An Objective Histopathological Scoring System for Placental Pathology in Pre-Eclampsia and Eclampsia

Abstract

Background and objective Pre-eclampsia and eclampsia are common complications in pregnancy, and they lead to uteroplacental vascular insufficiency. More than 38% of pregnant women succumb to seizures without meeting the clinical criteria for pre-eclampsia or eclampsia. This highlights the importance of a confirmatory diagnosis of preeclampsia or eclampsia using the histopathological changes seen in the placenta. Hence, the present study aimed to validate an objective histopathological scoring system of the placenta for an appropriate diagnosis of pre-eclampsia or eclampsia. Material and methods In this prospective study spanning two years, 50 cases of pre-eclampsia/eclampsia and 50 control subjects with normal placenta were included. The histomorphological changes in the placenta were examined for both groups and a scoring system was formulated to assess the severity of pre-eclampsia/eclampsia syndrome. A maximum score of 2 and a minimum score of 0 was assigned for maternal floor infarcts, calcification, villous basement membrane thickening, and fibrin deposition. Syncytial knots were assigned a minimum score of 0 and a maximum score of 1. The association of various placental histopathological variables with a clinical diagnosis of pre-eclampsia, eclampsia, and control was analyzed using the chisquared/Fisher's exact test. A one-way analysis of variance (ANOVA) test was used for comparing objective histopathological scores between pre-eclampsia, eclampsia, and control groups. A p-value of less than 0.05 was considered to be statistically significant. Results We found a significant association between each histopathological parameters of the placenta, including fibrin deposition, maternal floor infarction, calcification, villous basement membrane thickening, and syncytial knots, and clinical diagnosis of pre-eclampsia, eclampsia, and control groups. A median score of 2 significantly correlated with the normal group, while median scores of 4 and 6 correlated with pre-eclampsia and eclampsia respectively. Conclusion This comprehensive scoring system can be a basis for validating reporting patterns of the placenta in preeclampsia and eclampsia patients, as well as other disorders related to maternal uteroplacental insufficiency.

Investigation of CD56, ADAM17 and FGF21 Expressions in the Placentas of Preeclampsia Cases

“…Although the pathophysiology of PE is still not clearly explained, it is accepted that abnormal placentation, abnormal spiral artery remodeling, placental insufficiency and endothelial dysfunction are effective in the pathophysiology [ 3 , 5 , 7 ]. Abnormally released cytokines from the defective placenta, which cause placental insufficiency, also cause widespread systemic endothelial dysfunction [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] with various effects of oxidative stress, increased inflammation, genetic and environmental factors contributing to the PE clinic.…”

“…These preparations were evaluated by a single pathologist (FB) with a light microscope (Leica DM2500 microscope, Leica Microsystems, Wetzlar, Germany) by semiquantitatively scoring the histopathological findings showing maternal hypoxia, blinded for the study groups. Histopathological findings showing maternal hypoxia, Perivillous and intervillous fibrin deposition, intervillous hemorrhage, placental infarcts, placental calcification, syncytial nodes, distal villous hypoplasia, placental regional giant cell increase, laminar necrosis and chorionic pseudocysts were examined under light microscope and scored as; 0: no histological change, 1: mild histological change, 2: significant histological change, 3: severe histological change [ 17 , 18 ].…”

Histopathological Study of Placentas of Hypertensive Disorders

“…The core of the villi contains umbilical blood capillaries embedded in thin layer of fetal connective tissue. The cross -section of villi are surrounded by maternal blood (RBCs) [1,2]. The villus capillary pressure varies from 20 to 40 ml of Hg.…”

Study of Histopathological Changes in the Placenta in Preeclampsia

“…The least score of 0 and the highest score of 1 were assigned to syncytial knots. A Chi-squared/Fisher’s exact test was used to analyze the relationship between the variables of the placenta histopathologically with the clinical detection of eclampsia, preeclampsia, and control [ 9 ]. An analysis of variance (ANOVA) test was used to compare the histopathological scores of preeclampsia, eclampsia, and control groups.…”

“…A median score of 2 correlated significantly with the normal group, whereas a median score of 4 and 6 correlated significantly with preeclampsia and eclampsia, respectively. So, from the above results, we can conclude that the newly devised system of scores can prove to be a reasonable basis for clinically establishing the diagnosis of preeclampsia and eclampsia in females along with other abnormalities related to uteroplacental insufficiency [ 9 ]. Certain pathological variations in the placenta can be seen in pregnancy-induced hypertension (PIH), resulting in decreased blood supply to the placenta.…”