Morphological development of the human placenta in normal and complicated gestation: a quantitative and ultrastructural study.

Abstract

In order to evaluate the structural potentialities of the placenta, we analyzed placentas in the following conditions: normal full term gestation, hypertensive status, twin pregnancy and abortion at 8-12 weeks of gestation, comparing cell structures, surface organization and tissue reaction. We quantitatively evaluated (1) the arborization of the placental villous tree, and (2) the microvillous density per unit of surface area, paralleling these data with ultrastructural and immunohistochemical features. In early gestation (8-12 weeks of pregnancy) the limited degree of branching of placental villi parallels a reduced number of clefts per unit of surface area (0.7/1,000 microns2), if compared with controls (2.7/1,000 microns2). In the full term twin placenta, the number of furrows is 2.26/1,000 microns2: this value reflects a low arborization potentiality, testifying to a low placental maturity. On the contrary, a high branching of the placental villous tree is present at term in hypertension. In this gestational condition, the number of sulci of 3.1/1,000 microns2 reveals a compensatory attitude of the placenta, aiming to sustain the impaired fetal-maternal metabolic interchange. In all these cases, syncytiotrophoblastic microvilli are reduced in number in comparison with the normal placenta, and this is likely to be an expression of a low trophoblastic maturation degree. The placenta is a barrier with a highly specialized function that conditions fetal outgrowth, and microenvironmental modifications are promptly faced by this structure through morphofunctional modulations.