Placental morphological and histopathological changes in preeclampsia and eclampsia: a prospective case-control study using an objective scoring system

Sonal Tripathi; Kachnar Varma; Sarika Gupta; Amrita Chaurasia; Vatsala Misra

doi:10.18203/2320-1770.ijrcog20253747

Authors

Sonal Tripathi Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India https://orcid.org/0000-0001-8255-6448
Kachnar Varma Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India https://orcid.org/0000-0003-0072-7368
Sarika Gupta Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India https://orcid.org/0009-0008-9950-0414
Amrita Chaurasia Department of Obstetrics and Gynaecology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
Vatsala Misra Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253747

Keywords:

Hypertensive disorders of pregnancy, Placental pathology, Morphological scoring

Abstract

Background: The hypertensive disorders of pregnancy (HDP), particularly preeclampsia (PE) and eclampsia (EC) play a major role in maternal and perinatal morbidity. Despite extensive descriptive work on placental lesions in these conditions, only a few studies have attempted to objectively quantify the morphological damage. This study was undertaken to apply a structured histopathological scoring system to placental lesions in PE and EC and to determine whether the scores correlate with the severity of disease and adverse fetal outcome.

Methods: This prospective case-control study included 100 placentas: 50 from PE, 25 from EC, and 25 from normotensive pregnancies as controls. Gross and microscopic features were assessed using a semi-quantitative histopathological scoring system evaluating fibrin deposition, maternal floor infarction, syncytial knot, calcification, and villous basement membrane thickening. Scores were correlated with placental weight and fetal outcome, indicating uteroplacental insufficiency.

Results: Placenta; weight and thickness were significantly reduced in hypertensive cases compared with controls (p<0.001). Histological lesions such as fibrin deposition, maternal floor infarction, and syncytial knotting were markedly increased in the PE and EC groups (p<0.001). The median composite histopathological score was 4 in controls, 6 in PE, and 8 in EC. Higher scores were significantly associated with low placental weight and adverse fetal outcome.

Conclusions: Placental histopathological scoring offers an objective and reproducible approach to quantity morphological damage in PE and EC. The scoring system correlates with disease severity and fetal outcome, underscoring its potential value as a morphological marker of uteroplacental insufficiency.

Metrics

Metrics Loading ...

References

Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, Vogel JP, et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: A secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121(1):14-24. DOI: https://doi.org/10.1111/1471-0528.12629

Mathew R, Devanesan BP, Srijana, Sreedevi NS. Prevalence of hypertensive disorders of pregnancy, associated factors and pregnancy complications in a primigravida population. Gynecol Obstet Clin Med. 2023;3(2):119-23. DOI: https://doi.org/10.1016/j.gocm.2023.01.002

Prathiba D, Einstien D, Sudhakar R, Saraswathi M. Correlation of placental morphometry with fetal outcome in preeclamptic pregnancies. J Res Med Dent Sci. 2022;10(8):273-8.

Parmar KM, Shah GV, Alamchandani RR. Histological evaluation of placenta in hypertensive pregnancies. Int J Res Med Sci. 2019;7(1):40-5. DOI: https://doi.org/10.18203/2320-6012.ijrms20185360

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;17:388. DOI: https://doi.org/10.1186/s12884-017-1575-2

Rahman LA, Hairi NN, Salleh N. Association between pregnancy-induced hypertension and low birth weight: A population-based case-control study. Asia Pac J Public Health. 2008;20(2):152-8. DOI: https://doi.org/10.1177/1010539507311553

Donthi D, Malik P, Mohamed A, Kousar A, Subramanian RA, Manikyam UK. An objective histopathological scoring system for placental pathology in pre-eclampsia and eclampsia. Cureus. 2020;12(10):e11104. DOI: https://doi.org/10.7759/cureus.11104

Mallick S, Barik N, Pradhan S. Gestational hypertension and fetal outcome: A prospective study in a tertiary care centre. Indian J Obstet Gynecol Res. 2020;7(4):595-9. DOI: https://doi.org/10.18231/j.ijogr.2020.126

Nahar L, Nahar K, Hossain MI, Jahan S, Rahman M. Placental changes in pregnancy-induced hypertension. Mymensingh Med J. 2013;22(4):684-93.

American College of Obstetricians and Gynecologists (ACOG). Hypertension in pregnancy: Practice Bulletin No. 222. Obstet Gynecol. 2020;135(6):e237-60. DOI: https://doi.org/10.1097/AOG.0000000000003891

Udainia A, Jain ML. Morphometric study of placenta in normal and hypertensive pregnancies. Indian J Pathol Microbiol. 2018;61(3):433-8.

Sharma R, Singh N, Tiwari A, Gupta A, Kumar V, Patel R. Maternal and fetal outcomes in hypertensive disorders of pregnancy: A tertiary care experience. J Family Med Prim Care. 2023;12(1):45-51.

Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: Current concepts. Am J Obstet Gynecol. 1998;179(5):1359-75. DOI: https://doi.org/10.1016/S0002-9378(98)70160-7

Phipps E, Thadhani R, Benzing T, Karumanchi SA. Preeclampsia: Pathogenesis, prevention, and long-term complications. Hypertens Pregnancy. 2022;41(3):123-34.

Patil S, Mehta P, Desai R, Pawar S. Placental morphology and outcomes in hypertensive disorders of pregnancy. Indian J Obstet Gynecol Res. 2022;9(2):174-9.

Begum F, Jahan I, Rahman F, Chowdhury T, Sultana R, Yasmin N. Correlation of placental changes with severity of preeclampsia. Int J Reprod Contracept Obstet Gynecol. 2021;10(6):2104-9.

Pacher J, Brix E, Lehner R. The mode of delivery in patients with preeclampsia at term subject to elective or emergency cesarean section. Arch Gynecol Obstet. 2014;289(2):263-7. DOI: https://doi.org/10.1007/s00404-013-2936-3

Sibai BM, Ewell M, Levine RJ, Klebanoff MA, Esterlitz J, Catalano PM, et al. Risk factors associated with preeclampsia in healthy nulliparous women: The Calcium for Preeclampsia Prevention (CPEP) study. Am J Obstet Gynecol. 1997;177:1003-10. DOI: https://doi.org/10.1016/S0002-9378(97)70004-8

Kumar S, Sharma P, Yadav A, Patel S. Maternal age and parity in relation to pre-eclampsia: A clinical correlation study. Cureus. 2021;13(8):e17245.

Bhatnagar R, Singh A, Verma R, Kaur S. Maternal and perinatal outcome in severe preeclampsia and eclampsia. J Obstet Gynaecol India. 2020;70(5):389-95.

Gupta A, Sharma P, Singh N, Dubey S. Placental pathology in preeclampsia and correlation with fetal outcome. J Clin Diagn Res. 2023;17(4):EC01-6.

Harmon EQ, Lee Y, Ewing AC, McIntire DD, Casey BM, Leveno KJ. Hypertensive disorders and stillbirth: Population-based analysis. Am J Obstet Gynecol. 2021;225(5):553.e1-10.

Akhlaq M, Nagi AH, Yousaf AW. Placental morphology in pre-eclampsia and eclampsia and the likely role of NK cells. Indian J Pathol Microbiol. 2012;55(1):17-21. DOI: https://doi.org/10.4103/0377-4929.94848

Singhal SR, Deepika, Anshu, Nanda S. Maternal and perinatal outcome in severe preeclampsia and eclampsia. J South Asian Fed Obstet Gynecol. 2009;1(1):25-8. DOI: https://doi.org/10.5005/jp-journals-10006-1005

Choudhary A, Patel M, Reddy R, Kapoor S. Placental morphometry and histopathological changes in hypertensive pregnancies: A tertiary care study. J Clin Diagn Res. 2021;15(10):EC01-5.

Redline RW. Placental pathology: A systematic approach with clinical correlations. Placenta. 2021;114:57-67.

Vora K, Bansal P, Patel S. Placental morphometry in normal and hypertensive pregnancies: A comparative study. Indian J Anat Sci. 2020;11(1):23-8.

Singh P, Kumar R, Rani A. Morphometric and histopathological evaluation of placenta in pregnancy-induced hypertension. Int J Reprod Med. 2022;2022:8372961.