CAN PLACENTAL HISTOPATHOLOGICAL LESIONS BE A GUIDE TO MATERNAL AND NEONATAL OUTCOMES IN PATIENTS WITH PREECLAMPSIA?

Abstract

Objective: The aim of this study was to investigate the predictive role of massive perivillous fibrinoid deposition (MPFD), syncytial knots, and accompanying histopathological features of placentas of preeclampsia (PE) on maternal and neonatal outcomes.
Matherials and methods: A retrospective clinicopathological study was conducted in a tertiary unit. In the study, 51 pregnant women admitted with PD and 55 normotensive healthy pregnant women matched for age and gestational age were compared. Information regarding clinical characteristics, neonatal findings, and placental properties such as syncytial knots, vascular structure density, placental area, volume, and weight) was retrieved.
Results: Massive perivillous fibrinoid deposition, syncytial knots and decreased vessels in terminal villi were significantly frequent in the PE group compared to the controls. However, these histopathological findings were not associated with clinical and neonatal outcomes.
Conclusions: Syncytial knot and perivillous fibrin deposition are significant microscopic findings of preeclampsia. However, the presence and amount of fibrin deposition were not correlated with perinatal outcome.

Keywords

• Preeclampsia
• Massive perivillous fibrinoid deposition
• Syncytial knots
• Neonatal outcomes
• Obstetric complications

PREEKLAMPSİLİ HASTALARDA PLASENTAL HİSTOPATOLOJİK LEZYONLAR MATERNAL VE NEONATAL SONUÇLAR İÇİN BİR REHBER OLABİLİR Mİ?

Abstract

Amaç: Bu çalışma preeklampsi (PE) plasentalarında perivillöz fibrinoid birikimini (PFB), sinsityal düğümleri ve eşlik eden histopatolojik özelliklerin klinik etkisini araştırmayı amaçladı.
Gereç ve yöntem: Retrospektif bir klinikopatolojik çalışma olarak üçüncü basamak hastanede yürütüldü. Çalışmaya obstetri kliniğinde PE tanısı konmuş olan 51 gebe ile yaş ve gestasyonel süre açısından eşleştirilmiş 55 normotansif sağlıklı gebe dahil edildi. Klinik özellikler ve gebeliğe ait veriler (maternal-gestasyonel yaş, gravida, parite, intrauterin büyüme geriliği, oligohidramniyoz & anhidramniyoz durumu, koryoamniyonit varlığı, umblikal arter doppler pulsatilite indeksinde artış, preterm doğum, yenidoğanın 1. ve 5. dakika apgar skorları, doğum ağırlığı, hemogram parametreleri, umblikal kord kan gazı (umblikal arter) pH, baz açığı ve kalsiyum düzeyleri) karşılaştırıldı. Ayrıca, sinsityal düğümler, vasküler yapılanma yoğunluğu, plasental alan, volüm ve ağırlık gibi plasental veriler de hesaplandı.
Bulgular: Perivillöz fibrinoid birikimi ve sinsityal düğümler, PE grubunda kontrollere kıyasla anlamlı derecede sık ve yoğundu. Terminal villuslarda azalmış damarlar, artmış sinsityal düğüm ve artmış perivillöz fibrin birikimi PE ile ilişkilidir. Parametrelerin klinik ve neonatal etkileri araştırıldığında, sadece umblikal kord kan gazı analizinde kalsiyum seviyelerinde gruplar arasında anlamlı fark elde edildi (p=0.008).
Sonuç: Sinsityal düğüm ve perivillöz fibrin birikimi preeklampsinin önemli mikroskobik bulgularıdır. Fibrin birikiminin varlığı ve miktarı, fetal ağırlık ve plasentanın makroskopik özellikleri (plasenta ağırlığı, alanı ve hacmi) ile ilişkili değildi. Bu bulguların

Keywords

• Preeklampsi
• Masif perivillöz fibrinoid birikimi
• Sinsityal düğümler
• Neonatal sonuçlar
• Obstetrik komplikasyonlar

References

1. 1. Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol 2012;36(1):56-9. [CrossRef] google scholar
2. 2. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010;376(9741):631-44. [CrossRef] google scholar
3. 3. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020;135(6):1492-5. [CrossRef] google scholar
4. 4. Granger JP, Alexander BT, Llinas MT, Bennett WA, Khalil RA. Pathophysiology of preeclampsia: linking placental ischemia/hypoxia with microvascular dysfunction. Microcirculation 2002;9(3):147-60. [CrossRef] google scholar
5. 5. Roberts JM, Pearson GD, Cutler JA, Lindheimer MD; National Heart Lung and Blood Institute. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertension In Pregnancy 2003;22(2):109-27. [CrossRef] google scholar
6. 6. Kliman HJ. Uteroplacental blood flow. The story of decidualization, menstruation, and trophoblast invasion. Am J Pathol 2000;157(6):1759-68. [CrossRef] google scholar
7. 7. Falco ML, Sivanathan J, Laoreti A, Thilaganathan B, Khalil A. Placental histopathology associated with pre-eclampsia: systematic review and meta-analysis. Ultrasound Obstet Gyneco 2017;50(3):295-301. [CrossRef] google scholar
8. 8. Ernst LM. Maternal vascular malperfusion of the placental bed. APMIS 2018;126(7): 55160. [CrossRef] google scholar

9. 9. Benirschke K, Kaufmann P. Pathology of Maternal Floor Infarction. In: Pathology of the Human Placenta. New York, NY: Springer; 1990;406-411. [CrossRef] google scholar
10. 10. Jones CJ, Fox H. An ultrastructural and ultrahistochemical study of the placenta of the diabetic woman. J Pathol 1976;119(2):91-9. [CrossRef] google scholar
11. 11. Bane AL, Gillan JE. Massive perivillous fibrinoid causing recurrent placental failure. BJOG 2003;110(3):292-5. [CrossRef] google scholar
12. 12. Tenney B, Parker, F. The pathology in toxemia of pregnancy. Amer J Obstet Gynecol 1940;39(6):1000-5. [CrossRef] google scholar
13. 13. Spencer MK, Khong TY. Conformity to guidelines for pathologic examination of the placenta. Arch Pathol Lab Med 2003;127(2):205-7. [CrossRef] google scholar
14. 14. Janthanaphan M, Kor-Anantakul O, Geater A. Placental weight and its ratio to birth weight in normal pregnancy at Songkhlanagarind Hospital. J Med Assoc Thai 2006;89(2):130-7. google scholar
15. 15. Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth 2010;37(3):219-26. [CrossRef] google scholar
16. 16. Sirenden H, Sunarno I, Arsyad MA, Idris I. Birth weight, Apgar score, and fetal complications in mothers with severe preeclampsia. Enferm Clin 2020;30:533-6. [CrossRef] google scholar
17. 17. Sheikh M, Zoham MH, Hantoushzadeh S, Shariat M, Dalili H, Amini E. Umbilical blood gas analysis in preeclamptic versus healthy pregnancies with preterm birth. J Matern Fetal Neonatal Med 2016;29(15):2549-54. google scholar
18. 18. Heazell AE, Moll SJ, Jones CJ, Baker PN, Crocker IP. Formation of syncytial knots is increased by hyperoxia, hypoxia and reactive oxygen species. Placenta 2007;28:33-40. [CrossRef] google scholar
19. 19. Fogarty NM, Ferguson-Smith AC, Burton GJ. Syncytial knots (Tenney-Parker changes) in the human placenta: evidence of loss of transcriptional activity and oxidative damage. Am J Pathol 2013;183(1):144-52. [CrossRef] google scholar
20. 20. Devisme L, Merlot B, Ego A, Houfflin-Debarge V, Deruelle P, Subtil D. A case-control study of placental lesions associated with pre-eclampsia. Int J Gynaecol Obstet 2013;120(2):165-8. [CrossRef] google scholar
21. 21. Zigic Z, Markovic S, Grbesa D, Ramic S, Halilovic A. Quantitative research of capillaries in terminal villi of mature placentae. Bosn J Basic Med Sci 2010;10(2):147-52. [CrossRef] google scholar
22. 22. Sankar KD, Bhanu PS, Ramalingam K, Kiran S, Ramakrishna BA. Histomorphological and morphometrical changes of placental terminal villi of normotensive and preeclamptic mothers. Anat Cell Biol 2013;46(4):285-90. [CrossRef] google scholar
23. 23. Hofmeyr GJ, Duley L, Atallah A. Dietary calcium supplementation for prevention of pre-eclampsia and related problems: a systematic review and commentary. BJOG. 2007;114(8):933-43. [CrossRef] google scholar
24. 24. Sende PP, Isah AY, Nwegbu MM, Ekele BA, Agida T, Adebayo FO. Plasma calcium levels in preeclampsia versus normotensive pregnant women in a tertiary hospital: A comparative study. J Fetal Med 2019:6;25-30. [CrossRef] google scholar
25. 25. Haller H, Oeney T, Hauck U, Distler A, Philipp T. Increased intracellular free calcium and sensitivity to angiotensin II in platelets of preeclamptic women. Am J Hypertens 1989;2(4):238-43. [CrossRef] google scholar
26. 26. Haller H, Ziegler EM, Homuth V, Drab M, Eichhorn J, Nagy Z, Busjahn A, Vetter K, Luft FC. Endothelial adhesion molecules and leukocyte integrins in preeclamptic patients. Hypertension 1997;29:291-6. [CrossRef] google scholar