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Ultrasound imaging of the placenta and its relationship to poor perinatal outcome has been studied since 1973. Studies have predominantly focussed on placental morphology in the third trimester or in high-risk pregnancies. We aimed to correlate abnormal placental appearances identified in the second trimester with histological appearances. We present four cases of abnormal placental morphology detected at the 20 week routine ultrasound scan in low-risk women and relate them to histological origins, which often involved areas of villous infarction. Abnormal placental appearances at routine second trimester anomaly ultrasound scans might identify women with placental dysfunction who merit increased fetal surveillance in the third trimester. [ABSTRACT FROM AUTHOR]

Research Question: Does a genetic condition underlie the diagnosis of primary ovarian insufficiency (POI) in a 13-year-old girl with primary amenorrhoea?, Design: A case report of a next-generation sequencing panel of 24 genes associated with syndromal and non-syndromal POI was conducted., Results: A homozygous missense variant c.1076C>T, p.(Pro359Leu) in BMP15 was identified., Conclusions: The biallelic variant c.1076C >T, p.(Pro359Leu) in BMP15 is associated with primary ovarian failure., (Copyright © 2022 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Placental mesenchymal dysplasia (PMD) is a rare human disorder associated with stillbirth, intrauterine growth restriction (IUGR) and Beckwith-Wiedemann syndrome. Although the morphology of this condition has been described in 86 cases, the underlying cellular origin is unclear. We investigate the placental cell type involved in a case of PMD associated with a live born female infant with IUGR. In PMD intermediate villi contain cisternae, lined by non-proliferative cells. Immunostaining reveals they are not of trophoblast or vascular endothelial origin. There is positive immunostaining for lymphatic endothelium; this abnormal lymphangiogenesis is in concordance with current hypotheses regarding the aetiology of PMD. Furthermore, such observations suggest that placental villous mesenchyme may differentiate into various cell types, even those not normally found in the human placenta.

Some cases of stillbirth are associated with placental abnormality; recent classification systems have included some features of placental pathology. This study aimed to determine whether placental investigations assist in determining the cause of stillbirth. A total of 71 consecutive cases of stillbirth were reviewed. Placental investigations were undertaken in 54% of cases. Women who had placental assessment were significantly less likely to have an unexplained stillbirth (OR = 0.17; 95% CI 0.04-0.70). In 47% of cases, the findings of placental investigation were included in the classification of stillbirth. In 16% of cases the classification was determined primarily by placental examination. Some placental abnormalities found were associated with clinical causes of stillbirth, such as placental infarction and IUGR or leukocyte infiltration and chorioamnionitis (p < 0.05). We conclude that assessment of the placenta can aid classification of stillbirth and recommend that histological analysis of placental tissue be offered in all cases of stillbirth, even when full infant post-mortem is declined.

Objective: To evaluate whether women referred to a gynaecology clinic requesting sterilisation were receiving appropriate counselling about sterilisation and other forms of long-term contraception, and to determine the proportion of women who ultimately underwent sterilisation., Methods: A retrospective audit of 100 women referred requesting sterilisation., Results: 15% of women referred did not attend the clinic, 54% had sterilisation and 29% ultimately chose an alternative method. Alternative forms of contraception discussed were levonorgestrel-releasing intrauterine system (69%), vasectomy (34%) and subdermal progestogen implants (21%). At the clinic 70 (82%) women chose sterilisation; however, 15 (21%) of these women cancelled the operation., Conclusions: Almost half of the women referred for sterilisation did not proceed with it, suggesting that there was insufficient counselling about sterilisation and alternative long-term contraception before referral to the gynaecology clinic and also within the clinic itself.

Objective: The study was designed to determine whether fetal fibronectin would predict delivery before 37 weeks in women at high risk of preterm delivery., Study Methods: Forty-three women considered at risk of preterm delivery were recruited antenatally into a blind longitudinal study. Quantitative assays of fetal fibronectin were obtained from sequential high vaginal swabs taken fortnightly from 24 to 34 weeks of gestation. Fibronectin concentrations of 0.05 microgram/ml or more were considered as positive., Results: Results were calculated by swab and by subject. The sensitivity of an individual fibronectin swab in predicting preterm delivery within 14 days of testing was 71% and the specificity was 93%. The overall positive predictive value was 31% and the negative predictive value was 99%. The sensitivity of the fibronectin swab in predicting delivery before 37 weeks was 17% and the specificity was 93%. The positive predictive value was 50% and the negative predictive value was 73%. For a woman who has had a positive swab the sensitivity in predicting preterm delivery within 14 days of testing was 80% and the specificity was 83%; a woman was counted as positive only if the final swab was positive and preceded delivery by not more than 14 days. The positive predictive value was 36% and the negative predictive value was 97%. For a woman who has had a positive swab the sensitivity in predicting delivery before 37 weeks was 54%. The specificity, the positive predictive value and the negative predictive value were 85%, 64% and 79%, respectively. Women were counted as positive if any swab in the sampling sequence was positive. Fibronectin swabbing when calculated by patient did predict preterm delivery within 14 days of testing (P=0.01) and before 37 weeks (P=0.01). Analysis of the accuracy of predicting delivery from 7 to 28 days after sampling revealed that the best prediction for delivery was within the following 14 days., Conclusion: Serial fetal fibronectin assessment from 24 to 34 weeks of gestation anticipated preterm delivery within 14 days of testing and before 37 weeks for high risk asymptomatic women. Such testing should be performed every two weeks.