Morphological and immunohistochemical features of placenta in postpartum women with hyperprolactinemia history

Abstract

Hyperprolactinemia (HP) is a persistent increase in serum prolactin levels, the most typical manifestation of which is a dysfunction of the reproductive system. Pregnant women with HP have a high incidence of perinatal complications; thus, the threat of self-abortion in these women is more than 48.4 %, and in 16.1 % of pregnant women it ends in premature birth. These patients often develop placental abnormalities that lead to fetal distress during pregnancy and childbirth.The aim: to investigate the morphological and immunohistochemical changes in the placental barrier, taking into account the expression of prolactin in postpartum women with a history of hyperprolactininemia.Materials and methods. In 30 puerperas with a history of endocrine infertility associated with hyperprolactinemia (group 1) and in 27 healthy puerperas without hyperprolactinemia and infertility (control group 2), the morphological features of the placentas were studied in the gestational period of 39–40 weeks using organometric, macroscopic, histological and immunohistochemical (IHC) methods.IHC studies were carried out on serial paraffin sections in accordance with standard protocols using monoclonal antibodies to prolactin (Rabbit a-Нu Prolactin Monoclonal Antibody (Clone EP 193) master diagnostica (Spain) and detection system Thermo scientific (USA).Results. The placenta weight of women in labor with hyperprolactinemia did not differ significantly from the weight of the placenta of women in labor without hyperprolactinemia. In 22 (73.3 %) postpartum women with hyperprolactinemia in the placenta, paracentral attachment of the umbilical cord took place, in 4 (13.3 %) patients malformation of the umbilical cord vessels was detected, in 7 (23.3 %) postpartum women significant stenosis and closure of the arterial lumen vessels of the umbilical cord were found. Histological examination of women in labor with hyperprolactinemia identified focal thickening of the decidua with the presence of significant fibrinoid masses (n = 18, 60 %), microbleeds and thinning of the decidua (n = 8, 26.6 % of women in labor). A number of observations revealed the presence of maternal internal infarctions with perivillous fibrin deposition, in 12 (40 %) postpartum women, the presence of fibrinoid-embedded villi with the replacement of the villus epithelium with fibrinoid masses was noted, in 15 (50 %) women fibrosis and collagenization of the stem and middle chorionic villi, fibrosis of small villi and avascular small villi was observed in 12 (40 %) postpartum women. In some observations, a decrease in the number of syncytial nodes and syncytiocapillary membranes was noted in the terminal villi. IHC study of the placenta of postpartum women with hyperprolactinemia in the gestational period of 39–40 weeks revealed multiple foci of decidual cells with overexpression of prolactin in the cytoplasm.Conclusions. Morphological changes in the placenta of postpartum women with hyperprolactinemia in anamnesis differ from changes in the placenta of women without hyperprolactinemia by the presence of focal vascular changes in the decidual membrane with its partial detachment and internal infarctions in the maternal part of the placenta, as well as by the presence of signs of partial perfusion disorders of the fetal foci placenta.In the placenta of women with hyperprolactinemia, immunohistochemical study revealed a long-term focal significant cytoplasmic expression of prolactin in the cells of the decidual membrane, which indicates disorders of prolactin synthesis in the body and discoordination in the work of the endocrine system of women.