Anatomical and Histopathologic Analysis of Placenta in Dilation and Evacuation Specimens

Abstract

Background: Anatomical and histopathologic examination of placenta in cases of abortion is crucial as to clarify the underlying causes of many adverse pregnancy outcomes. Dilation and evacuation (D&E) is the most common mode of uterine evacuation that commonly examined in pathology sections. The aim of this study is to discuss the various placental pathologies, and to demonstrate the importance of careful pathologic examination of D&E material, also to review the anatomy of placenta and to compare our findings with other publications worldwide. Material and Methods: A retrospective descriptive study for 200 placental tissues was collected in 18 months period and revised for normal anatomy and various placental pathologies. These placentas were obtained by dilation and evacuation (D&E) technique. All cases were undergone for histopathological sections that were stained by Hematoxylin and Eosin (H&E). Results: Placental infarction was observed in 25% of cases, and chorioammnitis was the most common form of placental infection and found in 12.5%. Molar changes were represented a lowered percentage of placental pathologies that found in 9% of specimens. Conclusion: Study and recognition of placental lesions among general surgical pathologists have clinical significance and awareness of deficiency, standardization of diagnostic criteria, and increased knowledge in placental pathology improve the quality of diagnosis in this area.

Histopathologic changes in aborted placenta

“…Most of the cases were seen at the older age group (≥30 years). In a study performed by Hassan et al, [2] molar changes were found in 5% of cases while a study conducted by Alsibiani [15] showed that partial mole was found in 0.2% of cases with mean age 33.7 ± 7.5 years that is similar to the mean age of cases in this study. However, the low incidence of molar change in the region of the study was due to sociomedical improvements.…”

“…In the present study, 92 placentae examined, of which 6.5% were histologically normal placentae. A 2% of cases recorded to have calcification in this study; they were at an older age group (>40 years) compared to a study by Hassan et al [2] that revealed deposits of calcification in 12.5% of cases. The presence of these deposits is common in abortion specimens, explained by poor transport through the trophoblasts; which not utilized by the fetus due to termination of capillary flow in villi.…”

“…The hydropic changes were seen in 19% of studied cases, comparing to different studies, different percentages of hydropic changes, 32% in a study conducted by Shetty and Narasimha [13] , and 5% in a study conducted by Hassan et al [2] These findings explained by reduced or loss of the villous vascular supply when categorized to the weeks of abortion since the hydropic change is more likely to be present with early embryonic death when the villi are not well vascularized. [9] Partial mole detected in 48% of studied cases with mean age 33.5 ± 6.3 years.…”

“…[14] In this study, increased vascularity (chorioangiosis) was in 13% of cases; however, no vascular abnormality detected in the rest of the cases. By reviewing other studies, a study performed by Hassan et al [2] showed areas of placental chorioangiosis in 2.5% of cases, whereas a study by Shetty and Narasimha [13] and a study by Ul Haque et al [12] revealed a markedly reduced vascularity in 72% and 75% of cases. These findings explained by defective vasculogenesis or secondary to fibrosis when stratified according to the weeks of abortion in these studies.…”

“…[1] The chorionic villi are the efficient unit of the placenta, their histological appearance varies with the gestational age, but the basic villous structure is the same regardless stage of development and maturation of the villous tree. [2] Maternal diseases and disorders such as diabetes, hypertension, anemias, and infections in pregnancy can contribute to fetal morbidity and mortality through the affection of the placenta structure and function. [3] Gestational trophoblastic disease characterized by the proliferation of trophoblastic tissue of the placenta, of which hydatidiform moles are the premalignant and most common form.…”