DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20171564

Placental damages from ultrasonic changes to histopathological findings in maturing placenta in pregnancy complicated with hypertension: an observational clinical study

Amit Dutta, Ramesh Kumar Sahu, Kripasindhu Chatterjee, Sanjay Kothari, S. K. Rafikul Rahaman, Shipra Sen

Abstract


Background: The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. Obstetric ultrasound provides a cornerstone to other modalities used for assessing hypertensive disorders of pregnancy. Placental architecture is modified in PE and eclampsia. This study was designed to detect the placental changes in hypertensive disorders of pregnancy and correlation with ultrasonic and histopathological changes.

Methods: The study group comprised of 42 patients with pregnancy complicated with hypertension with period of gestation above 20 weeks and B.P. more than 140/90 mm of Hg measured on two occasions 6 hours or more apart. The control group consists of 42 normotensive patients matched with age and parity. One ultrasonic examination was performed between 28 weeks and 34 weeks and another after 34 weeks till term. Apart from routine parameters i.e. BPD, AC, FL, Amniotic fluid index, EBW and gestational age routine placental grading were performed according to the classification proposed by Grannum and associates. To evaluate perinatal outcome following measurement were studied birth weight immediately after delivery, mode of delivery, perinatal morbidity and mortality, APGAR score, presence of fetal distress.

Results: In 97.62% cases (41 out of 42) of control group showed Grade–II changes as opposed to 57.14% of cases (24 out of 42) in study group before 34 weeks. All 21 cases in study group showing Grade ‘III’ changes before 34 weeks had infarction, calcification, increased syncytial knots, fibrinoid necrosis from 95.23 to 100% of these cases showed all these changes. Only 2 cases (9.52%) showed perivascular hemorrhage having Grade ‘III’ before 34 weeks.

Conclusions: Accelerated maturation of placenta in pregnancy complicated with hypertension are more common in the hypertensive group. Increased histopathological degenerative changes e.g. calcification, fibrinoid necrosis etc., are more marked even before 34 weeks of gestation in hypertensive group.


Keywords


Histopathological changes, Neonatal birth weight, Obstetric ultrasound, Placenta, Preeclampsia, Pregnancy, Pregnancy-induced hypertension

Full Text:

PDF

References


Palacios C, Pena-Rosas JP. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. WHO RHL Commentary. Available from: http://apps.who.int/rhl/pregnancy_childbirth/ antenatal_care/nutrition/cd001059_penasrosasjp_com/en/. [Accessed 19/01/2017].

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

Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol. 2003;102(1):181-92.

Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):S1-S22.

Bewly S, Cooper D, Campbell S. Doppler investigation of utero-placental blood flow resistance in the second trimester. A screening study for pre-eclampsia and intra-uterine growth retardation. Br J Obst Gynaecol. 1991;98:871-9.

Stock MK, Anderson DF, Phernetton TM, McLaughlin MK, Rankin JH. Vascular response of the maternal placental vasculature. J Dev Physiol. 1980;2:239-46.

Thomson AM, Billewickz, Hytten FE. Placenta in relation to birth weight. J Obstet Gynecol Br CW. 1969;76:865-72.

Salmani D, Purushothaman S, Somashekara SC, Gnanagurudasan E, Sumangaladevi K, Harikishan Ret al. Study of structural changes in placenta in pregnancy-induced hypertension. J Nat Sci Biol Med. 2014;5(2):352-55.

Brosens JJ, Pijnenborg R, Brosens IA. The myometrial junctional zone spiral arteries in normal and abnormal pregnancies: a review of the literature. Am J Obstet Gynecol. 2002;187(5):1416-23.

Gaccioli F, Lager S, Sovio U, Charnock-Jones DS, Gordon CS, Smith GCS. The pregnancy outcome prediction (POP) study: Investigating the relationship between serial prenatal ultrasonography, biomarkers, placental phenotype and adverse pregnancy outcomes. Placenta. 2016

Giordano R, Cacciatore A, Romano M, Rosa BL, Fonti I, Vigna R. Uterine artery Doppler flow studies in obstetric practice. J Prenat Med. 2010;4(4):59-62.

Salavati N, Sovio U, Mayo RP, Charnock-Jones DS, Smith GC. The relationship between human placental morphometry and ultrasonic measurements of utero-placental blood flow and fetal growth. Placenta. 2016;38:41-8.

Smith GC, Yu CK, Papageorghiou AT, Cacho AM, Nicolaides KH. Fetal medicine foundation second trimester screening, maternal uterine artery Doppler flow velocimetry and the risk of stillbirth. Obstet Gynecol. 2007;109(1):144-51.

Yu CK, Smith GC, Papageorghiou AT, Cacho AM, Nicolaides KH. Fetal medicine foundation second trimester screening, an integrated model for the prediction of preeclampsia using maternal factors and uterine artery Doppler velocimetry in unselected low-risk women. Am J Obstet Gynecol. 2005;193(2):429-36.

Chauhan SP, Rouse DJ, Ananth CV, Magann EF, Chang E, Dahlke JD, et al. Screening for intrauterine growth restriction in uncomplicated pregnancies: time for action. Am J Perinatol. 2013;30(1):33-9.

Sovio U, White IR, Dacey A, Pasupathy D, Smith GC. Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet. 2015;386(10008):2089-97.

Grannum PA, Berkowitz RL, Hobbins JC. The ultrasonic changes in the maturing placenta and their relation to fetal pulmonic maturity. Am J Obstet Gynecol. 1979;133(8):915-22.

Furuya M, Ishida J, Aoki I, Fukamizu A. Pathophysiology of placentation abnormalities in pregnancy-induced hypertension. Vasc Health Risk Managem. 2008;4(6):1301-13.

Hiby SE, Walker JJ, O’shaughnessy KM, Redman CWG, Carrington M, Trowsdale J et al. Combinations of maternal KIR and fetal HLA-C genes influence the risk of preeclampsia and reproductive success. J Exp Med. 2004;200:957-65.

van Dijk M, Mulders J, Poutsma A, Könst AAM, Lachmeijer AMA, Dekker GA et al. Maternal segregation of the Dutch preeclampsia locus at 10q22 with a new member of the winged helix gene family. Nat Genet. 2005;37:514-9.

Hu Y, Dutz JP, MacCalman CD, Yong P, Tan R, von Dadelszen P. Decidual NK cells alter in vitro first trimester extravillous cytotrophoblast migration: a role for IFN-gamma. J Immunol. 2006;177:8522-30.

Johnson MP, Fitzpatrick E, Dyer TD, Jowett JB, Brennecke SP, Blangero J et al. Identification of two novel quantitative trait loci for pre-eclampsia susceptibility on chromosomes 5q and 13q using a variance components-based linkage approach. Mol Hum Reprod. 2007;13:61-7.

Carroll B. Ultrasonic features of preeclampsia. J Clin Ultrasound. 1980;8(6):483-8.

Fox H. The significance of placental infarction in perinatal morbidity and mortality. Biol Neonat. 1967;11(1):87-105.

Fox H. The morphological basis of placental insufficiency. J Obstet Gynaecol India. 1975;25:441-50.

Boyd PA, Scott A. Quantitative structural studies on human placenta associated with preeclampsia essential hypertension and intrauterine growth retardation. Br J Obstet Gynaecol. 1985;92:714-21.

Predoi C, Grigoriu C, Vladescu R, Mihart A. Placental damages in preeclampsia-from ultrasound images to histopathological findings. J Med Life. 2015;8:62-5.

Kleinrouweler CE, Bossuyt PM, Thilaganathan B, Vollebregt KC, Ramírez JA, Ohkuchi A, et al. The added value of second trimester uterine artery Doppler in the identification of nulliparous women at increased risk for pre-eclampsia. Am J Obstet Gynecol. 2012;20:182-3.

Reis NS, Brizot ML, Schultz R, Nomura RM, Zugaib M. Placental lakes on sonographic examination: Correlation with obstetric outcome and pathologic findings. J Clin Ultrasound. 2005;33:67-71.

Scission A, Hayes E. Uterine artery Doppler Flow studies in obstetric practice. Am J Obstet Gynecol. 2009;201:121-6.

Mirchandani JJ, Mallik GB, Chitra S. Correlation of foetal outcome with some pathological changes of placenta. J Obstet Gynaecol India. 1979;29:1131-9.

Nahar L, Nahar K, Hossain MI, Yasmin H, Annur BM. Placental changes in pregnancy induced hypertension and its impacts on fetal outcome. Mymensingh Med J. 2015;24(1):9-17.

Bazaz G, Mirchandani JJ, Chitra S. Placenta in intrauterine growth retardation. J Obstet Gynecol India. 1979;29:805-10.

Nobis P, Das U. Placental morphology in hypertensive pregnancy. J Obstet Gynecol. 1991;41:166-9.

Bhatia A, Sharma SD, Jalnawalla SF, Sagreiya K. A comparative study of placental and foetal outcome. Indian J Pathol Microbiol. 1981;24:277-83.

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.

Teasdale F. Gestational changes in functional structure of the human placenta in relation to foetal growth. Am J Obstet. 1980;137:560-2.

Zacutti A, Borruto F, Bottacci G, Giannoni ML, Manzin A, Pallini M et al. Umbilical blood flow and placental pathology. Clin Exp Obstet Gynaecol. 1992;19:63-9.

Quinlan RW, Cruz AL, Buhi WC, Martin M. Changes in placental ultrasonic appearance. II. Pathologic significance of grade III placental changes. Am J Obstet Gynecol. 1982;144:471-3.

Quinlan RW, Cruz AL, Buhi WC, Martin M. Changes in placental ultrasonic appearance. I. Incidence of grade III changes in the placenta in correlation to fetal pulmonary maturity. Am J Obstet Gynecol. 1982;144:468-70.

Hill LM, Breckle R, Ragozzino MW, Wolfgram KR, O'Brien PC. Grade 3 placentation: incidence and neonatal outcome. Obstet Gynecol. 1983;61:728-32.

Hills D, Irwin GA, Tuck S, Baim R. Distribution of placental grade in high-risk gravidas. American Journal of Roentgenology. 1984;143:1011-3.

Damania KR, Salvi VS, Ratnaparki SK, Daftari SN. The placenta in hypertensive disorder in pregnancy. J Obst and Gynaecol Ind. 1989;39:28-31.

Lin CC, Lindheimer MD, River P, Moawad AH. Fetal outcome in hypertensive disorders of pregnancy. Am J Obstet Gynecol. 1982;142(3):255-60.