Correlation between changes in placental morphological features with abnormal Doppler flow in pregnancy induced hypertension
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20190259Keywords:
Calcification, Infarction, Placenta, Retroplacental clotsAbstract
Background: Placenta is one of the most challenging organs; it is an instrument of transfer of essential elements, i.e. nutrients and oxygen from mother to fetus and waste product of metabolism in reverse manner.
Methods: Cases of PIH between 20-36 weeks of gestation will be studied over a peri-od of 2 years having B.P ≥140/90mm Hg and protienuria ≥1+ in this prospective analytical study having color Doppler scanner with PI, RI of umbilical, uterine artery and middle cerebral artery PI along with placental morphological changes are observed.
Results: In present study where, placental weight was <300g also has LBW babies born were higher 51(100%). In placental gross examination 58% infarction, 42% calcification and 48% retroplacental were found. among 58 samples with infarction 76%, 42 placentas had calcification 48% and among 49 samples retroplacental clots 61% were belonged to uterine artery PI >1 group. While 78% placental infarction, 57% calcification and 69% retroplacental clots be-longed to uterine artery RI > 0.6 group. Infarction were 77.50%, calcification were same as infarction 77.50% while retroplacental clots 80% in group having MCA PI <1.3 that were higher than group of cases having MCA PI >1.3.
Conclusions: In recent years placenta has drawn attention as valuable indicator for maternal and fetal diseases in preeclampsia. Decreased circulation in placenta reflects on its morphological features and these changes causes alterations in Doppler flow velocities of uterine, umbilical and middle cerebral vessels pregnancy induced hyper-tension.
References
Roberts JM, Cooper DW. Pre-eclampsia etiology, Pathogenesis and genetics of pre-eclampsia. The Lancet. 2001;357(9249):53-6.
Soma H, Yoshida K, Mukaida T, Tabuchi Y ; Morphological changes in the hypertensive placenta, Contrib Gynecology and Obstetrics 1982;9:58-75.
Fox H, Langley F. The pathology of infarction in perinatal morbidity and mortality. Biologica neonatorum. 1973;11:87.
Robertson WB, Brosens I and Dixon HG; The pathological response of the vessels of the placental bed to hypertensive pregnancy. J Pathol Bacteriol 1967;93(2):581-92.
Norwitch ER, Chaur-Dong HSU, Rapke JT; Acute complication of preeclampsia. Clinic Obstet Gynecol. 2002;45(2):308-29.
Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Clinic Obstet Gynecol. 2003;102(1):181-92.
Ertan AK, Hendrik HJ, Schmidt W. Perinatologische Auffälligkeiten Bei Hochpathologischen Doppler-Flow-Befunden (Chapter 12). Farbdopplersonographie In Gynäkologie Und Geburtshilfe.(1st ed). Stuttgart: Thieme Verlag. 2000:177-87.
Fleischer A, Schulman H, Farmakides G, Bracero L, Blattner P, Randolph G. Umbilical artery velocity waveforms and intrauterine growth retardation.Am J Obstet Gynecol 1985; 151(4):502-5.
Devoe LD, Gardner PA, Dear C, Faircloth D. The significance of increasing umbilical artery systolic-diastolic ratios in third-trimester pregnancy. Obstet Gynecol 1992;80(4):684-87.
Rochelson B, Schulman H, Farmakides G, Bracero L, Ducey J, Fleischer A, et al The significance of absent end-diastolic velocity in umbilical artery velocity waveforms, Am J Obstet Gynecol. 1987; 156(5):1213-8.
Trudinger BJ, Cook CM, Giles WB, Ng S, Fong E, Connelly A, et al Fetal umbilical artery velocity waveforms and subsequent neonatal outcome. Br J Obstet Gynaecol. 1991;98(4):378-84.
Gudmundsson S, Marsal K. Umbilical and uteroplacental blood flow velocity waveforms in pregnancies with fetal growth retardation, Eur J Obstet Gynecol Reprod Biol. 1988;27(3):187-96.
Altschuler G, Ludwig M, Deppisch ; College of American Pathologists Conference XIX on examination of placenta : Report of the working group on indications for placental examination. Arch Pathology Lab Med. 1991;115(7):701-3.
Naeye RL ; Functionally important disorders of the placenta, umbilical cord and fetal membranes. Hum Pathol. 1987;18(7):680-91.
Udainia A, Jain ML, Morphological study of placenta in pregnancy induced hypertension with its clinical relevance, J Anat Soc India 2001;50(1):24-7.
Das B, Dutta D, Chakraborthy S, Nath P. Placental morphology in hypertensive disorders of pregnancy and its correlation with fetal outcome. J Obstet Gynecol India. 1996;46(1):40-6.
Nobis P., Das U. Placental morphology in hypertensive pregnancy J Obset Gynecol. 1991; 41:166-9.
Garg K, Rath G, Sharma S. Association of birth weight, placental weight and the site of umbilical cord insertion in hypertensive mothers. J Anat Soc India. 1996;44:4.
Dutta DK, Dutta B. Study of human placentae associated with preeclampsia and essential hypertension in relation to foetal outcome. J Obstet Gynecol India. 1989;39(6):757-63.
Harsh M, Sodhi S, Mohan PS. Fetal correlation with placental pathology in toxaemia of pregnancy. J Obstet Gynecol India. 1989;39:170-5.
Navbir P. Placental morphology and its co-relation with foetal outcome in pregnancy-induced hypertension. Int J Basic Applied Med Sci. 2012;2(3):120-5.
Fox H., Langley F. The pathology of infarction in perinatal morbidity and mortality. Biologica Neonatorum.1973;11:87.
Salvatore CA et al The placenta in toxemia: a comparative study. Am J Obstet Gynecol. 1968;102(3):347-53.
Salgado SS, Pathmeswaran A. Effects of placental infarctions on the fetal outcome in pregnancies complicated by hypertension. J Coll Physicians Surg Pak. 2008;18(4):213-6.
Genbacev O, Joslin R, Damsky CH, Polliotti BM, Fisher SJ Effects of hypoxia alters gestations human cytotrophoblast differentiation/invasion in vitro and models the placental defects in preeclampsia, J Clin Invest. 1996;97(2):540-50.
