Alterações histopatológicas em placentas humanas relacionadas às síndromes hipertensivas

Abstract

Alterações histopatológicas em placentas humanas relacionadas às síndromes hipertensivas Histopathological changes in human placentas related to hypertensive disordersAbstract PURPOSE: to determine the prevalence of histopathological changes, in human placentas, related to hypertensive syndromes. METHODS: a transversal study that compares histopathological changes identified in 43 placentae from hypertensive pregnant women (HypPr), with the ones from 33 placentae from normotensive pregnant women (NorPr). The weight, volume and macroscopic and microscopic occurrence of infarctions, clots, hematomas, atherosis (partial obliteration, thickness of layers and presence of blood vessels hyalinization) and Tenney-Parker changes (absent, discreet and prominent), as well as the locating of infarctions and clots (central, peripheral or the association of both) have been analyzed. The χ 2 and t Student tests have been used for the statistical analysis, as well as medians, standard deviations and ratios. It has been considered as significant, p<0.05. RESULTS: the macroscopic study of HypPr placentae have presented lower weight (461.1 versus 572.1 g) and volume (437.4 versus 542.0 cm 3 ), higher infarction (51.2 versus 45.5%; p<0.05: OR=1.15) and clots (51.2 versus 15.1%; p<0.05; OR=5.4) ratios, as compared to the NorPr's. In the HypPr and NorPr, microscopic clots have occurred in 83.7 versus 45.5% (p<0.05; OR=4.3), respectively. Atherosis and Tenney-Parker changes have been statistically associated to the hypertensive syndromes (p<0.05). CONCLUSIONS: the obtained data allow us to associate lower placentary weight and volume, higher ratio of macro and microscopic infarction, clots, atherosis and Tenney-Parker changes to placentae of gestations occurring with hypertensive syndromes.

Morphological Features of the Human Placenta and its Free Chorionic Villi in Normal Pregnancies and those with Diabetes and High Blood Pressure. Literature Review

“…In studies by Majumdar et al (2005), Janthanaphan et al (2006), and Artico et al (2009) on placentas in pregnant women with preeclampsia and prehypertension, a reduction in placental volumes and weights was found as well as an increase in the areas of infarction and hematomas. Histologically, these infarctions appeared as necrotic villous tissue; from the macroscopic point of view, they correspond to triangular areas, of variable dimensions, related to the basal plate and located mainly in the periphery of the placental disc.…”

The Role Played by Salicylic Acid and Omega 3 in the Placental Vascular Resistance Mechanism: A Pilot Study

“…Optimal placental function can be impaired by many mechanisms such as hypertension, oxidative stress, thrombophilias and, consequently, the incidence of infarctions [1][2][3]. Myometrial segments of uteroplacental circulation suffer severe hyperplasia and arteriosclerosis due to high resistance and peripheral pressure, a fact that impairs placentation and leads to hypoxia, vasospasm and oxidative stress [1][2][3][4][5].…”

“…Optimal placental function can be impaired by many mechanisms such as hypertension, oxidative stress, thrombophilias and, consequently, the incidence of infarctions [1][2][3]. Myometrial segments of uteroplacental circulation suffer severe hyperplasia and arteriosclerosis due to high resistance and peripheral pressure, a fact that impairs placentation and leads to hypoxia, vasospasm and oxidative stress [1][2][3][4][5]. The uterine artery Doppler investigation allows identifying these changes based on increased resistance and pulsatility indices and on the incidence of bilateral protodiastolic notch, which happens due to nontrophoblastic invasion in the myometrial segment of the spiral arteries [1][2][3][4][5].…”

“…Myometrial segments of uteroplacental circulation suffer severe hyperplasia and arteriosclerosis due to high resistance and peripheral pressure, a fact that impairs placentation and leads to hypoxia, vasospasm and oxidative stress [1][2][3][4][5]. The uterine artery Doppler investigation allows identifying these changes based on increased resistance and pulsatility indices and on the incidence of bilateral protodiastolic notch, which happens due to nontrophoblastic invasion in the myometrial segment of the spiral arteries [1][2][3][4][5]. The aim of the current study was to evaluate vascular resistance in pregnant women treated with ASA+omega in comparison to pregnant women treated only with ASA, since previous studies have already found increased uterine artery flow and, consequently, satisfactory blood supply in these patients.…”

“…Maternal inflammatory response at placentation time may be of paramount importance to help better understanding the etiopathogenesis of a series of pathologies such as hypertensive syndromes during pregnancy. Understanding this process also means understanding that the optimal placental function can be impaired by several mechanisms such as hypertension, oxidative stress, thrombophilias and, consequently, infarcts caused by changes in placental perfusion [1].…”