Histomorphometric Survey of Placentas of HIV-positive Mothers in Relation to their Clinical Stage in a Teaching Hospital in Uyo, South-South Nigeria.

Abstract

HIV infection in pregnancy affects the mother, her placenta, and fetus resulting in perinatal/maternal morbidity and mortality. Studies show that HIV-positive mothers have several placental morphological changes. This study aimed to describe the histomorphometric parameters/lesions of placentas of HIV-positive mothers in Uyo, Akwa Ibom State, Nigeria. A prospective cross-sectional hospital-based analytical study was conducted at the departments of Obstetrics and Gynecology, and Histopathology, University of Uyo Teaching Hospital, Nigeria from December 2015 to May 2016. We studied 144 pregnant mothers (48 HIV-positive as the test group vs. 96 HIV-negative as controls). Their placentas (fetal membrane, umbilical cord, and placental disk) were collected post-delivery and evaluated (grossly/microscopically) to determine the range of histomorphometric placental parameters/lesions. Relevant obstetric data were obtained from their case notes. The test group delivered more through cesarean section than the control group (52.1% vs. 31.3%), with mean birth weights of 2.8±0.7 and 3.1±0.6 kg (p = 0.004). The mean placental weights were 57±190.1 and 664.6±167.4 g (p = 0.003), with mean placenta-birth weight ratio of 20.1±4.8 and 20.5±4.57% (p = 0.33). The test groups placental fetal membranes, umbilical cords, and disks mainly displayed acute chorioamnionitis (47.9%), acute umbilical phlebitis (14.6%), and villous vasculopathy (33.3%). The test group had a higher stage/grade of placental inflammation than the control group. In the test group, two stage 4 HIV disease state cases presented with the most severe form of placental inflammatory lesions. The commonest placental histomorphometric parameters/lesions were acute chorioamnionitis, acute umbilical phlebitis, and acute intervillositis. There was no significant association between HIV/AIDS disease stage with the most severe forms of placental inflammatory lesions.