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Topic:Placenta

The equine placenta is a vital organ that facilitates nutrient and gas exchange between the mare and the developing fetus during pregnancy. It plays a role in hormone production and immune modulation to support fetal development. The placenta in horses is classified as a diffuse, epitheliochorial type, characterized by the widespread attachment of the chorionic villi to the endometrium. Research on the equine placenta encompasses studies on its structure, function, and the physiological processes involved in its development and maintenance. This page compiles peer-reviewed research studies and scholarly articles that explore the morphology, function, and clinical implications of the placenta in equine reproduction and health.
Clinical, pathologic, and epidemiologic features of nocardioform placentitis in the mare.
Theriogenology    May 25, 2021   Volume 171 155-161 doi: 10.1016/j.theriogenology.2021.05.023
Fedorka CE, Scoggin KE, Ruby RE, Erol E, Ball BA.Placentitis is the leading cause of infectious abortion in the horse and contributes to roughly 19% of all abortions in the United States. A type of placental infection, nocardioform placentitis (NP) is associated with gram-positive branching actinomycetes localized within the ventral body of the feto-maternal interface to create a lymphoplasmacytic mucoid lesion. While the etiology of this disease is poorly described, this placental infection continues to cause episodic abortions in addition to weak and/or growth retarded neonates. The goal of the present study was to perform a comprehensive ...
Horse Placental Extract Enhances Neurogenesis in the Presence of Amyloid β.
Nutrients    May 14, 2021   Volume 13, Issue 5 1672 doi: 10.3390/nu13051672
de Toledo A, Nomoto K, Hirano E, Tohda C.Human placental extract and animal-derived placental extracts from pigs and horses host a wide range of biological activities. Several placental products are used as medicines, cosmetics, and healthcare substances worldwide. However, the use of placental extracts for neuronal functioning is currently not established because the number of relevant studies is limited. A few previous reports suggested the neuroprotective effect and dendrite genesis effect of placental extract. However, no studies have reported on neurogenesis in placental extracts. Therefore, we aimed to investigate the effects o...
Serum amyloid A, Serum Amyloid A1 and Haptoglobin in pregnant mares and their fetuses after experimental induction of placentitis.
Animal reproduction science    May 11, 2021   Volume 229 106766 doi: 10.1016/j.anireprosci.2021.106766
Boakari YL, Esteller-Vico A, Loux S, El-Sheikh Ali H, Fernandes CB, Dini P, Scoggin KE, Cray C, Ball BA.Serum amyloid A (SAA) and Haptoglobin (Hp) are acute phase proteins, produced during inflammation, such as placentitis. In horses, SAA and SAA1 are protein coding genes. Objectives were to analyze SAA and Hp concentrations and relative abundance of SAA, SAA1 and Hp mRNA transcript in maternal and fetal tissues after experimental induction of placentitis or mares of a control group. Serum Amyloid A family proteins were in marked abundance in the stroma of the endometrium and chorioallantois associated with inflammatory cells. Maternal plasma SAA concentrations were greater (P = 0.01) in mares w...
Equine cervical remodeling during placentitis and the prepartum period: a transcriptomic approach.
Reproduction (Cambridge, England)    May 5, 2021   Volume 161, Issue 6 603-621 doi: 10.1530/REP-21-0008
El-Sheikh Ali H, Scoggin KE, Ruby R, Loynachan A, Boakari Y, Fernandes C, Dini P, Fedorka CE, Loux SC, Esteller-Vico A, Ball BA.Cervical remodeling is a critical component in both term and preterm labor in eutherian mammals. However, the molecular mechanisms underlying cervical remodeling remain poorly understood in the mare. The current study compared the transcriptome of the equine cervix (cervical mucosa (CM) and stroma (CS)) during placentitis (placentitis group, n = 5) and normal prepartum mares (prepartum group, n = 3) to normal pregnant mares (control group, n = 4). Transcriptome analysis identified differentially expressed genes (DEGs) during placentitis (5310 in CM and 907 in CS) and during the normal prepartu...
Parental bias in expression and interaction of genes in the equine placenta.
Proceedings of the National Academy of Sciences of the United States of America    April 16, 2021   Volume 118, Issue 16 e2006474118 doi: 10.1073/pnas.2006474118
Dini P, Kalbfleisch T, Uribe-Salazar JM, Carossino M, Ali HE, Loux SC, Esteller-Vico A, Norris JK, Anand L, Scoggin KE, Rodriguez Lopez CM, Breen J....Most autosomal genes in the placenta show a biallelic expression pattern. However, some genes exhibit allele-specific transcription depending on the parental origin of the chromosomes on which the copy of the gene resides. Parentally expressed genes are involved in the reciprocal interaction between maternal and paternal genes, coordinating the allocation of resources between fetus and mother. One of the main challenges of studying parental-specific allelic expression (allele-specific expression [ASE]) in the placenta is the maternal cellular remnant at the fetomaternal interface. Horses () ha...
Characterization of Nuclear Progesterone Receptor Isoforms in the Term Equine Placenta.
Frontiers in veterinary science    April 1, 2021   Volume 8 660177 doi: 10.3389/fvets.2021.660177
Nagy AM, Sathe SR, Atta AH, Hammam AMM, Hsu WH.In equine parturition, the role of progestins along with the nuclear progesterone receptor (nPR) signaling pathway in the placenta is not completely clarified. The progestins play an integral role in maintaining myometrial quiescence during the late stage of pregnancy via acting on nPR isoforms (PRA and PRB; PRB is more active than PRA). The current study aimed to determine the PRA and PRB expressions in the term equine placenta at the gene and protein levels. Six term equine placentas were used in this study. Reverse transcription polymerase chain reaction (RT-PCR) was used to quantify the mR...
Paternally expressed retrotransposon Gag-like 1 gene, RTL1, is one of the crucial elements for placental angiogenesis in horses†.
Biology of reproduction    March 12, 2021   Volume 104, Issue 6 1386-1399 doi: 10.1093/biolre/ioab039
Dini P, Carossino M, Balasuriya UBR, El-Sheikh Ali H, Loux SC, Esteller-Vico A, Scoggin KE, Loynachan AT, Kalbfleisch T, De Spiegelaere W, Daels P....RTL1 (retrotransposon Gag-like 1) is an essential gene in the development of the human and murine placenta. Several fetal and placental abnormalities such as intrauterine growth restriction (IUGR) and hydrops conditions have been associated with altered expression of this gene. However, the function of RTL1 has not been identified. RTL1 is located on a highly conserved region in eutherian mammals. Therefore, the genetic and molecular analysis in horses could hold important implications for other species, including humans. Here, we demonstrated that RTL1 is paternally expressed and is localized...
Interleukin-6 pathobiology in equine placental infection.
American journal of reproductive immunology (New York, N.Y. : 1989)    February 9, 2021   Volume 85, Issue 5 e13363 doi: 10.1111/aji.13363
Fedorka CE, Scoggin KE, El-Sheikh Ali H, Loux SC, Dini P, Troedsson MHT, Ball BA.Ascending placentitis is the leading cause of abortion in the horse. Interleukin (IL)-6 is considered predictive of placental infection in other species, but little is understood regarding its role in the pathophysiology of ascending placentitis. Sub-acute ascending placentitis was induced via trans-cervical inoculation of S zooepidemicus, and various fluids/serum/tissues collected 8 days later. Concentrations of IL-6 were detected within fetal fluids and serum in inoculated (n = 6) and control (n = 6) mares. RNASeq was performed on the placenta (endometrium and chorioallantois) to asses...
Transcriptomic analysis of equine placenta reveals key regulators and pathways involved in ascending placentitis†.
Biology of reproduction    December 22, 2020   Volume 104, Issue 3 638-656 doi: 10.1093/biolre/ioaa209
El-Sheikh Ali H, Dini P, Scoggin K, Loux S, Fedorka C, Boakari Y, Norris J, Esteller-Vico A, Kalbfleisch T, Ball B.Improved understanding of the molecular mechanisms underlying ascending equine placentitis holds the potential for the development of new diagnostic tools and therapies to forestall placentitis-induced preterm labor. The current study characterized the equine placental transcriptome (chorioallantois [CA] and endometrium [EN]) during placentitis (placentitis group, n = 6) in comparison to gestationally-matched controls (control group, n = 6). Transcriptome analysis identified 2953 and 805 differentially expressed genes in CA and EN during placentitis, respectively. Upstream regulator analys...
Detection of Neospora caninum Infection in Aborted Equine Fetuses in Israel.
Pathogens (Basel, Switzerland)    November 19, 2020   Volume 9, Issue 11 962 doi: 10.3390/pathogens9110962
Leszkowicz Mazuz M, Mimoun L, Schvartz G, Tirosh-Levy S, Savitzki I, Edery N, Blum SE, Baneth G, Pusterla N, Steinman A.In horses, and have been associated with fetal loss, and neurological disease, respectively. This study investigated the role of spp. infection in equine abortion in Israel. The presence of anti- spp. antibodies was evaluated in 31 aborting mares by indirect fluorescent antibody test (IFAT) and the presence of parasite DNA in their aborted fetuses was evaluated by polymerase chain reaction (PCR), using two target loci (ITS1 and Nc5). The seroprevalence found in aborting mares was 70.9% and the prevalence by DNA detection in the aborted fetuses was 41.9%. Transplacental transmission from pos...
The Yolk Sac of the Equine Placenta. Its Remnant and Potential Problems.
Journal of equine veterinary science    November 16, 2020   Volume 96 103322 doi: 10.1016/j.jevs.2020.103322
Vilaregut L, Lores M, Wilsher S.This review details the current state of knowledge about the equine yolk sac and its remnant (YSR) in the pregnant mare, which, incidentally, is the only animal species known to exhibit large and/or ossified YSR. It also describes the clinical significance of the YSR and details a case of a strangulating YSR that caused fetal death and abortion.
Kinetics of placenta-specific 8 (PLAC8) in equine placenta during pregnancy and placentitis.
Theriogenology    November 5, 2020   Volume 160 81-89 doi: 10.1016/j.theriogenology.2020.10.041
El-Sheikh Ali H, Scoggin K, Linhares Boakari Y, Dini P, Loux S, Fedorka C, Esteller-Vico A, Ball B.Placenta-specific 8 (PLAC8) is one of the placenta-regulatory genes which is highly conserved among eutherian mammals. However, little is known about its expression in equine placenta (chorioallantois; CA and endometrium; EN) during normal and abnormal pregnancy. Therefore, the current study was designed to 1) elucidate the expression of PLAC8 in equine embryonic membranes during the preimplantation period, 2) characterize the expression profile of PLAC8 in equine CA (45d, 4mo, 6mo, 10 mo, 11 mo and postpartum) and EN (14d, 4mo, 6mo, 10 mo, and 11 mo) obtained from pregnant mares (n = 4/...
Expression profile of proinflammatory mediators in the placenta of mares during physiological detachment and retention of fetal membranes.
Cytokine    October 1, 2020   Volume 137 155307 doi: 10.1016/j.cyto.2020.155307
Jaworska J, Ropka-Molik K, Kowalczyk-Zięba I, Boruszewska D, Wocławek-Potocka I, Siemieniuch M.Physiological parturition is characterized by sterile, inflammatory-like processes. During parturition, the placenta expresses various proinflammatory mediators, such as chemokines and IL-17. Nevertheless, inflammatory processes present in the parturient mare are poorly characterized. The aim of this study was to investigate the expression of selected chemokines and IL-17 in the allantochorion and the endometrium of mares that retained fetal membranes (RFM) and expelled them physiologically. We hypothesized that the expression of these mediators may be altered in the placenta of mares with RFM...
Fibrinonecrotic Placentitis and Abortion Associated With Pantoea agglomerans Infection in a Mare.
Journal of equine veterinary science    June 6, 2020   Volume 92 103156 doi: 10.1016/j.jevs.2020.103156
Henker LC, Lorenzett MP, Keller A, Siqueira FM, Driemeier D, Pavarini SP.Pantoea agglomerans, family Enterobacteriaceae, is a Gram-negative bacterium that may be isolated from soil and from plants. This bacterium has been associated with disease in plants, humans, and rarely in domestic animal species. We describe here a case of fibrinonecrotic placentitis and equine abortion associated with P. agglomerans infection in southern Brazil. A fetus with 10 months of gestation and its placenta were evaluated. Gross lesions were observed in the cervical star extending to the body of the chorioallantois and consisted of a focally extensive, transmural, severely thickened...
Morphological Characteristics of the Placenta and Umbilical Cord of Arabian Mares Foaling in the United Arab Emirates.
Journal of equine veterinary science    May 28, 2020   Volume 91 103124 doi: 10.1016/j.jevs.2020.103124
Wilsher S, Bowker A, Silva J, Allen WRT.A total of 127 normal placentas from Arabian mares resident in the United Arab Emirates were examined. The mean linear dimensions of the placenta were, on average, 84% of those previously recorded for the placentas of the Thoroughbred. Significant differences in the size of the allantochorion between primigravid and multiparous mares were seen only in the linear dimensions of the body portion. The pregnant horn was more commonly on the right than left side of the uterus (P = .01; 74/127; 58%). Cord attachment was primarily at the base of the two placental horns (112/127; 88%), with the remain...
New insights in equine steroidogenesis: an in-depth look at steroid signaling in the placenta.
Reproduction (Cambridge, England)    May 15, 2020   Volume 160, Issue 1 65-82 doi: 10.1530/REP-20-0015
Loux SC, Conley AJ, Scoggin KE, El-Sheikh Ali H, Dini P, Ball BA.Steroid production varies widely among species, with these differences becoming more pronounced during pregnancy. As a result, each species has its own distinct pattern of steroids, steroidogenic enzymes, receptors, and transporters to support its individual physiological requirements. Although the circulating steroid profile is well characterized during equine pregnancy, there is much yet to be explored regarding the factors that support steroidogenesis and steroid signaling. To obtain a holistic view of steroid-related transcripts, we sequenced chorioallantois (45 days, 4 months, 6 months, 1...
Serum cortisol and thyroid hormone concentrations and survival in foals born from mares with experimentally induced ascending placentitis.
Journal of veterinary internal medicine    April 27, 2020   Volume 34, Issue 3 1332-1338 doi: 10.1111/jvim.15758
Müller V, Toribio RE, Dembek K, Moraes BSS, Mousquer MA, Curcio BR, Nogueira CEW.There are few publications on occurrence of nonthyroidal illness syndrome in foals and on the prognostic value of cortisol and thyroid hormone (TH) concentrations in newborn foals. Objective: To determine serum cortisol and TH concentrations (total and free thyroxine: T and T ; total and free triiodothyronine: T and T ) in foals born from mares with placentitis, to determine their association with survival, and their use as prognostic markers. Methods: A cohort of 29 newborn foals comprising 5 Control, 14 Low-risk, and 10 Sick foals were evaluated over the first week of life. Methods: In thi...
Presence of Clock genes in equine full-term placenta.
Journal of animal science    March 27, 2020   Volume 98, Issue 4 skaa094 doi: 10.1093/jas/skaa094
Parsons Aubone AM, Bisiau CM, McCue PM, Bouma GJ.Mammals have a circadian rhythm that is synchronized by a master clock located in the hypothalamic suprachiasmatic nucleus (SCN). The SCN regulates additional clocks located in peripheral tissues, including some involved in endocrine or reproductive functions. Studies in humans and mice report that molecular clocks also exist in the placenta. However, little is known about the presence of "Clock genes," namely Circadian Locomotor Output Cycles Kaput (CLOCK), Brain and Muscle Arnt-Like 1 (BMAL1), Period 1 (PER1), Period 2 (PER2), Cryptochrome 1 (CRY1), and Cryptochrome 2 (CRY2), in equine place...
Equine hydrallantois is associated with impaired angiogenesis in the placenta.
Placenta    March 5, 2020   Volume 93 101-112 doi: 10.1016/j.placenta.2020.03.001
Dini P, Carossino M, Loynachan AT, El-Sheikh Ali H, Wolfsdorf KE, Scoggin KE, Daels P, Ball BA.Hydrallantois is the excessive accumulation of fluid in the allantoic cavities during the last trimester of pregnancy, leading to abdominal wall hernias, cardiovascular shock, abortion, and dystocia. It has been postulated that hydrallantois is associated with structural and/or functional changes in the chorioallantoic membrane. In the present study, we hypothesized that angiogenesis is impaired in the hydrallantoic placenta. Capillary density in the hydrallantoic placenta was evaluated in the chorioallantois via immunohistochemistry for Von Willebrand Factor. Moreover, the expression of angio...
Immunological memory and tolerance at the maternal-fetal interface: Implications for reproductive management of mares.
Theriogenology    February 28, 2020   Volume 150 432-436 doi: 10.1016/j.theriogenology.2020.02.043
Antczak DF.The development of placentation that coincided with the evolution of mammals presented new challenges to the transmission of life from one generation to the next, particularly with regard to the possibility of maternal immunological recognition and destruction of the developing conceptus. The balance between immunity and tolerance dominates the immunological relationship between mother and fetus during mammalian pregnancy, and the focal point of this relationship lies at the interface between the trophoblast cells that comprise the outermost layer of the placenta and the maternal endometrial t...
Pregnancy loss due to amnionitis in anglo-arabian mare-Case report.
Reproduction in domestic animals = Zuchthygiene    February 20, 2020   Volume 55, Issue 4 438-441 doi: 10.1111/rda.13625
Campos I, Batista B, Matos AC, Dutra F, Gomes G, Pinna A, Leite J, Ferreira A.The amnion is a layer of the foetal membrane that has mechanical protection function and allows expansion and growth. The diseases that affect amnion have rarely been reported in horses. Amnionitis and funiculitis have been implicated as components of abortions as observed in abortions caused by the mare reproductive loss syndrome. Here, we report an abortion at 240-day gestation of a 7-year-old Anglo-Arabian mare with a history of previous stillbirth. Blood samples from both mare and foetus were collected for serological testing. Fragments from the placenta were taken for macroscopic and hist...
Prediction of the onset of parturition in horses and cattle.
Theriogenology    February 19, 2020   Volume 150 308-312 doi: 10.1016/j.theriogenology.2020.01.072
Nagel C, Aurich J, Aurich C.Economic losses due to dystocia or neonatal death as well as animal welfare and ethical concerns demand a reliable prediction of parturition with the aim to improve survival of the dam and her offspring. In this review, estimation of gestational age by ultrasound and prediction of parturition based on clinical signs, behaviour changes and changes in body temperature, composition of mammary gland secretions as well as hormonal changes are discussed in comparison between horses and cattle. Based on the physiological changes associated with the end of gestation and onset of labor, several systems...
Impact of the corpus luteum on survival of the developing embryo and early pregnancy in mares.
Theriogenology    February 19, 2020   Volume 150 374-381 doi: 10.1016/j.theriogenology.2020.02.011
Pinto CRF.It has been more than a hundred years that studies aiming to elucidate the processes involved in cyclicity and pregnancy pointed out the requirement of ovaries and corpora lutea for embryo survival and pregnancy establishment. For horses, luteal progesterone is essential for pregnancy only during the first trimester. This progestational support is complex among domestic animals as ovarian luteal function is further enhanced by the LH-action role of equine chorionic gonadotropin (eCG) starting ∼ on Day 35 of pregnancy. Increased eCG secretion leads to the formation of supplementary corpora ...
Transcriptomic analysis reveals the key regulators and molecular mechanisms underlying myometrial activation during equine placentitis†.
Biology of reproduction    February 18, 2020   Volume 102, Issue 6 1306-1325 doi: 10.1093/biolre/ioaa020
El-Sheikh Ali H, Boakari YL, Loux SC, Dini P, Scoggin KE, Esteller-Vico A, Kalbfleisch T, Ball BA.The key event in placentitis-induced preterm labor is myometrial activation with the subsequent initiation of labor. However, the molecular mechanisms underlying myometrial activation are not fully understood in the mares. Therefore, the equine myometrial transcriptome was characterized during placentitis (290.0 ± 1.52 days of GA, n = 5) and the prepartum period (330 days of GA, n = 3) in comparison to normal pregnant mares (289.8 ± 2.18 days of GA, n = 4). Transcriptome analysis identified 596 and 290 DEGs in the myometrium during placentitis and the prepartum period, respectively...
The oxytocin-prostaglandins pathways in the horse (Equus caballus) placenta during pregnancy, physiological parturition, and parturition with fetal membrane retention.
Scientific reports    February 7, 2020   Volume 10, Issue 1 2089 doi: 10.1038/s41598-020-59085-1
Rapacz-Leonard A, Leonard M, Chmielewska-Krzesińska M, Siemieniuch M, Janowski TE.Despite their importance in mammalian reproduction, substances in the oxytocin-prostaglandins pathways have not been investigated in the horse placenta during most of pregnancy and parturition. Therefore, we quantified placental content of oxytocin (OXT), oxytocin receptor (OXTR), and prostaglandin E2 and F2 alpha during days 90-240 of pregnancy (PREG), physiological parturition (PHYS), and parturition with fetal membrane retention (FMR) in heavy draft horses (PREG = 13, PHYS = 11, FMR = 10). We also quantified OXTR and prostaglandin endoperoxide synthase-2 (PTGS2) mRNA expression ...
Biomarkers for placental disease in mares.
Theriogenology    January 30, 2020   Volume 150 302-307 doi: 10.1016/j.theriogenology.2020.01.073
Canisso IF, Loux SC, Lima FS.Placentitis is an important cause of abortion, stillbirth, and neonatal death in horses. The diagnosis of placentitis is based on occurrence of clinical signs (premature mammary gland development and vulvar discharge) and ultrasonography of the caudal placental pole. However, early and subtle cases can be missed. In the last few years, several studies have provided objective means of diagnosing placentitis in mares with single or serial measurements of blood markers. Among the markers evaluated the steroids produced by the fetoplacental unit have been shown to change in association with placen...
Steroid synthesis and metabolism in the equine placenta during placentitis.
Reproduction (Cambridge, England)    January 29, 2020   Volume 159, Issue 3 289-302 doi: 10.1530/REP-19-0420
El-Sheikh Ali H, Legacki EL, Scoggin KE, Loux SC, Dini P, Esteller-Vico A, Conley AJ, Stanley SD, Ball BA.Equine placentitis is associated with alterations in maternal peripheral steroid concentrations, which could negatively affect pregnancy outcome. This study aimed to elucidate the molecular mechanisms related to steroidogenesis and steroid-receptor signaling in the equine placenta during acute placentitis. Chorioallantois (CA) and endometrial (EN) samples were collected from mares with experimentally induced placentitis (n = 4) and un-inoculated gestationally age-matched mares (control group; n = 4). The mRNA expression of genes coding for steroidogenic enzymes (3βHSD, CYP11A1, CYP17A1, CYP19...
Identification of Novel lncRNAs Differentially Expressed in Placentas of Chinese Ningqiang Pony and Yili Horse Breeds.
Animals : an open access journal from MDPI    January 11, 2020   Volume 10, Issue 1 119 doi: 10.3390/ani10010119
Pu Y, Zhang Y, Zhang T, Han J, Ma Y, Liu X.As a nutrient sensor, the placenta plays a key role in regulating fetus growth and development. Long non-coding RNAs (lncRNAs) have been shown to regulate growth-related traits. However, the biological function of lncRNAs in horse placentas remains unclear. To compare the expression patterns of lncRNAs in the placentas of the Chinese Ningqiang (NQ) and Yili (YL) breeds, we performed a transcriptome analysis using RNA sequencing (RNA-seq) technology. NQ is a pony breed with an average adult height at the withers of less than 106 cm, whereas that of YL is around 148 cm. Based on 813 million high...
Physiological development of the equine fetus during late gestation.
Equine veterinary journal    December 17, 2019   Volume 52, Issue 2 165-173 doi: 10.1111/evj.13206
Fowden AL, Giussani DA, Forhead AJ.In many species, the pattern of growth and physiological development in utero has an important role in determining not only neonatal viability but also adult phenotype and disease susceptibility. Changes in fetal development induced by a range of environmental factors including maternal nutrition, disease, placental insufficiency and social stresses have all been shown to induce adult cardiovascular and metabolic dysfunction that often lead to ill health in later life. Compared to other precocious animals, much less is known about the physiological development of the fetal horse or the longer-...
[Retained placenta in mares – an analysis of 121 cases].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    December 6, 2019   Volume 47, Issue 6 373-379 doi: 10.1055/a-1019-7345
Schürmann C, Loose M, Failing K, Wehrend A.The aim of this study was to analyze data concerning history, clinical course, and prognosis of retained fetal membranes in mares. Methods: Patient records of 121 hospitalized mares with retained placenta were evaluated. In 82 cases, additional blood examinations were performed and analyzed. Results: There was no significant correlation between age, parity or course of parturition and retained placenta. Eighty-one mares (66.9 %) were presented solely with retained fetal membranes, 40 mares (33.1 %) had additional diseases at presentation, most commonly injuries of the labia, followed by perine...