The Ultrastructure of Placental Syncytial Knots in Normotensive, Preeclamptic and HELLP Syndrome Patients

Year 2016, Volume: 8 Issue: 1, 1 - 11, 15.06.2016

Dilek Yavuz Yusuf Nergiz Mehmet Sıddık Evsen Ercan Ayaz

Abstract

Background: Preeclampsia is one of the main causes of perinatal deaths and disabilities and is a
multisystemic disorder that is characterized by maternal hypertension, proteinuria, and increased
permeability of blood vessel damage.
Methods: In our study, increased syncytial nodes examined at ultrastructural level, and the effect of
the increase in syncytial node will be revealed by putting forward the possible changes in the
mentioned nodes both in women with preeclampsia and HELLP cases. We used the electron
microscope techniques to observe morphological and ultrastructural changes in the placenta and
placental deposits. Tissue samples were taken from 10 preeclamptic, 10 pregnant with HELLP and 10
healthy pregnant women from the control group. Through electron microscopy methods, the results of
the patients with preeclampsia, control group of pregnant women and patients with HELLP were
evaluated.
Results: As a result of electron microscopy studies, in placental tissues: in preeclampsia group, while
in fetal peripheral sections; we observed cytoplasmic common vacuolisations in syncytiotrophoblasts
and dilatation in endoplasmic reticulum cisterns, thinning in capillar endothelial cells and necrotic
appearance in syncytiotrophoblasts in contact with capillaries were found to be the dominant view. In
this group, reduction in the number of microvilli of syncytiotrophoblasts as well as the connective
tissue edema was one of the most remarkable findings. When HELLP maternal peripheral and central
cross-sections were analyzed, intracytoplasmic edema and degenerative vacuollar were observed in
syncytiotrophoblasts, both structures and villous edema seemed to be obvious. In HELLP fetal
peripheral sections, the presence of diffuse cellular debris in intervillous space was the most
important result.
Conclusion: Compared with the control group, increase was observed in the number of syncytial
nodes and histological changes in ultrastructural structure in placentas with preeclampsia and
HELLP.

Keywords

Preeclampsia, HELLP, Syncytial knot

References

• 1. Cunnigham FG, Mac Donald PC, Gant NF, Leveno KJ, Gilstarp LC. Hypertensive Disorders in Pregnancy. Williams Obstetrics 19th ed, Appleton and Lange, 1993: 763-819
• 2. Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD.Williams Obstetric. 21 st Edition. New York, McGraw- Hill 2001; Chapter 24.
• 3. Hauth JC, Ewell MG, Levine RJ, Esterlitz JR, Sibai B, Curet LB et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calsium for Preeklampsia Prevention Study Group. Obstet Gynecol 2000; 95: 24-28
• 4. Vigil-De-Gracia P. Pregnancy complicated by pre-eclampsiaeclampsia with HELLP syndrome. Int J Gynaecol Obstet. 2001; 72: 17-23.
• 5. Martin JN Jr, Blake PG, Lowry SL, Perry KG, Files JC, Morrison JC. Pregnancy complicated by preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver enzymes and low platelet count: How rapid is postpartum recovery? Obstet Gynecol. 1990; 76:737-41
• 6. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982; 142:159-67
• 7. Martin JN Jr, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: Comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. Am J Obstet Gynecol 1999; 180:1373
• 8. Carolyn J. P. Jones and H.Fox. Syncytial knots and intervillous bridges in the human placenta: an ultrastructural study. J. Anat. 1977; 124, 2, 275-86
• 9. Brunori I. L, Batini L, Brunori E, Lenzi P, Paparelli A, Simonelli M, Valentino, V, Genazzani A. R. Placental barrier breakage in preeclampsia: ultrastructural evidence. European Journal of Obstetrics &Gynecology ad Reproductive Biology. 2005; 118:182-189
• 10. Benirschke K, Kaufmann P. Pathology of the human placenta. Fifth Edition ed.pp. 327. New York: Springer; 2000.
• 11.Tenney B, Parker F. The placenta in toxemia of pregnancy. Am J Obstet Gynecol 1940;39:1000-5
• 12. Jones CJ, Fox H. Syncytial knots and intervillous bridges in the human placenta: an ultrastructural study. J Anat. 1977;124(2):275-86.
• 13. Kerr JF, Wyllie AH, Currie AR. Apoptosis: a basic biological phenomenon with wide-ranging implications in tissue kinetics. Br J Cancer 1972; 26(4):239-57
• 14. Smith SC, Baker PN, Symonds EM. Increased placental apoptosis in intrauterine growth restriction. Am J Obstet Gynecol 1997; 177(6): 1395-401.
• 15. Leung DN, Smith SC, To KF, Sahota DS, Baker PN. Increased placental apoptosis in pregnancies complicated by preeclampsia. Am J Obstet Gynecol 2001; 184(6):1249-50.
• 16. Allaire AD, Ballenger KA, Wells SR, McMahon MJ, Lessey BA. Placental apoptosis in preeclampsia. Obstet Gynecol 2000; 96(2):271-6
• 17. Rath G, Bastia B, Sood M, Mukherjee A. The effects of passive smoking on the terminal villi of human placenta, JASI. 2001; 50:24-27
• 18. de Luca Brunori I, Battini L, Brunori E, Lenzi P, Paparelli A, Simonelli M, Valentino V, Genazzani AR. Placental barrier breakage in preeclampsia: ultrastructural evidence . Eur J Obstet Gynecol Reprod Biol. 2005; 118(2):182-9.
• 19. Emanuelli M, Giannubilo SR, Landi, B. Placental Overexpression of Transforming Growth Factor Beta-3 in the HELLP Syndrome. Gynecol Obstet Invest, 2008; 65:1–5
• 20. Ball E, Robson SC, Ayis S, Lyall F, Bulmer JN. Expression of TGF beta in the placental bed is not altered in sporadic miscarriage. Placenta. 2007;28(8-9):965-71
• 21. Lyall F, Belfort M. Pre-eclampsia: Etiology and Clinical Practice. s.l. :Cambridge University Press, 2007
• 22. Madazlı R. Plasenta. Nobel Tıp Kitabevleri, 2008. 978-975-420-631-9
• 23. Lyall F, et al. Transforming growth factor-beta expression in human placenta and placental bed in third trimester normal pregnancy, preeclampsia, and fetal growth restriction. 2001, Am J Pathol, 159(5):1827- 38
• 24. Brosens I, Robertson WB, Dixon HG. The physiological response of the vessels of the placental bed to normal pregnancy. J Pathol Bacteriol 1967, 93:569–579.
• 25. Illsinger S, Janzen N, Sander S, Schmidt KH, Bednarcz KJ, Mallunat L et al. Preeclampsia and Hellp syndrome: impaired mitochondrial function in umbilical endothelial cells. Reprod Sci. 2010; 17:219-226
• 26. De Luca Brunori J, Battini L, Brunori E, Lenzi P, Paparelli A, Simonelli M et al. Placental barrier breakage in preeclampsia: Ultrastructural evidence. Eur J Obstet Gynecol Reprod Biol 2005:118:182-189
• 27. Dokras A, Hoffmann DS, Eastvold JS, Kienzie MF, Gruman LM, Kirby PA et al. Severe feto-placental abnormalities precede the onset of hypertension and proteinuria in a mouse model of preeclampsia. Biol Reprod 2006; 75: 899-907
• 28. Castejon OJ. The thesis of mitochondria as marker of lethal injury in the traumatic human brain oedema. An electron microscopic study using cortical biopsies. Acta Microscopica 2008; 17: 16-27
• 29. Robinson NJ, Wareing M, Hudson NK, Blankley RT, Baker PN, Aplin JD et al. Oxygen and the liberation of placental factors responsible for vascular compromise. Lab Invest 2008; 88:293-305
• 30. Heazell A.E.P, Moll, S.J, Jones, CJ.P, Baker P.N, Crocker I.P. Formation of Syncytial Knots is İncreased by Hyperoxia, Hypoxia and Reactive Oxygen Species. Placenta. 2007; 28 33-40.
• 31. Corr R.R.M, Gilio D.B, Cavellani C.L, Paschoini M.C, Oliveria F.A, Peres L.C, Reis M.A, Teixeira V.P.A, Castro E.C.C. Placental morphometrical and histopathology changes in the different clinical presentations of Hypertensive Syndromes in Pregnancy. Archives of Gynecology and Obstetrics. 2008; 277:201-206
• 32. Benirschke K, Kaufmann P, Baergen R.N. Pathology of the Human Placenta. Fifth Edition. Springer Science + Business Media, Inc.2006
• 33. Brunori I. L, Batini L, Brunori E, Lenzi P, Paparelli A, Simonelli M, Valentino V, Genazzani A. R. Placental barrier breakage in preeclampsia: ultrastructural evidence. European Journal of Obstetrics &Gynecology ad Reproductive Biology. 2005; 118:182-189
• 34. Battistelli M, Burattini S, Pomini F, Scavo M, Caruso A, Falcieri E..Ultrastructural Study on Human Placenta From İntrauterin Growth Reterdation Cases. Microscopy Research and Technique. 2004; 65:150- 158.