PLACENTAS CHANGES IN GESTATIONAL HYPERTENSIVE WOMEN IN DUHOK
Background: Placentas impact by hypertensive disorders and contribute significantly to maternal and fetal morbidity and mortality. This study was designed to investigate the gross and histological changes in the placentas of gestational hypertensive women.
Patients and Methods: The samples of this cross sectional study were collected from Duhok Obstetrics and Gynecology Hospital, Duhok city, Kurdistan region, Iraq. Total 73 placentas were collected from 20-40 years old women with full-term singleton pregnancies, 25 placentas from normo-tensive mothers having no hypertension before as control group and 48 from gestational hypertension women as gestational hypertension group. The maternal and neonatal data were recorded. Immediately after delivery, the placenta was washed, dried, photographed then weighted and dimensions were measured. Morphological features were recorded. Central biopsies were taken for qualitative and quantitative histopathological examination which included: terminal villi, stromal fibrosis, fibrinoid necrosis, calcification, syncytial knots, hyalinization, medial coat proliferation of medium sized blood vessel, avascular villi, congestion, chorangiosisandvasculosyncytial membrane. Statistical analyses were done by using student t-test and chi- square test.
Results: In the gestational hypertension, macroscopically, there was no statistical difference. Microscopic finding revealed a significant increase in calcification, fibrinoid necrosis, stromal fibrosesand congestion; whereas vasculosyncytial membrane and avascular villi increased insignificantly and chorangiosiswas not impacted. The gross and histological qualitative results coincided with the quantitative results.
Conclusions: The placentas were significantly and adversely affected by the gestational hypertension.
2. Gupta D, Khan S, Noor N, &Bhargava M. Study of pregnancy induced hypertension in relation to placental and fetal birth weight. Int J Reprod Contracept Obstet Gynecol. 2018; 7:1149-53.
3. Dicke JM. Placenta: chronicle of intrauterine growth restriction. F1000 Med Rep; 2010; 2: 69.
4. Park K. Textbook of Preventive and Social Medicine, 20th edition, Banarsidas Bhanot Publishers, Jabalpur; 2009; 482.
5. 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.
6. Bancroft JD & Stevens A. Theory and practice of histological techniques .Churchill Levingstone,Edinburgh.1987; 482-502
7. Günyeli I, Erdemoğlu E, Ceylaner S, Zergeroğlu S &Mungan T. Histopathological analysis of the placental lesions in pregnancies complicated with IUGR and stillbirths in comparison with noncomplicated pregnancies. J Turk Ger Gynecol Assoc.2011; 12(2):75-9.
8. Ahmed &Daver RG. Study of placental changes in pregnancy induced hypertension. Int J Reprod Contracept Obstet Gynecol.2013; 2(4): 524-527.
9. Khabat A. Ali, Lana S. Salih &Zrar S. Almarzany the role of leptin and insulin hormones in the pregnant women serum infected of diabetic mellitus and its histological structure effects on the American Journal of Hypertension, Ltd. and umbilical cord in Erbil city Raf.J.Sci.2012; 23(3): 38 -49.
10. Shalini J. Histopathological Study of Placenta in Pregnancy Induced Hypertension and its Comparison with That of Normal Pregnancies. M.V.J. Medical College & Research Hospital, Hoskote, Bangalore. india; 2014; 560.
11. Fox H. Pathology of placenta. 2nd ed. Philadelphia: W.B. Saunders Co.Ltd.1997.
12. Jain K, Kavi V, Raghuveer CV &Sinha R. Placental pathology in pregnancy induced hypertension with or without intrauterine growth retardation. Indian J Pathol Microbiol. 2007; 50 (3): 553-557.
13. Manjunatha HK, Kishanprasad HL, Ramaswamy AS, Aravinda P, Muddegowda PH, Lingegowda JB &etal . Study of histomorphological changes in placenta in pregnancy induced hypertension. Int J Cur Sci Res. 2012; 2(1):255-258.
14. Vijayalakshmi B, &Kittali S. "Morphological Changes of Placenta in Cases of Pre-eclampsia and Perinatal Outcome." Int J Sci Stud. 2015; 3: 137-142.
15. Goswami PR & Shah SN. Placenta in Normal and Pregnancy Induced Hypertension in Relation to its Clinical Significance: A Gross Study. Int J Sci Stud. 2016; 4(7):58-61.
16. Ranga SS, Thangam AT & Mallika V. Morphological and Histological Variations of Human Placenta in Hypertensive Disorders of Pregnancy. Int J Anat Res. 2017; 5(1):3591-3598.
17. Rosana RM, Daniel B, Camila L C, Marina CP, Flávia A O, Luís C P & etal . Castro Placental morphometrical and histopathology changes in the different clinical presentations of Hypertensive Syndromes in Pregnancy. Arch Gynecolobstr. 2008; 277(1):201-206.
18. Shevade S, Arole V, Bharambe V, Paranjape V. Morphology and Fetal Outcome in Preeclampsia And Normotensive Pregnancies. JDMS.2015; 14(4).
19. .Majumdar S, Dasguptha H, Bhattacharya K &Bhattacharya A. A study of placenta in normal and hypertensive pregnancies. J Anat Soc India. 2005; 54:34-8.
20. Baloch AH, Memon SF & Ansari AK. Comparison of placentae from hypertension associated pregnancies and normal pregnancies. JLUMHS.2012; 11(1):3- 6
21. Narasimha A &Vasudeva D S. Spectrum of changes in placenta in toxemia of pregnancy. Indian J Pathol Microbiol. 2011; 54 (1): 15-20.
22. 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.
23. Sreechithra K, Usha P, Jayalakshmy P S. Placental Pathology in Pregnancy Induced Hypertension. J Evo Med and Dental Sci. 2014; 3(35), August 14; 9272-8.
24. Bandekar PK, Kale PB. Placenta in pregnancy induced hypertension. Int J Reprod Contracept Obstet Gynecol. 2018;7:467-9.
25. Londhe PS & Mane AB. Morphometric study of placenta and its correlation in normal and hypertensive pregnancies. International Journal of Pharma and Biosciences. 2011; 4(2): 429-437.
26. Modi H N, Umaraniya YN, Prajapati HK, Rathod JB, Chauhan HM & Chaudhary SM . Morphology of placenta in pregnancy induced hypertension. Medical sciences. 2013; 2(9), 273-274.
27. Salmani D, Purushothaman S, Chikkannashetty S, Somashekara, Gnanagurudasan E & Sumangaladevi K. Study of structural chanhes in placenta in pregnancy induced hypertension. Journal of natural science, Biology and medicine.2014; 25(2), 352-355
28. Devishankar K, Bhanu PS, Kiran S, Ramakrishna BA &Shanthi V. Vasculo syncytial membrane in relation to syncytial knots complicates the placenta in preeclampsia: A histomorphometrical study. Anat Cell Biol. 2012; 45: 86-91.
29. Karmakar MK, Kar S, Kumar SM, Chattopadhyay SK, Vaid LK, Sen S. A study of histological changes of human placenta in rural population of eastern India. Int J Reprod Contracept Obstet Gynecol. 2018;7:3280-7.
30. Al-Mamori RHL. Macroscopical and microscopical study of placenta in normal and pregnancy induced hypertension. Al-Qadisiah Med J.2010; 6(10): 18-26.
31. Kurdukar MD, Deshpande NM, Shete SS &Zawar MP. Placenta in PIH. Indian J Pathol Microbiol. 2007; 50 (3): 493-497.
32. Dadhich A , Kataria SK, Kataria KR &Potaliya P. Study of effect of eclampsia and chronic hypertension on gross morphology of placenta. J Biol Med Res.2012; 3(2): 1771-1773
33. Fox H. Abnormalities of the foetal stem arteries in the human placenta. Journal of Obstetrics and Gynaecology of British Common wealth. 1967; 74: 734-738
34. Agarwal G C, SainiP, Pankaj J P, Pandey L N, Jain A. Morphological study of placenta in normal and hypertensive pregnancies. IAIM. 2015; 2(5): 121-128.
35. Dhawle MS, Tangde AR, Mundhe BP, Rathod SG, Bindu RS. Morphological study of placenta in pregnancy induced hypertension. Int J Res Med Sci. 2017; 5:3214-7.
36. KristinaL, Raanan S &Reecca B. Syncytial knots as a reflection of placental maturity: reference values for 20 to 40 weeks gestational age. Pediatric and developmental pathology.2010; 13(4):305-9.
37. Navbir P, Alka N & Antima G. Histological changes in placentae in pregnancies complicated by preeclampsia and eclampsia and correlation with fetal outcome. Int J Pharm Bio Sci. 2012; 3(2): 551-60.
38. Mehendale SS, Lele V & Godbole PV. Placental histopathology with intrauterine growth retardation. 1988; 138: 406-9.
39. Kaur P, Sharma S, Harsh & Kaushal S. Comparison of Villi in Pregnancy Induced Hypertensive and Normotensive Pregnancies. Ann Int Med Den Res. 2017; 3(4):10-12.