Placental barrier breakage in preeclampsia: ultrastructural evidence

Brunori, I De Luca; Battini, Lorella; Brunori, Elena; Lenzi, Paola; Paparelli, Antonio; Simonelli, M; Valentino, Valeria; Genazzani, Andrea Riccardo

doi:10.1016/j.ejogrb.2004.04.024

Cited by 36 publications

(29 citation statements)

References 14 publications

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“…Our finding of higher frequency of intervillous thrombosis in placentas from PE in comparison with HELLP is intriguing but correlates with a recent study by de Luca Brunori et al 17 Intervillous thromboses are not associated with parenchyma loss in the placenta, but they probably reflect fetomaternal hemorrhage at the trophoblastic interface. Evidence of placenta barrier breakage, at the villous structural level, in PE has been presented recently.…”

Section: Vinnars Et Al Severe Preeclampsia With and Without Hellpsupporting

confidence: 77%

Severe Preeclampsia With and Without HELLP Differ With Regard to Placental Pathology

et al. 2008

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Abstract-The aim of the present study was to evaluate the histopathology in placentas from patients with severe preeclampsia with and without hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. An additional aim was to compare the prevalence of infants born small for gestational age in the 2 groups. The study is retrospective and includes 178 women who have been diagnosed at the Karolinska University Hospital Huddinge or at the Free University Medical Center between 2000 and 2005 with severe preeclampsia. A total of 96 women had severe preeclampsia without signs of HELLP (preeclampsia group), whereas 82 fulfilled the criteria for having HELLP syndrome (HELLP group). Infarction (Pϭ0.014), intervillous thrombosis (PϽ0.001), and abruption (Pϭ0.002) were more common in the preeclampsia group than in the HELLP group. There was no statistically significant difference in the frequency of accelerated villous maturation (Pϭ0.61), decidual arteriopathy (Pϭ0.27), or chorioamnionitis (Pϭ0.61). Furthermore, there was a higher mean placental weight, adjusted for gestational age, in the Swedish HELLP material than in the preeclampsia group (PϽ0.001). Finally, mothers in the preeclampsia group gave birth significantly more often to small for gestational age babies than mothers suffering from HELLP syndrome (PϽ0.001). The histopathologic profile and the range of placental lesions were partly different in the preeclampsia and HELLP patients. Considering the central role that placenta seems to have in preeclampsia, the present result might suggest that different underlying pathogenetic mechanisms and courses can be in play in patients with preeclampsia and HELLP syndrome. Key Words: eclampsia Ⅲ gestational hypertension Ⅲ pregnancy hypertension Ⅲ preeclampsia Ⅲ pregnancy Ⅲ proteinuria Ⅲ women P reeclampsia (PE) affects 2% to 7% of healthy nulliparous women and is a major cause of maternal and fetal morbidity and mortality. 1 It is further subclassified into late-onset and early onset PE, severe and mild PE, and into a maternal and fetal syndrome. 2,3 The syndrome is characterized by hypertension and proteinuria, and a common fetal feature is intrauterine growth restriction. 2 Common pathological features in PE include small placentas with decidual arteriopathy, infarcts in central portions of the placenta, abruption placentae, and intervillous thrombosis. Arteriopathy is commonly found in PE, as well as intrauterine growth restriction, whereas the other findings are nonspecific. 4 -6 Hemolysis, elevated liver enzymes, and low platelets (HELLP) occurs in 20% of severe PE. The pathogenesis of this complication is not clear. Involvement of the coagulation system is seen in HELLP patients, which is not present in PE patients without HELLP. Symptoms include malaise, right upper quadrant tenderness, nausea, vomiting, edema, relative or absolute hypertension, and a varying degree of proteinuria. 7 Although the classical severe PE with manifest hypertension is more common in an African population, the HELLP syndrome is...

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Section: Vinnars Et Al Severe Preeclampsia With and Without Hellpsupporting

confidence: 77%

Severe Preeclampsia With and Without HELLP Differ With Regard to Placental Pathology

et al. 2008

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show abstract

“…In addition, the observed ultra-structural alterations are, to some extent, in agreement with a previously published study on endothelial cell damage in PE [44]. In our EM analysis we have mainly focused on the plasma membrane structure, ECM architechture and organelle morphology of syncytio-/cyto-throphoblasts.…”

Section: Discussionsupporting

confidence: 74%

“…Gene array analysis showed an up-regulation of genes related to apoptosis and oxidative stress-response. The morphological alterations showed a high similarity to those observed in PE placentas [44]. Furthermore, the results also suggest that the hemeand radical scavenger A1M can prevent several of the harmful effects of the Hb-insult.…”

Section: Discussionsupporting

confidence: 53%

Perfusion of human placenta with hemoglobin introduces preeclampsia-like injuries that are prevented by α1-microglobulin

May¹,

Rosenlöf²,

Olsson³

et al. 2011

Placenta

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“…In comparison, the study went a step further by including pre-eclamptic hypertension, increased albumin levels, decreased pup weights, creatine clearance and urine volume as well as shown in (Figures 1-5). Other than the apoptotic signs seen in the syncytial layer, there was an apparent damage in the mitochondria and the microvilli of the syncytial layer (Figures 14,18) in pre-eclamptic placenta, a finding similar to that of De Luca Brunori et al [15]. In this study, mitochondrial degenerative changes occur in syncytiotrophoblast cells under doing apoptosis.…”

Section: Disscussionsupporting

confidence: 75%

“…Our electron microscopic examination revealed destructed apical villi (brush border) with signs of apoptosis as increased cytoplasmic vacuoles and irregular contour of the nucleus (Figures 9,17 and 18). These changes were in harmony with those described by [15]. The authors studied the factors of preeclampsia in vitro and found that hypoxia and reperfusion could induce apoptosis in the syncytiotrophoblasts.…”

Section: Disscussionmentioning

confidence: 49%

Electron and Scanning Microscopic Observations on the Syncytiotrophoblast Microvillous Membrane Contribution to Preeclampsia in Early Placental Rats

Selim¹,

Elshmry²,

Rashed³

2013

J Blood Disord Transfus

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Placental barrier breakage in preeclampsia: ultrastructural evidence

Cited by 36 publications

References 14 publications

Severe Preeclampsia With and Without HELLP Differ With Regard to Placental Pathology

Severe Preeclampsia With and Without HELLP Differ With Regard to Placental Pathology

Perfusion of human placenta with hemoglobin introduces preeclampsia-like injuries that are prevented by α1-microglobulin

Electron and Scanning Microscopic Observations on the Syncytiotrophoblast Microvillous Membrane Contribution to Preeclampsia in Early Placental Rats

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