Chronic histiocytic intervillositis (CHI) is a rare placental disorder that affects approximately 1 in 600 pregnancies.1 It is diagnosed when at least 5% of the intervillous space is occupied by maternal CD68+ immune cells (histiocytes) and is often accompanied by massive perivillous fibrin deposition.2 CHI is strongly associated with miscarriage (24%), stillbirth (29%), fetal growth restriction (72%) and […]
Category: Medical Research
Chronic intervillositis of unknown etiology (CIUE) is a rare, poorly understood, histopathological diagnosis of the placenta that is frequently accompanied by adverse pregnancy outcomes including miscarriage, fetal growth restriction, and intrauterine fetal death. CIUE is thought tohave an immunologically driven pathophysiology and may be related to human leukocyte antigen mismatches between the mother and the […]
This is a case study (looking at a single person) about a woman in Singapore who had an early miscarriage (around 7 weeks) that appears to have been due to CHI. They note that there are no current clinical guidelines regarding the management of CHI and go on to discuss the current literature and suggestions […]
This paper from the UK gives a detailed and thorough summary of a lot of the current knowledge about CHI. As well as the pathophysiology (the body processes when things go wrong), it covers many things that we already suspect – CHI is a rare condition (6 in 10,000 pregnancies) but that if you are […]
This paper from Malaysia provides pathologists with information about what to look for when examining a placenta after a stillbirth or a miscarriage by discussing a case study of a woman who had several miscarriages and was found to have signs in three of her pregnancies in her placenta of CHI. They describe how lots […]
This is a case-control study: which means they have the ‘cases’ – the people with CHI and they try to find people who are similar in every other way except they don’t have CHI – the ‘controls’, and see how the outcomes for the two groups compare. Unfortunately, it very much suggests that those with […]
This ‘retrospective observational’ study (which means a study where they look at people who were diagnosed with CHI and looked back to see if there was anything special about their pregnancies) looked at 33 pregnancies with confirmed ‘CHI’ in Toronto, Canada. They looked at blood results and ultrasound results as well as the overall health […]
This is a case study series looking at 3 subsequent pregnancies in a woman who has unfortunately had 4 previous early miscarriages and been diagnosed with CHI. They found that pregnancy outcomes changed depending on treatment with the most successful being a combination of low dose aspirin and prednisolone. File: Ozawa et al. – Chronic histiocytic […]
This study looks in detail at the type of immune cells that are found in placentas with CVUE and MCI. It hypotheseses that these might be differing severities of the same underlying pathology. It also explicitly states two different ideas as to what causes CVUE/MCI – either due to the fetus responding to an infectious […]
Reus et al. – An Immunological Basis for Chronic Histiocytic Intervillositis in Recurrent Fetal Loss – 2013 – American Journal of Reproductive Immunology This paper ‘scores’ or grades placentas as to how many/much lesions associated with CHI and finds that a higher score (more lesions) is associated with worse outcomes and is considered to be […]
Changes in expression of the CD200 tolerance-signaling molecule and its receptor (CD200R) by villus trophoblasts during first trimester missed abortion and in chronic histiocytic intervillositis (Clark DA, Dmetrichuk JM, McCready E, et al) – 2017 This paper looks at the immune response in a pregnancy in women with recurrent miscarriage and specifically CHI. It was […]
This New Zealand case report looks at a woman who had recurrent pregnancy loss and was diagnosed with CHI. A subsequent pregnancy was successful with a combination of therapy including: prednisone, enoxaparin, calcium and aspirin, close monitoring with regular growth scans, and an elective c-section at 34 weeks when it was seen the baby’s growth was […]
This Australian paper looks at a single woman who unfortunately had 4 pregnancies affected by CHI. Her fetuses also appeared to have a bone condition (osteogenesis imperfecta – OI) although the histology (looking down a microscope) of the bones didn’t match typical OI and she didn’t have any genetic markers for it either. Crawford […]
This paper notes the previously known histological (looking down the microscope) similarity between placental malaria and CHI and suggests that they may both result/be due to cells ‘expressing’ receptors on their surface. They looked at cells from CHI placentas as well as cells from normal placentas and those from CVUE placentas and found that there […]
Chronic histiocytic intervillositis: Outcome, associated diseases and treatment in a multicenter prospective study. Citation: Mekinian A, Costedoat-Chalumeau N, Masseau A, et al. Chronic histiocytic intervillositis: Outcome, associated diseases and treatment in a multicenter prospective study. Autoimmunity 2014;6934:1–6. doi:10.3109/08916934.2014.939267 Introduction: In this prospective multicenter study, we aimed to describe (1) the outcome of pregnancy in the case […]
Abstract: Chronic histiocytic intervillositis of the placenta (CHI) is a rare and potentially recurrent disease. Characteristically it shows accumulation of CD68+ cells in the intervillous space but no destructive tissue infiltration. An immunopathological background is likely but it is unknown what attracts circulating monocytes to the placenta. Methods: We analysed the expression profile of 102 inflammation- […]
Letter to the Editor (case report) SIR, Chronic intervillositis is a rare and poorly understood disease characterized by intervillous infiltrates of maternal origin. The intervillositis infiltrates from mononuclear cells (monocytes, histiocytes) correlate with placental insufficiency, and result in intrauterine growth restriction, intrauterine fetal death and spontaneous miscarriage [1]. Chronic intervillositis aetiology is not well established. […]
DIAGNOSES: Intrauterine fetal demise (second trimester). Diffuse villous fibrosis, perivillous and intravillous fibrin deposition associated with chronic villitis and intervillositis (placentitis), histiocytic type. Influenza A virus infection (type not specified) with ultrastructural, immunohistochemical, and PCR confirmation. CASE 2: Fetal Demise Associated With Influenza A Infection. Richard Lieberman, MD
Context.—Chronic histiocytic intervillositis is an uncommon and poorly recognized lesion associated with poor perinatal outcomes, including intrauterine growth retardation and stillbirth. It has a high recurrence rate. Objective.—To evaluate utility of CD68 immunostaining in the evaluation of chronic histiocytic intervillositis. Design.—Institutional review board–approved retrospective review was performed. Cases were selected from the departmental archives of […]
ABSTRACT Chronic intervillositis (CI) and massive perivillous fibrin deposition (MFD), together with its related entity, maternal floor infarction (MFI), are rare and poorly understood placental lesions. Both MFD/MFI and CI are associated with poor fetal outcome and high risk of recurrence. We report a patient who was found to have both MFD and CI in […]
Summary (translation from the original paper in French): We report the cases of two patients who had a favourable outcome with aspirin and corticosteroid therapy during pregnancy for chronic villitis of unknown etiology complicated by labor asphyxia and further intrauterine fetal demise in one gravida 3 patient and for chronic intervillositis of unknown etiology diagnosed […]
RÉSUMÉ- Article en Français Les auteurs rapportent les résultats favorables obtenus en cours de grossesse par l’association aspirine et corticoïdes, d’une part, chez une patiente troisième geste ayant présenté des lésions placentaires de villite chronique d’étiologie indé- terminée, compliquée d’une asphyxie fœtale pendant le travail, puis d’une mort in utero, d’autre part, chez une quatrième […]
(Summary to come!) Chronic histiocytic intervillositis of unknown etiology: Clinical features in a consecutive series of 69 cases: Marchaudon et. al
This study talks about Chronic intervillositis of unknown etiology (CIUE) which appears to be yet another term for CHI/CHIV/MCI. It looks at 20 pregnancies across 14 women affected by CIUE; 10 resulted in live births and the recurrence rate for multiple pregancies was 100% (it should be noted however, that this is a smaller sample […]
CVUE is thought to be different but a similar and more common disease compared to CHI. It talks about associations with maternal BMI, multiple pregnancies and ethnicity. It also found it showed up in pregnancies affected by autoimmune or alloimmune diseases. It suggests aspirin and corticosteroids as a possible regimen. Chronic villitis of unknown etiology: […]
