DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20185360

Histological evaluation of placenta in hypertensive pregnancies

Kantilal M. Parmar, Gopal V. Shah, Ravi R. Alamchandani

Abstract


Background: Maternal and fetal status are reflected in placenta. Toxemia of pregnancy exerts great impact on placenta and thereby fetal and maternal outcomes. Placenta reflects changes of toxemia and these changes are seen morphology as well as histology. Hence study of placenta gives information on the in-utero fetal condition.

Methods: A total of 1000 placenta, 500 each from hypertensive and normotensive groups were included in this study conducted in Anatomy Department of SBKS Medical College and Research Centre, Vadodara. Histological evaluation of the samples taken was done under microscope.

Results: Microscopic examination of the placenta revealed the presence of calcification, infarction, fibrinoid necrosis, villous hyalinization, syncytial knots and cytotrophoblastic cellular proliferation in both control and hypertension groups. In the present study, calcification was seen in 35.8% in the control group, while the same was seen in 53.8% patients in test group. Fibrinoid necrosis was seen in 48.8% patients in control group as against 69% patients in test group. Villous Hyalinization was seen in 7.40% and 21.4% patients in control and test groups respectively. On the other hand, syncytial knots were seen in 38% and 69% patients in control and test groups respectively. In test group, cytotrophoblastic cellular proliferation was seen in 69% patients while in control group, it was seen in 33.2% patients. Infarction was also seen in test (42.4%) and control (12.6%) groups.

Conclusions: Hypertensive disorders of pregnancy have significant effect on the histology of placenta and also influences the fetal outcomes.


Keywords


Histology, Hypertensive pregnancies, Microscopic examination, Placenta, Pre-eclampsia

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References


Udainia A, Bhagwat SS, Mehta CD. Relation between placental surface area, infarction and foetal distress in pregnancy induced hypertension with its clinical relevance. J Anat Soc Ind. 2004;53(1):27-30.

Robertson WB, Brosens I, Dixon HG. The pathological response of the vessels of the placental bed to hypertensive pregnancy. J Pathol Bacteriol. 1967 Apr;93(2):581-92.

Norwitch ER, Chaur-Dong HSU, Rapke JT. Acute complication of preeclampsia. Clinical Obstet Gynecol. 2002;45(2):308-29.

Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstetri Gynecol. 2003 Jul 1;102(1):181-92.

Browne JM, Veall N. The maternal placental blood flow in normotensive and hypertensive women. BJOG: Int J Obstet Gynaecol. 1953 Apr;60(2):141-7.

Landesman R, Douglas RG, Holze E. The bulbar conjunctival vascular bed in the toxemias of pregnancy. Am J Obstet Gynecol. 1954;68(1):170-3.

Stock MK, Anderson DF, Phernetton TM, McLaughlin MK, Rankin JH. Vascular response of the fetal placenta to local occlusion of the maternal placental vasculature. J Develop Physiol. 1980 Oct;2(5):339-46.

Dutta DC. The placenta and fetal membranes, hypertensive disorder of pregnancy. In: Textbook of Obstetrics, 4th edn. 1998. New Central Book Agency, Calcutta. 1998;28-40, 234-55.

Majumdar S, Dasgupta H, Bhattacharya K, Bhattacharya A. A study of placenta in normal and hypertensive pregnancies. J Anat Soc India. 2005;54(2):1-9.

Siva Sree Ranga MK, Adaline Thangam. TF, Mallika MC, Indira MV. Morphological and histological variations of human placenta in hypertensive disorders of pregnancy. Int J Anat Res. 2017;5(1):3591-98.

Kambale T, Iqbal B, Ramraje S, Swaimul K, Salve S. Placental morphology and fetal implications in pregnancies complicated by pregnancy-induced hypertension. Med J Dr. DY Patil University. 2016 May 1;9(3):341-7.

Kheir AE, Ali RB, Kononna AA. Neonatal outcome in hypertensive disorders of pregnancy in a tertiary neonatal unit in Sudan. J Med Medical Res. 2014;2(5):59-65.

Kumari P, Sharma SN, Kumar S, Kumar M. A Comparative study of blood pressure in normal and pregnancy induced hypertensive cases for early diagnosis of hypertensive disorders in a tertiary care hospital. Int J Sci Study. 2014 June; 2(3):33-37.

Adu-Bonsaffoh K, Ntumy MY, Obed SA, Seffah JD. Perinatal outcomes of hypertensive disorders in pregnancy at a tertiary hospital in Ghana. BMC Pregnancy Childbirth. 2017 Dec;17(1):388.

Pokorna V, Pazmanova T, Kaluzay J, Skultetyova D, Minarikova Z, Pontuch P. Hypertension in pregnancy: fetal outcome. A Single-center 4-year retrospective study. J Hypertension. 2016 Sep 1;34:e264.

Allen VM, Joseph KS, Murphy KE, Magee LA, Ohlsson A. The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study. BMC Pregnancy Childbirth. 2004 Dec;4(1):17.

Rahman LA, Hairi NN, Salleh N. Association between pregnancy induced hypertension and low birth weight; a population based case-control study. Asia Pacific J Public Health. 2008 Apr;20(2):152-8.

Keche HA, Keche AS. Morphometric differentiation between placenta in PIH and normal pregnancy. Int J Med Sci Public Health. 2015 Feb 1;4:250-5.

Habli M. Neonatal outcomes in pregnancies with preeclampsia or gestational hypertension and in normotensive pregnancies that delivered at 35, 36, or 37 weeks of gestation. Am J Obstet Gynecol. 2007 Oct;197(4):406.

McKay DG, Hertig AT, Adams EC, Richardson MV. Histochemical observations on the human placenta. Obstetr Gynecol. 1958 Jul 1;12(1):1-36.

Wigglesworth JS. Morphological variations in the insufficient placenta. BJOG. 1964 Dec 1;71(6):871-84.

Kline BS. Microscopic observations of development of human placenta. Am J Obstet and Gynae. 1951;61:1065-1074.

Fox H. The significance of villous syncytial knots in the human placenta. Int J Obstetr Gynaecol. 1965 Jun;72(3):347-55.

Kumari V, Sinha UP. Histopathological and gross anatomical study of human placenta in patients with preeclampsia. J Evidence Based Med Healthcare. 2016 Jan 1;3(59):3162-5.

Kher AV, Zawar MP. Study of placental pathology in toxemia of pregnancy and its fetal implications. Indian J Pathol Microbiol. 1981;24:245-51.

Fox H. General pathology of the placenta. In: Fox H, editor. Haines and Taylor Obstetrical and Gynecological Pathology. 4th ed. Edinburgh: Churchill Livingstone: 1995:1480-2.

Narasimha A, Vasudeva DS. Spectrum of changes in placenta in toxemia of pregnancy. Indian Journal of Pathology and Microbiology. 2011 Jan 1;54(1):15-20.