Introduction.Placentaforms connection between fetus and the uterine wall of mother. It plays therole of excretory, hepatic, gastrointestinal,endocrine, respiratory and immune system1 . Umbilical cordforms a conduit between fetus and placenta.
Thus, placenta plays an importantrole in pregnancy and its careful examination in many pregnancy related medicaldisorders can help us understanding their etiology. These disorders are thereasons for maternal and perinatal morbidity and mortality. Disorders likegestational diabetes, pregnancy induced hypertension, eclampsia, preeclampsiaresult in destruction of placenta and alteration in its functions causingplacental insufficiency2.Pregnancy Induced Hypertension can cause distressand fatality in mother, fetus and newborn3. Fetuses in theseconditions are most likely to suffer from intrauterine growth retardation,prematurity and intrauterine death. It causes decrease in size and weight ofplacenta4. It may also cause infarcts within the placenta and fetaldeath due to decreased blood flow5. Preeclampsia is the hypertensivecondition to the extent of 140/90 mmHg along with edema and proteinuria.
Itoccurs after 20th week of gestation6.Eclampsia is condition in which preeclampsia is accompanied by the onset ofconvulsions. Hypertension, eclampsia, preeclampsia, intrauterine growthrestriction can lead to preterm labor7.Gestational diabetes mellitus (GDM) is a condition in whichblood sugar level is increased and it occurs in the second part of thepregnancy.
Most women do not have hyperglycemia after delivery8. Babiesborn to GDM mothers suffer from fetal macrosomia ( birth weight >4000g )9.Asevery perinatal outcome is associated with abnormal placenta and vice versa,placenta provides information about child’s prenatal life. In this project grossand histopathological changes in placentas of the common disorders of pregnancyincluding pregnancy induced hypertension, eclampsia, preeclampsia, gestationaldiabetes, anaemia, stillbirths, will be studied and compared with placentas ofnormal pregnancies.
Aims andobjectives. To study pathology (morphology and histology) of placenta in medical disorders of pregnancy. To compare pathological changes of medical disorders of pregnancy with the normal placentas.3.
Toestablish possible correlation between placental abnormalities and outcome ofpregnancy.4. Changesspecific to some particular medical disorder will be observed and studied. Methodology.Present study is a hospital based prospective study which will be carried out atDepartment of Pathology in collaborationwith the Department of Obstetrics and Gynecology of Peoples College Of Medical Sciences & Research Centre, Bhopal over the span of given timeperiod. Placentas will becollected just after the delivery which will comprise of placentas associatedwith medical disorders of pregnancy and the normal placentas during Antenatalperiod.
Detailed obstetric and medical history will be recorded and informed consentwill be obtained from all the patients. The placentas with attached membranes andumbilical cord will be collected soon after delivery, washed in phosphatebuffer saline to remove blood contamination, labeled, and then fixed with 10% buffered formalin overnight. The blood clots willbe removed if present. Gross examination of placenta would be done including :- Length, width, thickness in cm Weight Shape Length, diameter of umbilical cord Knots in umbilical cord Insertion, twists, knots in umbilical cord Insertion, color, hematomas in membranes Number of vessels and presence of masses, thrombi, fibrin Infarction at fetal surface Calcification, infarction, strictures, ulcers, hyper/hypocoiling, present of masses or other abnormalities Sectionswill be taken from umbilical cord, membrane, maternal surface of placenta andfetal surface of placenta. For microscopic examination placental tissue will beprocessed and 4µm thick sections would be obtained for histopathologicalexamination. Rehydration with ethanol series and staining with hematoxylin andeosin (H) will be done. Analyses will be done by light microscopy.
Ineach placental slide. 10 smallest terminal villi be observed in 10 differentfields (magnification × 400). Microscopic examination will include examinationof following :- Trophoblast abnormalities Stromal abnormalities Villous vessels abnormalities Infarction Calcification Other abnormalitiesGross and microscopic findings will be thenlisted and correlated with the obstetric history. Keywords.
Eclampsia, Preeclampsia, PIH (Pregnancy InducedHypertension), GDM (Gestational Diabetes Mellitus), Placental insufficiency Implications. Thisstudy will help us in better understanding of the changes in placenta caused bymedical disorders of pregnancy and role of placenta in the etiology of those.Proper differentiation of the changes specific to certain diseases would bepossible. By comparing the placenta associated with medical disorders ofpregnancy with placentas of normal pregnancy, we can have a better understandingof pathology of such disorders and factors responsible for them. It can proveto be of an utmost importance in improving management of subsequent pregnanciesby diagnosis of pregnancy related diseases that may have tendency ofreoccurrence or might be preventable and treatable. Placental studies can beused to plan the future care for the mother and child.
References. 1. GuttmacherAE, Maddox YT, Spong CY. The Human Placenta Project: Placental Structure,Development, and Function in Real Time.
Patil SS,Siddheshware R, Sambarey PW. Clinical correlation with pathology of placenta inmedical disorders of pregnancy and its comparison in normal pregnancy. Int JReprod Contracept Obstet Gynecol 2017;6:127-32.3. Evangelia Kintiraki, SophiaPapakatsika, George Kotronis, Dimitrios G.
Goulis, Vasilios Kotsis HORMONES 2015, 14(2):211-2234. Deepalaxmi, Salmani Suja,Purushothaman Saligrama, Chikkanasetty, Somashekara, Ekambaram, Gnanagurudasan,Kampli, Sumangaladevi, RecapuHarikishan, and MuthinpalaVenkateshwarareddy Study of structural changes in placenta inpregnancy-induced hypertension J Nat Sci Biol Med. 2014 Jul-Dec; 5(2): 352–355.5.
Goswami PR, Shah SN. Placenta inNormal and Pregnancy Induced Hypertension in Relation to its ClinicalSignificance: A Gross Study. Int J Sci Stud 2016;4(7):58-61.6. D.C Dutta Text BookOf Obstetrics 6th edition 2004 ISBN: 81-7381-142-3 Robert L Goldenberg, Jennifer F Culhane, Jay D Iams, Roberto Romero, Epidemiology and causes of preterm birth, The Lancet, Volume 371, Issue 9606, 2008, Pages 75-84, ISSN 0140-6736, Gestational Diabetes After DeliveryJohn L. Kitzmiller, Leona Dang-Kilduff, M. Mark TaslimiDiabetes Care Jul 2007, 30 (Supplement 2) S225-S235 Gilmartin A “Bird” H, Ural SH, Repke JT.
Gestational Diabetes Mellitus. Reviews in Obstetrics and Gynecology. 2008;1(3):129-134.