Морфофункціональні зміни в плаценті у вагітних при затримці росту плода

Abstract

The objective: to reveal morphofunctional changes in the placenta of pregnant with intrauterine growth retardation of different severity. Patients and Methods. The study included 100 pregnant (from 23 to 40 weeks of gestation). The main group consisted of 80 pregnant women with intrauterine growth retardation of different severity. The control group consisted of 20 women with physiological course of pregnancy. The patients of the main group were divided into three clinical groups regarding intrauterine growth retardation staging. Group I included 38 pregnant with stage 1 IUGR, 22 pregnant women with stage II IUGR were in group 2 and 20 pregnant with stage 3 IUGR – in group III. Revealing intrauterine growth retardation in pregnant women, the form and the stage, as well as violations of the uteroplacental and fetal blood flow was based on the results of ultrasound Doppler studies. The comparison of fetometry results and normative indices of the definite duration of gestation was made to diagnose intrauterine growth retardation. For morphological studies full-thickness placenta tissue sections were cut from a central, paracentral and areas after the separation of the placenta. From the marginal areas there were cut tissue sections with membranes. From umbilical cord there were cut two sections at 2 cm distance from the insertion of the umbilical cord to the placenta and on the opposite side. The tissue samples were fixed with 10% neutral formalin and embedded in paraffin; histologic sections were stained by hematoxylin-eosin. We paid attention to the severity of compensatory adaptive and involutory destructive reactions in the placenta. The maturity of villous tree was evaluated using the criteria for Voloshchuk’s classification of villous tree maldevelopment. The variational methods were used to make the statistical analysis of outcomes by standard licensed computer programs: STATISTICA 6.0, Microsoft Excel, ANOVA «Statistica». Differences among values were considered statistically significant if p<0.05. Results. The morphology of the placenta in case of intrauterine growth retardation is characterized by a high incidence of uteroplacental blood flow violations. The changes are mainly caused by insufficient maternal blood in intervillous space. The most common morphological manifestations of the violated blood flow in intervillous space were heart attacks, afunctional areas, successive narrowing and thrombosis of intervillous space. The incidence of blood flow violations in intervillous space is growing with increased severity of fetal growth retardation. Conclusions. Placental insufficiency due to morphological and functional changes in the placenta is the leading cause of intrauterine growth retardation and fetal hypoxia. It develops as a result of fetal and placenta combined reaction to various disorders in the mother’s body. The incidence of blood flow violations in intervillous space is growing with increased severity of fetal growth retardation. Key words: intrauterine growth retardation, pregnant, placenta, placental insufficiency, morphofunctional changes.