Abstract
Preeclampsia and eclampsia remain the major causes of maternal and perinatal mortality and morbidity worldwide, causing 12-15% of direct maternal deaths. Although preeclampsia and related hypertensive disorders of pregnancy continue to affect 8% of all pregnancies, the incidence of preeclampsia has increased 40% in recent years. This study was carried out to analyse the different placental lesions and fetal outcome in different grades of maternal hypertension and to see if there is a linear relationship of the same. A total of 539 placenta specimens received at the department of Pathology from October 2017 to March 2019 were collected after obtaining informed consent. Of the 539 placentas, 87 hypertensive cases were graded and grouped according to the severity as gestational hypertension, mild preeclampsia, severe preeclampsia, eclampsia, and chronic hypertension and compared with 88 normotensive cases. The gross and microscopic findings were tabulated and analysed using the Statistical Package for the Social Sciences (SPSS) software. Incidence of fetal death and growth restriction increased with increasing grade of maternal hypertension (p= 0.001). Abnormal shape of placenta (p= 0.034) and abnormal umbilical cord insertion (p= 0.028) were seen significantly more in the hypertensive group than in the normotensive group. Infarct and abnormal vasculo-syncytial membrane (p < 0.05) and abnormal villous maturation (p= 0. 039) were significantly increased in the hypertensive group than the normotensive group. The incidence of adverse fetal outcome and placental changes suggestive of feto-maternal malperfusions shows a proportional trend with the increasing grade of maternal hypertension.
Highlights
Preeclampsia and eclampsia remain the major causes of maternal and perinatal mortality and morbidity worldwide, causing 12–15% of direct maternal deaths [1, 2]
There was a trend observed in the study, and showed increased adverse fetal outcome such as fetal death and growth restriction with increasing grade of maternal hypertension, which was found to be statistically significant (p= 0.001, wherein p stands for probability value) as shown in Figure 1, 2, and Table I
Twelve (33.3%) cases of gestational hypertension, 6 (50%) cases of the mild preeclampsia group, 17 (73.9%) cases of severe preeclampsia, 7 (87.5%) cases of the eclampsia group, and 7 (87.5%) cases of chronic hypertension resulted in preterm delivery of the fetuses, further adding to the fetal complication (p= 0.0001)
Summary
Preeclampsia and eclampsia remain the major causes of maternal and perinatal mortality and morbidity worldwide, causing 12–15% of direct maternal deaths [1, 2]. This study was carried out to analyse the various placental lesions and fetal outcome in different grades of maternal hypertension and to see if there is a linear relationship of the same. All the cases with maternal hypertension, irrespective of the gestational age and fetal outcome were included in this study. Out of the 539 cases included in this study, 87 cases had a maternal history of hypertension. These placentas were compared with 88 other normotensive placentas grossly and microscopically and the results were analysed for statistical significance. Parenchyma were examined for villitis, calcification, fibrin deposition (grading used), acute or chronic infarct, abnormal maturation, villous edema, fetal vessel thrombosis, endarteritis of stem villi, crowding and the status of the vasculo-syncytial membrane. The results were statistically analysed using Statistical Package for the Social Sciences (SPSS) version 21
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