

    Article  Google Scholar 

  10. Falco ML, et al. Placental histopathology associated with pre-eclampsia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017;50(3):295–301.

    Article  CAS  Google Scholar 

  11. Kalafat E, Thilaganathan B. Cardiovascular origins of preeclampsia. Curr Opin Obstet Gynecol. 2017;29(6):383–9.

    Article  Google Scholar 

  12. American College of, O., Gynecologists, and P. Task force on hypertension in, hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ task force on hypertension in pregnancy. Obstet Gynecol. 2013;122(5):1122–31.

    Article  Google Scholar 

  13. Practice Bulletin No. 169. Summary: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 2016;128(4):926–8.

    Article  Google Scholar 

  14. Wood SL, et al. Evaluation of the twin peak or lambda sign in determining chorionicity in multiple pregnancy. Obstet Gynecol. 1996;88(1):6–9.

    Article  CAS  Google Scholar 

  15. American College of, O. and B.-O. Gynecologists Committee on Practice. ACOG Practice Bulletin No. 118: antiphospholipid syndrome. Obstet Gynecol. 2011;117(1):192–9.

    Article  Google Scholar 

  16. American College of, O. and P. Gynecologists Women’s Health Care, ACOG Practice Bulletin No. 138. Inherited thrombophilias in pregnancy. Obstet Gynecol. 2013;122(3):706–17.

    Article  Google Scholar 

  17. Committee on Obstetric, P. ACOG committee opinion: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2002;99(5 Pt 1):871–3.

    Article  Google Scholar 

  18. Dollberg S, et al. Birth weight standards in the live-born population in Israel. Isr Med Assoc J. 2005;7(5):311–4.

    PubMed  Google Scholar 

  19. Redline RW. Classification of placental lesions. Am J Obstet Gynecol. 2015;213(4 Suppl):S21–8.

    Article  Google Scholar 

  20. Khong TY, et al. Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Arch Pathol Lab Med. 2016;140(7):698–713.

    Article  Google Scholar 

  21. Weiner E, et al. The placental component and obstetric outcome in severe preeclampsia with and without HELLP syndrome. Placenta. 2016;47:99–104.

    Article  Google Scholar 

  22. Pinar H, et al. Reference values for singleton and twin placental weights. Pediatr Pathol Lab Med. 1996;16(6):901–7.

    Article  CAS  Google Scholar 

  23. Parks WT. Placental hypoxia: the lesions of maternal malperfusion. Semin Perinatol. 2015;39(1):9–19.

    Article  Google Scholar 

  24. Brosens I, et al. The “Great Obstetrical Syndromes” are associated with disorders of deep placentation. Am J Obstet Gynecol. 2011;204(3):193–201.

    Article  Google Scholar 

  25. Redline RW. Clinical and pathological umbilical cord abnormalities in fetal thrombotic vasculopathy. Hum Pathol. 2004;35(12):1494–8.

    Article  CAS  Google Scholar 

  26. Redline RW, et al. Placental diagnostic criteria and clinical correlation--a workshop report. Placenta. 2005;26(Suppl A):S114–7.

    Article  Google Scholar 

  27. Salafia CM, et al. Clinical correlations of patterns of placental pathology in preterm pre-eclampsia. Placenta. 1998;19(1):67–72.

    Article  CAS  Google Scholar 

  28. Vinnars MT, et al. The severity of clinical manifestations in preeclampsia correlates with the amount of placental infarction. Acta Obstet Gynecol Scand. 2011;90(1):19–25.

    Article  Google Scholar 

  29. Kovo M, et al. The placental component in early-onset and late-onset preeclampsia in relation to fetal growth restriction. Prenat Diagn. 2012;32(7):632–7.

    Article  Google Scholar 

  30. Ogge G, et al. Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia. J Perinat Med. 2011;39(6):641–52.

    Article  Google Scholar 

  31. Weiner E, et al. The role of placental histopathological lesions in predicting recurrence of preeclampsia. Prenat Diagn. 2016;36(10):953–60.

    Article  CAS  Google Scholar 

  32. Mosca L, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. J Am Coll Cardiol. 2011;57(12):1404–23.

    Article  Google Scholar 

  33. White WM, et al. A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later. Am J Obstet Gynecol. 2016;214(4):519–e1–519 e8.

    Article  Google Scholar 

  34. Heyborne KD, Porreco RP. Selective fetocide reverses preeclampsia in discordant twins. Am J Obstet Gynecol. 2004;191(2):477–80.

    Article  Google Scholar 

  35. Hagay ZJ, et al. Single fetal demise in twin gestation resulting in the resolution of severe pre-eclampsia. Eur J Obstet Gynecol Reprod Biol. 1994;56(2):137–8.

    Article  CAS  Google Scholar 

  36. Sarhanis P, Pugh DH. Resolution of pre-eclampsia following intrauterine death of one twin. Br J Obstet Gynaecol. 1992;99(2):159–60.

    Article  CAS  Google Scholar 

  37. Weiner E, et al. Placental component and pregnancy outcome in singleton versus twin pregnancies complicated by preeclampsia. Fetal Diagn Ther. 2017.

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel

    Eran Weiner, Ohad Feldstein, Ehud Grinstein, Elad Barber, Ann Dekalo, Yossi Mizrachi, Jacob Bar & Michal Kovo

  2. Department of Pathology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel

    Letizia Schreiber

Authors
  1. Eran Weiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ohad Feldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Letizia Schreiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ehud Grinstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elad Barber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ann Dekalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yossi Mizrachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jacob Bar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michal Kovo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eran Weiner.

Ethics declarations

Approval for the study was obtained from the local ethics committee (decision number 0102-15-WOMC dated 6.8.2015).

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weiner, E., Feldstein, O., Schreiber, L. et al. None, One, or Both Placentas Involved with Malperfusion Lesions in Twin Pregnancies Complicated by Preeclampsia—Does It Matter?. Reprod. Sci. 27, 845–852 (2020). https://doi.org/10.1007/s43032-019-00087-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43032-019-00087-4

Keywords

Search

Navigation