Placental changes in hypertensive pregnancy: a comparison with normotensive pregnancy

Abstract

Background: Hypertensive pregnancy may be responsible for vascular damage, enhanced systemic inflammation and insulin resistance in the placenta as oxygen and nutrient transfer is impaired and oxidative stress is generated affecting the placental growth and development. Placental growth pattern in hypertensive pregnancies shows a variable pattern owing to placental insufficiency. Present study was done to investigate the morphological and histological changes in placenta in hypertensive pregnancy.Methods: A total of 42 pregnant women with hypertensive disorder with gestational age 28-42 weeks and singleton pregnancy were enrolled as cases in the study. A total of 42 matched normotensive pregnant women were enrolled as controls. All the women were followed up till delivery. At delivery, placental specimen were collected and assessed for morphological, morphometric and histological changes. Findings were compared with normotensives. Data was compared using Independent sample’s ‘t’-test and Chi-square test.Results: Mean age of cases was 27.60±4.37 years, majority were gravida 1/2 (66.7%), 45.2% had moderate to severe edema, 50% had urinary albumin levels >100 mg/dl. A total of 8 (19.0%) had gestational hypertension, 16 (38.1%) had preeclampsia, 10 (23.8%) had severe preeclampsia and 8 (19.0%) had eclampsia. Mean placental weight and diameter of cases was significantly higher than that of control group. Mean placental thickness was also higher but difference was not significant statistically. Calcification, infarction and hematoma were seen in 45.2%, 16.7% and 11.9% of cases as compared to 28.6%, 4.97% and 0% of controls. Histologically, syncytial knots, cytotrophoblastic cellular proliferation, hyalinized area, proliferation of medium sized blood vessels, stromal fibrosis and fibrinoid necrosis in significantly higher proportion of cass as compared to controls (p<0.05). Mean fetoplacental ratio was 5.01±0.99 and 5.24±0.61 in controls (p=0.195).Conclusions: Hypertension during pregnancy affects the placental growth and development.

Histomorphometric Variations of the Placenta in Normal and Hypertensive Pregnancies

“…Ranjan et al, Pramar et al and Chhatwal et al in their studies also observed and reported the findings that are consistent with our study. 11,21,22 Limited funds and time duration were one of the major constraints of the present study. The current study focused on histomorphometric changes in the placenta, while the status of the newborn babies in terms of APGAR score should also be evaluated in association with microscopic studies of the placenta.…”

Comparison of gross morphological and histological features of placenta between hypertensive and normotensive pregnant women attending Muhimbili National Hospital.

“…Previous histological studies of the placentas have revealed the presence of calcifications, infection, fibrinoid necrosis, syntial knots, villous hyalinization in both groups however these findings were significantly predominant in the hypertensive group (Parmar, Shah and Alamchandani, 2019) (Salmani et al, 2014) (Nag and Vk, 2013) (Sankar et al, 2013) (Chhatwal, Chaudhary and Chauhan, 2018). These studies have been done among Caucasians and have revealed some different findings in some aspects.…”

“…Previous morphological studies of the placentas revealed that the mean weight and mean a number of cotyledons were significantly less in the hypertensive pregnant mothers compared to normotensive pregnant mothers. Also altered shapes of the placentas that are in irregular shape and marginal insertion of umbilical cord were significantly more in the hypertensive group as compared to the normotensive group (Goswami and Shah, 2016) (Sankar et al, 2013) (Chhatwal, Chaudhary and Chauhan, 2018) (Communication, 2017) (Nag and Vk, 2013) though the study done by (Ashfaq, Janjua and Channa, 2005) showed that the placentas were roughly oval with the central attachment of umbilical cord in both groups.…”

Histomorphological Characteristics of the Placenta in Women with Obesity and Preeclampsia

“…1. У плацентах жінок з фізіологічною масою тіла та ожирінням, перебіг вагітності яких був ускладнений розвитком ПЕ, встановлені домінуючі та клінічно значущі гістологічні показники у вигляді вогнищевої проліферації термінальних ворсин і їх капілярів, тотальної проліферації синцитія з утворенням виражених синцитіальних вузликів з одночасною наявністю незрілих та «юних» ворсин, вираженого ангіоматозу строми термінальних ворсин, великої кількості синцитіокапілярних мембран, фіброзу стовбурових ворсин, ворсин середнього калібру та термінальних ворсин, осередкового скупчення позаворсинчастого трофобласту, вогнищевих ішемічних інфарктів термінальних ворсин та геморагічного інфаркту міжворсинчастого простору з осередковим тромбозом капілярів ворсин, дистрофічних та некробіотичних змін децидуальних клітин базальної оболонки, що ототожнюється з даними інших авторів [11,12,13,14]. Вище вказані морфологічні зміни у тканині досліджуваних плацент та ступінь їх вираженості свідчать про значне порушення плацентарного кровотоку, що ініціює розвиток процесів адаптації і компенсації.…”

“…Вище вказані морфологічні зміни у тканині досліджуваних плацент та ступінь їх вираженості свідчать про значне порушення плацентарного кровотоку, що ініціює розвиток процесів адаптації і компенсації. Проте, їхня різка вираженість дозволяє припустити факт недостатності компенсаторно-пристосувальних реакцій в плаценті при ПЕ [12,15,16].…”