Placenta percreta with bladder invasion is an extremely rare complication causing life-threatening hemorrhage, up to 17 liters.1 Most reported cases have been diagnosed after 30 weeks of pregnancy and few have presented before 20 weeks.2 Only 20 cases of placenta percreta with invasion of the bladder have been reported during last decade. In this condition, chorionic villi attach directly to the myometrium without intervening decidua. The exact etiology of impaired decidualization is unknown; however, a previous endometrial insult, such as previous cesarian section or endometrial curettage may be a contributing factor. To avoid massive bleeding, uterine body incision, hypogastric artery ligation before hysterectomy and uterine cervical removal have been attempted.1 Chorionic villi may attach to the myometrium (accreta), invade the myometrium(increta), or in its severe form (percreta) the trophoblastic tissue penetrates the whole myometrium and invades adjacent structures. We experienced a case of placenta previa percreta with bladder invasion and review the literatures.
Animals ; Arteries ; Chorionic Villi ; Curettage ; Decidua ; Female ; Hemorrhage ; Hysterectomy ; Ligation ; Mice ; Myometrium ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy ; Trophoblasts ; Urinary Bladder* ; Uterine Hemorrhage

BACKGROUND: The human placenta is an important organ in the maintenance of pregnancy, having functions in maturation and differentiation until the end of pregnancy. The bcl-2 protein is a proto-oncogene that prevents apoptosis and maintains cell survival. However, the mechanism through which bcl-2 inhibits apoptosis is unclear. The aims of this study are to localize bcl-2 at the placenta and to determine whether the expression of bcl-2 in early normal pregnancy is different from that of a missed abortion. METHODS: Immunohistochemistry was performed for bcl-2 in formalin-fixed chorionic villi and decidual tissue collected from five early normal pregnancies and eleven missed abortions having histories of recurrent abortions during the first trimester. RESULTS: The bcl-2 protein was observed in the syncytiotrophoblasts of chorionic villi and decidua in both the normal pregnancy and the missed abortion, and the expression of bcl-2 significantly increased in the missed abortion group (p<0.05). CONCLUSION: The bcl-2 may be necessary to maintain pregnancy through modulating the survival of the syncytiotrophoblast and decidua without affecting cell proliferation, and the increased bcl-2 expression is presumed to be a reparative process to the increased apoptotic activity.
Abortion, Habitual ; Abortion, Missed ; Apoptosis ; Cell Proliferation ; Cell Survival ; Chorionic Villi ; Decidua ; Female ; Humans ; Immunohistochemistry ; Placenta ; Pregnancy Trimester, First ; Pregnancy* ; Proto-Oncogenes ; Trophoblasts

Telomerase is an enzyme that maintains telomeres and prevents telomere shortening, and may be linked with cellular proliferation or the aging process. The purpose was to examine telomerase activity in human chorionic villi from early and term normal pregnancies, and to analyze the correlation of telomerase activity (TA) with MIB-1 & bcl-2. A total of 37 placentae were obtained from 16 early and 21 term pregnancies. TA was assayed by telomeric repeat amplification protocol, and immunohistochemical staining was performed for MIB-1 & bcl-2 expression. TA & MIB-1 expression were strong in early placenta, but bcl-2 was highly expressed in term placentae. Thirteen (81.25%) of 16 early placentae showed TA, but only 2 (9.52%) of 21 term placentae expressed TA (p<0.01). MIB-1 was observed in nuclei of cytotrophoblast, and the expression rate was 16.09% in early placentae and 2.87% in term placentae (p<0.01). bcl-2 was observed only in the cytoplasm of syncytiotrophoblast. Term placenta demonstrated stronger expression of bcl-2 compared to early placentae (p<0.05). These findings suggest that TA, MIB-1 & bcl-2 expression are critically regulated over the course of gestation: cytotrophoblast, main cells of early chorionic villi, may be a common source of telomerase and proliferative activity. The TA showed good correlation with cellular proliferative activity. Syncytiotrophoblast, may be a main source of bcl-2 expression which is stronger in the term placentae.
Aging ; Cell Proliferation ; Chorion* ; Chorionic Villi* ; Cytoplasm ; Humans* ; Placenta ; Pregnancy* ; Telomerase* ; Telomere ; Telomere Shortening ; Trophoblasts

OBJECTIVE: To observe the difference in telomerase activity (TA) expression in the placenta between fetal growth restriction (FGR) with preeclampsia and those without and to evaluate the effect of oxygen concentration on the TA expression in the trophoblastic cells. METHODS: Telomerase activity was measured in 48 (normal pregnancies, 16; preeclampsia with FGR, 15; normotensive FGR, 17) placentas which were obtained between 32 and 41 weeks' gestations. Trophoblastic cells were extracted from 8 chorionic villi samples obtained from 8-10 weeks' placenta and were cultured in either 2%, 8%, and 20% oxygen atmosphere. Then TA was examined by using telomeric repeat amplification protocol (TRAP) assay. RESULTS: During 3rd trimester of pregnancy, exhibited TA expression in normal pregnancy, FGR complicated by preeclampsia, and normotensive FGR groups were 11 of 16 (68.8%), 4 of 15 (26.7%), and 4 of 17 (23.5%), respectively. Significantly lower level of TA was detected in the FGR group compared to the normal pregnancies (p=0.009), whereas within FGR pregnancies, presence of preeclampsia did not seem to have statistically significant effect on TA expression. TA expression levels were measured by optical density in trophoblasts cultured under various oxygen concentration which revealed that significantly higher TA was exhibited in the cells cultured in 2% oxygen compared to 8% and 20% (p<0.001). However no significant difference was noted in TA between cells cultured in 8% and 20% oxygen. CONCLUSION: Decreased TA in the placenta from pregnancies with FGR was noted regardless of presence of preeclampsia indicating a probable correlation between FGR and placental senescence. Since increased TA was noted in trophoblastic cells that were cultured in hypoxic condition, we could speculate that the intervillous oxygen tension during early-stage placental development plays a certain role in the placental degeneration in pregnancies complicated by FGR and preeclampsia.
Aging ; Anoxia* ; Atmosphere ; Chorionic Villi ; Fetal Development* ; Oxygen ; Placenta ; Placentation ; Pre-Eclampsia ; Pregnancy* ; Telomerase* ; Trophoblasts

Natural killer (NK) cells are the main immune cells at the maternal-fetal interface and accumulate in the uterine decidua in early pregnancy. Many studies have shown that NK cells at the maternal-fetal interface have unique phenotypes and play critical roles in various processes, including immune tolerance during pregnancy, decidualization, invasion of trophoblasts, remodeling of the uterine spiral artery, formation of the placenta and growth of embryo. However, specific functions of NK cells and their mechanism remain to be fully elucidated. This review summarizes the research progress of NK cells at the maternal-fetal interface and their roles in the pregnancy-related disorders in recent years. The aims of this review are to gain deep insight of the function of NK cells at the maternal-fetal interface and provide new ideas for intervention of pregnancy-related diseases.
Decidua ; Female ; Humans ; Killer Cells, Natural ; Maternal-Fetal Exchange ; Placenta ; Pregnancy ; Trophoblasts ; Uterus

No abstract available.
Placenta* ; Trophoblasts*

Pulmonary placental transmogrification (PT) is a rare lung disease that takes on the histologic appearance of placental chorionic villi. We herein report a case of PT in a 66-year-old woman who presented with a single nodule on chest radiography performed during a routine health examination. She had no complaints of any symptoms. Chest radiography showed a focal ill-defined nodular opacity in the right lower lobe; chest computed tomography revealed a 17-mm lobulated, focal irregular mass with fissural retraction in the right lower lobe, suggestive of lung cancer. Pathology of a percutaneous needle aspiration biopsy revealed papillary structures resembling placental villi. These were lined by cytotrophoblast-like cells and syncytiotrophoblasts. This characteristic pathologic finding led to a diagnosis of PT. PT of the lung is found mainly in bullous or cystic lesions. However, this patient presented with a single nodule on chest radiography.
Aged ; Biopsy, Needle ; Chorionic Villi ; Diagnosis ; Female ; Humans ; Lung Diseases ; Lung Neoplasms ; Lung* ; Needles ; Pathology ; Placenta ; Radiography ; Thorax ; Trophoblasts

Placental GnRH is one of the potential paracrine regulator of hCG secretion from the trophoblasts during pregnancy. However, this paracrine function is not clearly confirmed. The present study was designed to evaluate the possible correlation between the synthesis and cellular distribution of GnRH and GnRH -receptor in the placental villi. 6 to 40 weeks termed twenty five human placental tissues were used in this study. GnRH and GnRH -receptor mRNAs were localized in the placenta by in situ hybridization using the corresponding cRNA probes. GnRH mRNA was present in all cell types of placenta including cytotrophoblasts, syncytiotrophoblasts and stromal cells. The GnRH -receptor mRNA signals were localized in both cytotrophoblasts and syncytiotrophoblasts. The GnRH -receptor mRNA signals were also localized in some stromal cells at the full term placenta. GnRH mRNA signals were detected abundantly at 6 ~7 weeks and the intensities were remarkably increased with the following gestational ages. GnRH -receptor mRNA signals were detected at 6 ~7 weeks, peaked at 9 ~10 weeks, declined at 23 ~24 weeks and focally expressed at full term placenta. The present study demonstrates that GnRH mRNA is expressed in all cell types of the placenta, however GnRH -receptor mRNA is expressed only in the cytoptrophblasts and syncytiotrophoblasts and exhibits parallel change with the time course of hCG secretion during pregnancy. These data provide a morphological understanding that placental GnRH has a paracrine/autocrine role through its receptor from 6 ~7 weeks gestation to term placenta.
Chorionic Villi ; Gestational Age ; Gonadotropin-Releasing Hormone* ; Humans* ; In Situ Hybridization ; Placenta* ; Pregnancy ; RNA, Complementary ; RNA, Messenger* ; Stromal Cells ; Trophoblasts

Autophagy is a degradation process that acts in response to environmental stressors. Recently, autophagy has been detected in normal term, preeclamptic and intrauterine growth-restricted placentas. The object of this work was to investigate the presence of autophagy in first trimester voluntary interruption of pregnancy placental villi by the expression of autophagy-related proteins, light chain 3 (LC3), and Beclin-1. In first trimester placental villi laser scanning confocal microscopy (LSCM) analysis revealed LC3 and Beclin-1 immunoreactivity prevalently located in villous cytotrophoblasts. Using LSCM, LC3, and Beclin-1 were localized to the cytoplasm of the trophoblast layer in human full-term placentas. Beclin-1 expression and LC3 activation were confirmed by western blotting. These data emphasize that autophagy activation is different among cytotrophoblasts and syncytiotrophoblasts depending on the gestational age and thus we speculate that autophagy might play a prosurvival role throughout human pregnancy.
Autophagy ; Blotting, Western ; Chorionic Villi ; Cytoplasm ; Female ; Gestational Age ; Humans ; Light ; Microscopy, Confocal ; Placenta ; Pregnancy ; Pregnancy Trimester, First ; Proteins ; Trophoblasts

No abstract available.
Placenta*