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Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns
Placental examination can be a useful tool for specifying the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to test the reliability of a predetermined set of placental reaction patterns seen with maternal vascular underperfusion in the hope that this...
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| Published in: | Pediatric and developmental pathology 2004-05, Vol.7 (3), p.237-249 |
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| container_title | Pediatric and developmental pathology |
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| creator | Redline, Raymond W Boyd, Theonia Campbell, Valarie Hyde, Scott Kaplan, Cynthia Khong, T Yee Prashner, Heather R Waters, Brenda L |
| description | Placental examination can be a useful tool for specifying the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to test the reliability of a predetermined set of placental reaction patterns seen with maternal vascular underperfusion in the hope that this might provide a useful diagnostic framework for practicing pathologists. Study cases (14 with clinical and pathologic evidence of maternal underperfusion plus 6 controls) were evaluated for the presence or absence of 11 lesions by eight perinatal pathologists. After analysis of initial results, diagnostic criteria were refined and a second, overlapping set of cases was reviewed. The collective sensitivity, specificity, and efficiency of individual assessments for the 11 lesions relative to the group consensus ranged from 74-93% (22/33 > 90%). Reproducibility was measured by unweighted kappa-values and interpreted as follows: < 0.2 poor, 0.2-0.6 fair/moderate, > 0.6 substantial. Kappa values for lesions affecting villi and the intervillous space were increased syncytial knots (any -0.42, severe -0.50), villous agglutination (0.42), increased intervillous fibrin (0.25), and distal villous hypoplasia (0.57). Individual estimates of percent involvement for syncytial knots, intervillous fibrin, and distal villous hypoplasia were correlated with placental and fetal weight for gestational age. Extent of increased intervillous fibrin showed the strongest correlation with both placental weight ( R = -0.64) and fetal weight ( R = -0.45). Kappa values for lesions affecting maternal vessels and the implantation site were acute atherosis (0.50), mural hypertrophy of membrane arterioles (0.43), muscularized basal plate arteries (0.48), increased placental site giant cells (0.54), and immature intermediate trophoblast (0.36). Correlation of maternal vessel and implantation site lesions with the clinical diagnosis of preeclampsia showed that excessive placental site giant cells and immature intermediate trophoblast were more sensitive and efficient predictors, whereas atherosis and muscularized basal plate arteries were more specific. Kappa value for a thin umbilical cord, a possible indicator of fetal volume depletion, was 0.61. Reproducibility for a global impression of maternal vascular underperfusion, taking into account all of the above lesions, was moderate (kappa 0.54) and improved after inclusion of additional pathologic and clinical data (kappa 0.68). Adoption of this |
| doi_str_mv | 10.1007/s10024-003-8083-2 |
| format | article |
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The purpose of this study was to test the reliability of a predetermined set of placental reaction patterns seen with maternal vascular underperfusion in the hope that this might provide a useful diagnostic framework for practicing pathologists. Study cases (14 with clinical and pathologic evidence of maternal underperfusion plus 6 controls) were evaluated for the presence or absence of 11 lesions by eight perinatal pathologists. After analysis of initial results, diagnostic criteria were refined and a second, overlapping set of cases was reviewed. The collective sensitivity, specificity, and efficiency of individual assessments for the 11 lesions relative to the group consensus ranged from 74-93% (22/33 > 90%). Reproducibility was measured by unweighted kappa-values and interpreted as follows: < 0.2 poor, 0.2-0.6 fair/moderate, > 0.6 substantial. Kappa values for lesions affecting villi and the intervillous space were increased syncytial knots (any -0.42, severe -0.50), villous agglutination (0.42), increased intervillous fibrin (0.25), and distal villous hypoplasia (0.57). Individual estimates of percent involvement for syncytial knots, intervillous fibrin, and distal villous hypoplasia were correlated with placental and fetal weight for gestational age. Extent of increased intervillous fibrin showed the strongest correlation with both placental weight ( R = -0.64) and fetal weight ( R = -0.45). Kappa values for lesions affecting maternal vessels and the implantation site were acute atherosis (0.50), mural hypertrophy of membrane arterioles (0.43), muscularized basal plate arteries (0.48), increased placental site giant cells (0.54), and immature intermediate trophoblast (0.36). Correlation of maternal vessel and implantation site lesions with the clinical diagnosis of preeclampsia showed that excessive placental site giant cells and immature intermediate trophoblast were more sensitive and efficient predictors, whereas atherosis and muscularized basal plate arteries were more specific. Kappa value for a thin umbilical cord, a possible indicator of fetal volume depletion, was 0.61. Reproducibility for a global impression of maternal vascular underperfusion, taking into account all of the above lesions, was moderate (kappa 0.54) and improved after inclusion of additional pathologic and clinical data (kappa 0.68). Adoption of this clearly defined, clinically relevant, and pathologically reproducible terminology could enhance clinicopathologic correlation and provide a more objective framework for future clinical research.</description><identifier>ISSN: 1093-5266</identifier><identifier>EISSN: 1615-5742</identifier><identifier>DOI: 10.1007/s10024-003-8083-2</identifier><identifier>PMID: 15022063</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Female ; Humans ; Placenta - blood supply ; Placenta - pathology ; Placenta Diseases - complications ; Placenta Diseases - pathology ; Placental Circulation ; Pregnancy ; Pregnancy Complications - pathology ; Reproducibility of Results ; Sensitivity and Specificity ; Terminology as Topic</subject><ispartof>Pediatric and developmental pathology, 2004-05, Vol.7 (3), p.237-249</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c363t-f7c92b151111f70784f95e6bce8793beb90ffa7991aa1f280a1822d893fc0abe3</citedby><cites>FETCH-LOGICAL-c363t-f7c92b151111f70784f95e6bce8793beb90ffa7991aa1f280a1822d893fc0abe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,783,787,27936,27937</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15022063$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Redline, Raymond W</creatorcontrib><creatorcontrib>Boyd, Theonia</creatorcontrib><creatorcontrib>Campbell, Valarie</creatorcontrib><creatorcontrib>Hyde, Scott</creatorcontrib><creatorcontrib>Kaplan, Cynthia</creatorcontrib><creatorcontrib>Khong, T Yee</creatorcontrib><creatorcontrib>Prashner, Heather R</creatorcontrib><creatorcontrib>Waters, Brenda L</creatorcontrib><creatorcontrib>Society for Pediatric Pathology, Perinatal Section, Maternal Vascular Perfusion Nosology Committee</creatorcontrib><creatorcontrib>For the Society for Pediatric Pathology, Perinatal Section, Maternal Vascular Underperfusion Nosology Committee</creatorcontrib><title>Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns</title><title>Pediatric and developmental pathology</title><addtitle>Pediatr Dev Pathol</addtitle><description>Placental examination can be a useful tool for specifying the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to test the reliability of a predetermined set of placental reaction patterns seen with maternal vascular underperfusion in the hope that this might provide a useful diagnostic framework for practicing pathologists. Study cases (14 with clinical and pathologic evidence of maternal underperfusion plus 6 controls) were evaluated for the presence or absence of 11 lesions by eight perinatal pathologists. After analysis of initial results, diagnostic criteria were refined and a second, overlapping set of cases was reviewed. The collective sensitivity, specificity, and efficiency of individual assessments for the 11 lesions relative to the group consensus ranged from 74-93% (22/33 > 90%). Reproducibility was measured by unweighted kappa-values and interpreted as follows: < 0.2 poor, 0.2-0.6 fair/moderate, > 0.6 substantial. Kappa values for lesions affecting villi and the intervillous space were increased syncytial knots (any -0.42, severe -0.50), villous agglutination (0.42), increased intervillous fibrin (0.25), and distal villous hypoplasia (0.57). Individual estimates of percent involvement for syncytial knots, intervillous fibrin, and distal villous hypoplasia were correlated with placental and fetal weight for gestational age. Extent of increased intervillous fibrin showed the strongest correlation with both placental weight ( R = -0.64) and fetal weight ( R = -0.45). Kappa values for lesions affecting maternal vessels and the implantation site were acute atherosis (0.50), mural hypertrophy of membrane arterioles (0.43), muscularized basal plate arteries (0.48), increased placental site giant cells (0.54), and immature intermediate trophoblast (0.36). Correlation of maternal vessel and implantation site lesions with the clinical diagnosis of preeclampsia showed that excessive placental site giant cells and immature intermediate trophoblast were more sensitive and efficient predictors, whereas atherosis and muscularized basal plate arteries were more specific. Kappa value for a thin umbilical cord, a possible indicator of fetal volume depletion, was 0.61. Reproducibility for a global impression of maternal vascular underperfusion, taking into account all of the above lesions, was moderate (kappa 0.54) and improved after inclusion of additional pathologic and clinical data (kappa 0.68). Adoption of this clearly defined, clinically relevant, and pathologically reproducible terminology could enhance clinicopathologic correlation and provide a more objective framework for future clinical research.</description><subject>Adult</subject><subject>Female</subject><subject>Humans</subject><subject>Placenta - blood supply</subject><subject>Placenta - pathology</subject><subject>Placenta Diseases - complications</subject><subject>Placenta Diseases - pathology</subject><subject>Placental Circulation</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - pathology</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Terminology as Topic</subject><issn>1093-5266</issn><issn>1615-5742</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><recordid>eNpFkE1LAzEQhoMotlZ_gBfJyVt0knSTjTcpfkHFix4lZLOJrKSbNdkV-u9NacE5zMxh3ofhQeiSwg0FkLe5dLYkAJzUUHPCjtCcClqRSi7ZcdlBcVIxIWboLOdvACqlgFM0oxUwBoLP0eerGV3qTcC_JtspmISnvnVpcMlPuYv9He5jjiF-bbHpW5zckGI72a7pQjducfR4CMa6fiyI5IwdSwYPZtxR8zk68SZkd3GYC_Tx-PC-eibrt6eX1f2aWC74SLy0ijW0oqW8BFkvvaqcaKyrpeKNaxR4b6RS1BjqWQ2G1oy1teLegmkcX6DrPbc89zO5POpNl60LwfQuTlkLIZZCSF4O6f7Qpphzcl4PqduYtNUU9M6p3jvVxaneOdWsZK4O8KnZuPY_cZDI_wCj2nQm</recordid><startdate>20040501</startdate><enddate>20040501</enddate><creator>Redline, Raymond W</creator><creator>Boyd, Theonia</creator><creator>Campbell, Valarie</creator><creator>Hyde, Scott</creator><creator>Kaplan, Cynthia</creator><creator>Khong, T Yee</creator><creator>Prashner, Heather R</creator><creator>Waters, Brenda L</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040501</creationdate><title>Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns</title><author>Redline, Raymond W ; Boyd, Theonia ; Campbell, Valarie ; Hyde, Scott ; Kaplan, Cynthia ; Khong, T Yee ; Prashner, Heather R ; Waters, Brenda L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c363t-f7c92b151111f70784f95e6bce8793beb90ffa7991aa1f280a1822d893fc0abe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Female</topic><topic>Humans</topic><topic>Placenta - blood supply</topic><topic>Placenta - pathology</topic><topic>Placenta Diseases - complications</topic><topic>Placenta Diseases - pathology</topic><topic>Placental Circulation</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - pathology</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Terminology as Topic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Redline, Raymond W</creatorcontrib><creatorcontrib>Boyd, Theonia</creatorcontrib><creatorcontrib>Campbell, Valarie</creatorcontrib><creatorcontrib>Hyde, Scott</creatorcontrib><creatorcontrib>Kaplan, Cynthia</creatorcontrib><creatorcontrib>Khong, T Yee</creatorcontrib><creatorcontrib>Prashner, Heather R</creatorcontrib><creatorcontrib>Waters, Brenda L</creatorcontrib><creatorcontrib>Society for Pediatric Pathology, Perinatal Section, Maternal Vascular Perfusion Nosology Committee</creatorcontrib><creatorcontrib>For the Society for Pediatric Pathology, Perinatal Section, Maternal Vascular Underperfusion Nosology Committee</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric and developmental pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Redline, Raymond W</au><au>Boyd, Theonia</au><au>Campbell, Valarie</au><au>Hyde, Scott</au><au>Kaplan, Cynthia</au><au>Khong, T Yee</au><au>Prashner, Heather R</au><au>Waters, Brenda L</au><aucorp>Society for Pediatric Pathology, Perinatal Section, Maternal Vascular Perfusion Nosology Committee</aucorp><aucorp>For the Society for Pediatric Pathology, Perinatal Section, Maternal Vascular Underperfusion Nosology Committee</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns</atitle><jtitle>Pediatric and developmental pathology</jtitle><addtitle>Pediatr Dev Pathol</addtitle><date>2004-05-01</date><risdate>2004</risdate><volume>7</volume><issue>3</issue><spage>237</spage><epage>249</epage><pages>237-249</pages><issn>1093-5266</issn><eissn>1615-5742</eissn><abstract>Placental examination can be a useful tool for specifying the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to test the reliability of a predetermined set of placental reaction patterns seen with maternal vascular underperfusion in the hope that this might provide a useful diagnostic framework for practicing pathologists. Study cases (14 with clinical and pathologic evidence of maternal underperfusion plus 6 controls) were evaluated for the presence or absence of 11 lesions by eight perinatal pathologists. After analysis of initial results, diagnostic criteria were refined and a second, overlapping set of cases was reviewed. The collective sensitivity, specificity, and efficiency of individual assessments for the 11 lesions relative to the group consensus ranged from 74-93% (22/33 > 90%). Reproducibility was measured by unweighted kappa-values and interpreted as follows: < 0.2 poor, 0.2-0.6 fair/moderate, > 0.6 substantial. Kappa values for lesions affecting villi and the intervillous space were increased syncytial knots (any -0.42, severe -0.50), villous agglutination (0.42), increased intervillous fibrin (0.25), and distal villous hypoplasia (0.57). Individual estimates of percent involvement for syncytial knots, intervillous fibrin, and distal villous hypoplasia were correlated with placental and fetal weight for gestational age. Extent of increased intervillous fibrin showed the strongest correlation with both placental weight ( R = -0.64) and fetal weight ( R = -0.45). Kappa values for lesions affecting maternal vessels and the implantation site were acute atherosis (0.50), mural hypertrophy of membrane arterioles (0.43), muscularized basal plate arteries (0.48), increased placental site giant cells (0.54), and immature intermediate trophoblast (0.36). Correlation of maternal vessel and implantation site lesions with the clinical diagnosis of preeclampsia showed that excessive placental site giant cells and immature intermediate trophoblast were more sensitive and efficient predictors, whereas atherosis and muscularized basal plate arteries were more specific. Kappa value for a thin umbilical cord, a possible indicator of fetal volume depletion, was 0.61. Reproducibility for a global impression of maternal vascular underperfusion, taking into account all of the above lesions, was moderate (kappa 0.54) and improved after inclusion of additional pathologic and clinical data (kappa 0.68). Adoption of this clearly defined, clinically relevant, and pathologically reproducible terminology could enhance clinicopathologic correlation and provide a more objective framework for future clinical research.</abstract><cop>United States</cop><pmid>15022063</pmid><doi>10.1007/s10024-003-8083-2</doi><tpages>13</tpages></addata></record> |
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| ispartof | Pediatric and developmental pathology, 2004-05, Vol.7 (3), p.237-249 |
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| language | eng |
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| source | SAGE |
| subjects | Adult Female Humans Placenta - blood supply Placenta - pathology Placenta Diseases - complications Placenta Diseases - pathology Placental Circulation Pregnancy Pregnancy Complications - pathology Reproducibility of Results Sensitivity and Specificity Terminology as Topic |
| title | Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns |
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