DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183799

Placental changes in hypertensive pregnancy: a comparison with normotensive pregnancy

Jashan Chhatwal, Dev Nanda Chaudhary, Neena Chauhan

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.


Keywords


Hypertension in pregnancy, Histopathology, Morphometry, Placental morphology, Preeclampsia

Full Text:

PDF

References


Dolea C, Abou Zahr C, eds. Global Burden of Hypertensive Disorders of Pregnancy in the Year 2000. Geneva:World Health Organisation;2003.

Muti M, Tshimanga M, Notion GT, Bangure D, Chonzi P. Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare, Zimbabwe. BMC Cardiovasc Disorders. 2015;15:111.

Ye C, Ruan Y, Zou L, Li G, Li C, Chen Y, et al. The 2011 Survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS One. 2014 Jun 17;9(6):e100180.

Arshad A, Pasha W, Khattak TA, Kiyani RB. Impact of pregnancy induced hypertension on birth weight of newborn at term. 2011;15(2):113-5.

Kurdukar MD, Deshpande NM, Shete SS, Zawar MP. Placenta in PIH. Indian J Pathol Microbiol. 2007 Jul; 50(3):493-7.

Krielessi V, Papantoniou N, Papageorgiou I, Chatzipapas I, Manios E, Zakopoulos N et al. Placental pathology and blood pressure’s level in women with hypertensive disorders in pregnancy. Obstet Gynecol Int. 2012;2012:684083.

Soma H, Yoshida K, Mukaida T, Tabushi Y. Morphologic changes in the hypertensive placenta. Contributions Gynecol Obstet. 1982;9:358-75.

Myatt L. Role of placenta in preeclampsia. Endocrine. 2002;19(1):103-11.

Misra DP, Salafia CM, Miller RK, Charles AK. Non-linear and gender-specific relationships among placental growth measures and the fetoplacental weight ratio. Placenta. 2009;30(12):1052-7.

Kingdom J. Adriana and Luisa Castellucci Award Lecture. Placental pathology in obstetrics: adaptation or failure of the villous tree? Placenta. 1997;19(5-6):347-51.

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

Singh S and Gugapriya TS. A cross sectional morphometric study of hypertensive with normal placentae and its correlation with fetal outcome. Int J Anat Res. 2014;2(2):437-42.

Qureshi MA, Bhurgri GR, Yousfani GM. Morphological and histological changes in placenta of hypertensive and gestational diabetic women. Med Formum Monthly. 2014;25(10):10-4.

Motwani R, Sontakke Y, Goyal M. Effects of Pregnancy Induced Hypertension on human placenta. JEMDS. 2013;2(33):6275-82.

Kulandaivelu AR, Srinivasamurthy BC, Murgan A, Morphology and morphometric study of human placenta in rural southern India. Br J Med Med Res. 2014;4(15):2995-3008.

Nag U, Chakravarthy VK, Rao DR. Morphological changes in placenta of hypertensive pregnant women. IJRRMS. 2013;3(2):1-4.

Salmani D, Purushothaman S, Somashekara SC, Gnanagurudasan E, Sumangaladevi K, Harikishan R, et al. Study of structural changes in placenta in pregnancy-induced hypertension. J Natural Sci Biol Med. 2014;5(2):352-5.

Singh S and Gugapriya TS. A cross sectional morphometric study of hypertensive with normal placentae and its correlation with fetal outcome. Int J Anat Res. 2014;2(2):437-42.

Porwal V, Jain D, Gupta S, Khandelwal S, Kasliwal N. Spectrum of placental changes in pregnancy induced hypertension. Annal Pathol Lab Med. 2017;4(1):A69-A76.

Siva Sree Ranga MK, Kumar KV, Thangam A, Vasantha Mallika MC. Morphological variations of human placentae in preterm labor, pregnancy-induced hypertension, and gestational diabetes mellitus. Int J Scientific Study. 2017;4(11):144-9.

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;55:17-21.

Rana S, Diwan Y, Chauhan RS, Diwan D, Gupta A. Comparative study of histology of placenta in normotensive and hypertensive cases. JMSCR. 2017;5(3):18635-40.

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