Macroscopic Changes in the Human Placenta in Hypertensive Disorders of Pregnancy in Indian Women: A Cross-sectional Study

Abstract

Introduction: Hypertension (HTN) is a common complication in 6-10% of pregnancies and is one of the prime factors for foetal, as well as, maternal fatalities and morbidities. Significant pathological changes are seen in the placenta in hypertensive pregnancies before affecting the foetus. These changes may serve as an early warning system for detecting foetal issues like low birth weight and growth restriction. Early detection and intervention of morphological changes in the placenta and umbilical cord can help prevent adverse foetal outcomes. Aim: To study the macroscopic changes in the placenta in women with HTN induced by pregnancy compared to non hypertensive pregnant women. Materials and Methods: The present cross-sectional descriptive study was conducted in the Department of Anatomy and the Department of Obstetrics and Gynaecology, Ramaiah Medical College Hospital, Bengaluru, Karnataka, India, between December 2017 and January 2019. A sample size of 43 each was taken for non hypertensive and hypertensive subjects, including those with preeclampsia and chronic HTN with superimposed preeclampsia. The placental morphological parameters, routine biochemical tests and neonatal outcomes of both groups were analysed statistically using the Shapiro-Wilk test, Independent t-test and Chi-square test. A probability value less than 0.05 was considered for statistical significance. Results: The mean age of participants was 28.35±3.026 years in the hypertensive group and 26.23±2.636 years in the control group. The circular, oval and irregular shapes were 29 (65.9%), 10 (22.7%) and 4 (9.3%) in non hypertensive subjects and 33 (78.6%), 7 (16.27%) and 3 (7.1%) in the hypertensive subjects, respectively. The surface area (mean-142.44±49.69; p-value<0.001), radius (mean-6.622±1.24; p-value<0.001), circumference (mean-37.419±6.091; p-value<0.001), the quantum of cotyledons (mean-13.09±3.344; p-value<0.001) were lesser in the hypertensive group than the non hypertensive subjects. There were differences in placental and foetal weight among non hypertensive and hypertensive subjects, but the differences were insignificant. The Appropriate for Gestational Age (AGA) babies were more in non hypertensive subjects. Conclusion: The present study found hypertensive pregnancies to be associated with a greater occurrence of unfavourable foetal outcomes. Furthermore, it highlights the importance of investigating the placenta’s physical attributes and their association with foetal outcomes to develop standard operating protocols for diagnostic and therapeutic approaches in normal/ complicated pregnancies.