Гістоморфологічні особливості плацент у жінок із ожирінням та прееклампсією

Abstract

Reducing the incidence of preeclampsia is an important issue in modern obstetrics, as preeclampsia is still remaining one of the leading causes of maternal and perinatal morbidity and mortality. This problem is especially relevant for pregnant women with concomitant obesity, since they are at high risk for preeclampsia. Placental ischemia can result in the development of endothelial dysfunction and, as a consequence, can lead to the emergence of gestational endotheliosis, which is a leading pathogenetic segment in the preeclampsia pathogenesis. The purpose of the study is to investigate the histomorphological features of the placenta in women with physiological body weight and concomitant class II obesity in preeclampsia, who took the therapeutic and prophylactic complex, designed to prevent preeclampsia in pregnant women with class II obesity. Materials and methods. We studied 25 placenta samples from women with physiological body weight and class II obesity, whose pregnancy was complicated with the development of preeclampsia. 5 study groups were formed: group I consisted of women with class II obesity, whose pregnancy was complicated by preeclampsia; group II included women with physiological body weight, who developed preeclampsia; group III included women with class II obesity, who took the therapeutic and prophylactic complex; group IV involved women with class II obesity who did not receive the therapeutic and prophylactic complex, and group V was the control one. A comprehensive assessment of the structural characteristics of the placenta included macroscopic diagnosis, organometry and examination histology. Results and discussion. Dominant and clinically significant histological parameters of the structure of pathologically altered placental tissue from women whose pregnancy was complicated by the preeclampsia development have been found out. Pathomorphological changes in the tissue of the studied placentas and their severity indicate a significant impairment of placental circulation that initiates the development of processes of adaptation and compensation along with the lack of compensatory-adaptive reactions. Conclusion. We have revealed involutive-dystrophic compensatory processes and moderate compensatory responses within the gestational normal limits without fixing pathological morphological changes in placental tissue in placental samples from women with concomitant class II obesity, who received the therapeutic and prophylactic complex (acetylsalicylic acid, L-arginine, calcium preparations) and semisynthetic diosmin in order to prevent preeclampsia; no pathological morphological changes in placental tissue were detected. No cases of preeclampsia associated with endothelial dysfunction in pregnant women with concomitant class II obesity, who received therapeutic and prophylactic complex, proves its effectiveness in managing this cohort of patients