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Mother's Chronic Histiocytic Intervillositis can be a Death Sword to the Baby

Creator: Dr. Jayashree
Keywords: Pregnancy, Mother�s immunity, Placental condition, Chronic Histiocytic Intervillositis

by Dr. Jayashree on November 16, 2022 at 4:32 PM

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Highlights:

Chronic Histiocytic Intervillositis (CHI) is a rare condition of the placenta
The immune cells of a mother block the placental passage of nutrients to the baby
This condition mostly affects women with autoimmune disorders

Placenta Immunomodulatory Role in Pregnancy

During pregnancy, the mother and the fetus coexist in harmony. To shield the embryo from immune identification and rejection, several fetal, maternal, and placental mechanisms collaborate to make the fetus semi-allogeneic. The placenta plays a crucial immunomodulatory role in addition to mediating the fetus's hormonal, nutritional, and oxygen support (1^✔).

Although there are many different morphological kinds among mammals, they all share in common the placenta, which allows for a close apposition of the maternal and fetal circulations. The inter-hemal membrane is a general term for the tissue that separates the two circulations of the mother and the fetus. Its cell layers can vary in number and type (2^✔). The uterus too undergoes a number of modifications during human placentation.

Stillbirth Due to Chronic Histiocytic Intervillositis (CHI)

Stillbirth is a tragic reality for many families around the world. A stillbirth occurs when a baby dies either before or during delivery. Although both miscarriage and stillbirth are types of pregnancy loss, they may differ in terms of timing.

‘Chronic Histiocytic Intervillositis (CHI) is a rare placental condition which impairs the passage of nutrients and waste products between the mother and fetus’

Stillbirth has a negative impact on the family's emotional health. The incident might be just as heartbreaking for expectant mothers as a miscarriage. Even if it is sometimes possible to understand the possible causes of a stillbirth, other times it is not always possible to prevent one. One of these unidentified causes of stillbirth is an uncommon placental disease, which is only detectable after delivery when a microscopic study of the placenta is undertaken. The illness is known as Chronic Histiocytic Intervillositis (CHI).

Chronic histiocytic intervillositis (CHI) is a pregnancy disorder and affects placenta. Placenta is the tissue that connects the mother and the fetus, includes blood arteries inside the structures known as villi during a normal pregnancy. The exchange of nutrients occurs when these are in close touch with the fetus's blood. In this uncommon illness, the mother's immune cells may block the placental channel, impeding the passage of nutrients and waste products between the mother and fetus, endangering the unborn child. Only few of these pregnancies, according to doctors, result in live births. Other times, an emergency caesarean delivery is required to deliver babies.

In Chronic histiocytic intervillositis a subset of maternal white cells (macrophages) infiltrates into the intervillous space of the human placenta and there may be also associated deposit of fibrin clots in the placenta villi.

Strong links exist between CHI and higher risk of stillbirth and fetal growth restriction. Although uncommon, involving 6 in every 10,000 pregnancies that last longer than 12 weeks, the recurrence rate is substantial at 25%-100% (3^✔).

Dr. Emily Cornish, write an award-winning piece about recurrent pregnancy loss. Her essay on Chronic Histiocytic Intervillositis (CHI) won the Medical Research Council's (MRC) Max Perutz Science Writing Award, wrote the article Hope after Grace: Addressing Recurrent Pregnancy Loss.

According to the researcher, the issue may recur in eight out of ten instances during a subsequent pregnancy. She added that it is still difficult to forecast or diagnose the condition's cause. The placenta, however, can seem as a "rejected kidney transplant" when examined under a microscope after delivery. According to the researcher's proposed theory, the disease could result in the mother's body creating antibodies against the placenta, which could cause inflammation of the organ and cause a sudden surge of the mother's white blood cells to clog it. The researcher also told the tale of a woman who suffered from the ailment and had four sons killed by CHI in a span of three years(4^✔).

COVID-19, Stillbirth and Chronic Histiocytic Intervillositis

Some research discovered a link between the syndrome and COVID-19 as the pandemic began. According to reports, 64 stillbirths and four neonatal deaths where the placenta was infected with the virus were evaluated by a group of 44 researchers from 12 different nations. According to the research, almost all placentas had significant deposits of the clotting protein fibrin as well as a peculiar kind of inflammation called Chronic Histiocytic Intervillositis. According to some scientists, the virus appeared to be "chewing the placenta," as there had been reports of severe placental damage (5^✔).

Treatment of Chronic Histiocytic Intervillositis

Prednisolone or hydroxychloroquine should be used in the therapy regimen for pregnancies after a diagnosis of CHI in order to reduce the severity of placental lesions. Consequently, a reduced CHI severity increases the chance of a live birth in subsequent pregnancies.

In light of this, the standardized treatment protocol of CHI includes aspirin. There are very few studies on the effectiveness of prednisolone, hydroxychloroquine, and other immunomodulatory drugs used to treat the illness.

References:

Immune mechanisms at the maternal-fetal interface: perspectives and challenges - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC5070970/)
Placental Origins of Chronic Disease - (https:journals.physiology.org/doi/full/10.1152/physrev.00029.2015)
Chronic histiocytic intervillositis: A breakdown in immune tolerance comparable to allograft rejection? - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC7988544/#:~:text=Chronic%20histiocytic%20intervillositis%20(CHI)%20is,with%20accompanying%20perivillous%20fibrin%20deposition)
Dr Emily Cornish Wins The Max Perutz Science Writing Award 2022 - (https:www.wellbeingofwomen.org.uk/news/read-dr-emily-cornishs-winning-essay-in-the-max-perutz-science-writing-award-2022)
Association Between COVID-19 Pregnant Women Symptoms Severity and Placental Morphologic Features - (https:www.frontiersin.org/articles/10.3389/fimmu.2021.685919/full)

Source: Medindia

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