Syncytial Knots Research Articles

Морфологические особенности плацент при хронической плацентарной недостаточности и задержке роста плода

The most reliable criterion for differential diagnosis between small-for-gestational-age fetus and fetal growth restriction (FGR) is chronic placental insufficiency (CPI) verified by morphological analysis. CPI is associated with abnormal development of the placental villous tree and is traditionally divided into primary, which develops during implantation, early embryogenesis, and placentation, and secondary, which develops after the completion of trophoblast invasion. CPI is morphologically manifested by abnormal development of the placental villous tree, changes in its vascular structure, increased number of syncytial knots, as well as the presence of infarctions and sometimes inflammatory changes. At the same time, it is noted that the differences in placental histology between early-onset and late-onset FGR are more quantitative than qualitative. Key words: intrauterine development, chronic placental insufficiency, fetal growth restriction

Pharmaceutical Effects on Placental Morphology in Women with Gestational Diabetes Mellitus

Objective: The purpose of this study was to see how food organization and Metformin affected placental morphology in women with GDM.
 Methods: 66 GDMs were registered after providing informed consent permission. 35 patients of GDM through blood sugar levels 140 mg/dl remained allocated Set B (2500-3000Kcal/day and 30-minute walk three times a week). They remained reserved on diet control, while 34 patients of GDM through blood sugar levels >140 mg/dl have been delegated Set C and remained reserved on diet with tablet Metformin (550mg TDS). Lastly, 28 healthy pregnant women remained retained in Set A as controls. Placentas were stored and analyzed for morphology after delivery.
 Results: Heavy placentae thru extensive villous immature, charangoists, and syncytial knots were observed in set B, while fibrinoid necrosis and calcification were observed in set C. Placental and cord width were significant in Set B against A, but only cord width was relevant in Set C against A in gross morphology. In light microscopy, charangoists, infarction, and syncytial loops showed detected in sample 2 against with a villous maturity; moreover, charangoists and syncytial knots have been found in appendix B versus C placental width, but C versus A results were negligible.
 Conclusion: In comparison to the diet group, metformin exhibited beneficial benefits on placental morphology that were equivalent to normal controls.

Ultrastructural changes of the placenta in cases of preeclampsia

The placenta plays vital roles during fetal development and growth. The ultrastructure of the placenta together with remodeling of the uterine spiral arteries are very important to maintain the utero-placental blood flow. Preeclampsia (PE) is a multifactorial disorder with abnormal placentation affecting the mother and fetus. The aim of this study was to study the ultrastructural abnormalities of the placenta in cases of PE. The placentas of 10 PE women and 10 controls were studied. Women of PE group were delivered by caesarian section while seven control women were delivered vaginally, and three by caesarian section. Placental samples were studied both morphologically and histologically by light and transmission electron microscopy. Light microscopic study of control placentas showed numerous microvilli, few syncytial knots, thin-walled blood vessels. PE placentas showed reduced number of microvilli with numerous syncytial knots, thick-walled vessels, edematous spaces, fibrotic areas and fibrinoid degeneration. Electron microscopic study of the control placentas showed a thick layer of syncytiotrophoblast (Sy), numerous microvilli and a thin layer of cytotrophoblast (Cy). PE placenta showed hypertrophy of Cy with atrophy of Sy and scarce microvilli. The trophoblast showed edematous vacuoles and glycogen storage areas. The villous core had congested capillaries, edematous spaces, glycogen storage areas and widespread areas of fibrosis. All the changes in PE placentas were attributed to hypoxia and oxidative stress and reduced utero-placental flow due to abnormal remodeling of the uterine spiral arteries that was aggravated by the thick placental barrier and the presence of edema, fibrosis and glycogen storage areas.

Malaria in Pregnancy: From Placental Infection to Its Abnormal Development and Damage.

Malaria remains a global health burden with Plasmodium falciparum accounting for the highest mortality and morbidity. Malaria in pregnancy can lead to the development of placental malaria, where P. falciparum-infected erythrocytes adhere to placental receptors, triggering placental inflammation and subsequent damage, causing harm to both mother and her infant. Histopathological studies of P. falciparum-infected placentas revealed various placental abnormalities such as excessive perivillous fibrinoid deposits, breakdown of syncytiotrophoblast integrity, trophoblast basal lamina thickening, increased syncytial knotting, and accumulation of mononuclear immune cells within intervillous spaces. These events in turn, are likely to impair placental development and function, ultimately causing placental insufficiency, intrauterine growth restriction, preterm delivery and low birth weight. Hence, a better understanding of the mechanisms behind placental alterations and damage during placental malaria is needed for the design of effective interventions. In this review, using evidence from human studies and murine models, an integrated view on the potential mechanisms underlying placental pathologies in malaria in pregnancy is provided. The molecular, immunological and metabolic changes in infected placentas that reflect their responses to the parasitic infection and injury are discussed. Finally, potential models that can be used by researchers to improve our understanding on the pathogenesis of malaria in pregnancy and placental pathologies are presented.

The Number of Syncytial Knots and VEGF Expression in Placental Villi in Parturient Woman with COVID-19 Depends on the Disease Severity

A comparative morphological study was carried out to analyze the number of syncytial knots and VEGF expression in placental villi in parturient women with COVID-19 categorized by the disease severity. The number of syncytial knots was assessed on specimens stained with hematoxylin and eosin. VEGF expression was determined by immunohistochemical analysis in syncytiotrophoblast and villous endothelial cells. Morphological study of the placenta tissue of parturient women with COVID-19 showed increased numbers of syncytial knots in the villi, indicating the development of preplacental hypoxia. High VEGF expression in syncytiotrophoblast and vascular endotheliocytes reflects a stereotyped response to hypoxia and can underlie the development of a preeclampsia-like syndrome. The number of syncytial knots and VEGF expression in placental villi in parturient women with COVID-19 depended on the disease severity.

Circulating angiogenic profiles and histo-morphological placental characteristics of uncomplicated post-date pregnancies

IntroductionThe objectives of this study were to describe the histo-morphology of post-date placentas in clinically uncomplicated pregnancies without adverse delivery outcomes and the association with maternal circulating pre-delivery Placental Growth Factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1), as well as the sFlt-1/PlGF ratio. MethodsPost-date placentas (gestational week ≥40+2, n = 87) were macroscopically and histo-morphologically assessed according to the international, standardized Amsterdam Workshop Consensus Group criteria. Inter-rater agreement was evaluated by percentage of agreement. PlGF and sFlt-1 concentrations were available from maternal serum sampled close to delivery, and were compared by Mann-Whitney U test. Linear regression analyses were adjusted for predefined potential confounders. ResultsThe majority of the post-date placentas showed morphological signs of delayed maturation. About half of the placentas showed increased syncytial knotting and fibrin. In placentas with increased presence of intervillous fibrin, median maternal PlGF level was significantly lower (p = 0.004), median sFlt-1 level higher and sFlt-1/PlGF ratio significantly higher (p = 0.002) compared to those with normal fibrin amounts. Increased placental syncytial knotting was associated with lower levels of PlGF, higher sFlt-1 and higher sFlt-1/PlGF ratio compared to those with normal knotting. DiscussionOur standardized morphological study of post-date placentas in clinically healthy women with uncomplicated pregnancies and delivery outcomes revealed delayed maturation in the majority of placentas. Increased pre-delivery circulating anti-angiogenic profile was associated with increased intervillous fibrin and syncytial knotting. We propose that circulating maternal angiogenic biomarkers may be of future use in clinical post-date pregnancy assessment, as they reflect important aspects of placental health and function.

Comparative Histological study of Normal human placentae with Hypertensive placentae in Western part of Tamilnadu state (Kongunadu region)

Background: Placenta forms an intimate bonding between the mother and the foetus. Apart from gaseous exchange, transport of nutrients from mother to the foetus, any disease or disorder affecting the mother also reflects the foetus. Hypertension during antenatal period produces maternal vasospasm and vascular damage due to luminal constriction of uterine spiral arterioles causing histological changes in the placenta and ultimately leads to foetal hypoxia and death. Aim of the study: To compare the histological features between the normal and hypertensive placenta. Materials and Methods: 30 normal and 30 hypertensive placentae were collected, processed in the Department of Anatomy, Karpagam Faculty of Medical Sciences and Research, Coimbatore, Tamilnadu, and visualised under light microscope and their histological features are noted. Results: Various histological features obtained are Syncytial knots, Fibrinoid necrosis, Calcification of Placenta, Placental infarction, Stromal fibrosis, Hypovascularity of Villous, Intervillous fibrin deposition and Basement membrane thickening. Conclusion: In our study, the histological features are more prominent and their areas in microscopic field is noted more in hypertensive placentae than normal placentae.Histtological features are mainly due to maternal vasospasm and vascular endothelial injury.The statistical analysis calculated for the histological features was found to be significant. KEY WORDS: Placenta, Hypertension, Histology, Syncytial knots, Calcification.

Syncytiotrophoblast stress in preeclampsia: the convergence point for multiple pathways

Preeclampsia evolves in 2 stages: a placental problem that generates signals to the mother to cause a range of responses that comprise the second stage (preeclampsia syndrome). The first stage of early-onset preeclampsia is poor placentation, which we here call malplacentation. The spiral arteries are incompletely remodeled, leading to later placental malperfusion, relatively early in the second half of pregnancy. The long duration of the first stage (several months) is unsurprisingly associated with fetal growth restriction. The first stage of late-onset preeclampsia, approximately 80% of total cases, is shorter (several weeks) and part of a process that is common to all pregnancies. Placental function declines as it outgrows uterine capacity, with increasing chorionic villous packing, compression of the intervillous space, and fetal hypoxia, and causes late-onset clinical presentations such as "unexplained" stillbirths, late-onset fetal growth restriction, or preeclampsia. The second stages of early- and late-onset preeclampsia share syncytiotrophoblast stress as the most relevant feature that causes the maternal syndrome. Syncytiotrophoblast stress signals in the maternal circulation are probably the most specific biomarkers for preeclampsia. In addition, soluble fms-like tyrosine kinase-1 (mainly produced by syncytiotrophoblast) is the best-known biomarker and is routinely used in clinical practice in many locations. How the stress signals change over time in normal pregnancies indicates that syncytiotrophoblast stress begins on average at 30 to 32 weeks' gestation and progresses to term. At term, syncytiotrophoblast shows increasing markers of stress, including apoptosis, pyroptosis, autophagy, syncytial knots, and necrosis. We label this phenotype the "twilight placenta" and argue that it accounts for the clinical problems of postmature pregnancies. Senescence as a stress response differs in multinuclear syncytiotrophoblast from that of mononuclear cells. Syncytiotrophoblast irreversibly acquires part of the senescence phenotype (cell cycle arrest) when it is formed by cell fusion. The 2 pathways converge on the common pathologic endpoint, syncytiotrophoblast stress, and contribute to preeclampsia subtypes. We highlight that the well-known heterogeneity of the preeclampsia syndrome arises from different pathways to this common endpoint, influenced by maternal genetics, epigenetics, lifestyle, and environmental factors with different fetal and maternal responses to the ensuing insults. This complexity mandates a reassessment of our approach to predicting and preventing preeclampsia, and we summarize research priorities to maximize what we can learn about these important issues.

Placental pathology of the third trimester pregnant women from COVID-19

AimsTo explore the clinical characteristics and placental pathological changes of pregnant women with 2019 novel coronavirus (CoV) disease (COVID-19) in the third trimester, and to assess the possibility of vertical transmission.Methods and resultsThe placenta tissues were evaluated by using immunohistochemistry for inflammatory cells and Hofbauer cells, and using severe acute respiratory syndrome (SARS) CoV-2 RNA Fluorescence In-Situ Hybridization (FISH) and SARS-CoV-2 spike protein immunofluorescence (IF) double staining. All eight placentas from the third trimester pregnancy women were studied. All patients were cured, no clinical or serological evidence pointed to vertical transmission of SARS-CoV-2. Features of maternal vascular malperfusion (MVM) such as increased syncytial knots were present in all 8 cases (8/8), and increased focal perivillous fibrin depositions were presented in 7 cases (7/8). No significate chronic histiocytic intervillositis was noted in the placenta. The number of macrophages and inflammatory cells such as T cells, B cells and plasma cells in the placental villous was not significantly increased in all cases. Moreover, all of eight cases demonstrated negative results by FISH using a SARS-CoV-2 virus RNA probe and by IF using a monoclonal antibody against SARS-CoV-2 spike protein.ConclusionsWe found no evidence of vertical transmission and adverse maternal-fetal outcomes in the placentas of third trimester COVID-19 pregnancy women, which provided further information for the clinical management of those women in the third trimester. However, further studies are still needed for patients with infections in different stage of gestation, especially in first and second trimester.

Evaluation of Morphological (Macroscopic and Microscopic) Parameters of Placentas in Pregnancies Complicated by Preeclampsia, Diabetes and Preeclampsia and Diabetes

This study was done to compare the morphometric parameters of placentas in well controlled patients withpreeclampsia, diabetes, and preeclampsia-diabetes with that of normal uncomplicated placentas.Patients &Methods: A total of Twenty four placentas were freshly collected. Six placentas for controlgroup and eighteen placentas for complicated group (preeclamptic- diabetic and preeclamptic--diabeticsubgroups). The placentas were grossly examined (shape, number of cotyledons, weight, and thickness).After suitable fixation, tissue processing and sectioning, the sections were stained by hematoxylin and eosinto study the general morphology and morphometry of the following parameters: number of terminal villi,number of syncytial knots, number of apoptotic cells and number of fetal capillaries.Result: The weight of the baby in D- subgroup was significantly increased when compared with controlgroup and with P and P-D subgroups . Microscopical morphometry regarding number of terminal villi,apoptotic cells, syncytial knots and fetal capillaries were increased in complicated subgroups. The thicknessof basement membrane was 0.8µm in control group and it was increased in all complicated subgroups. Thehighest value was reported by D- subgroup (2 µm).

Placental Pathology in COVID-19: Case Series in a Community Hospital Setting.

ObjectiveTo report the histopathologic findings in the placentas of pregnant women with coronavirus disease-19 (COVID-19).MethodsPregnant women with COVID-19 delivering between April 2020 to June 2020 were identified. A retrospective study of placentas from COVID positive women received in the Department of Pathology, Monmouth Medical Center affiliate of Robert Wood Johnson Barnabas Health were examined and compared to control cohort of placentas from COVID negative women. The mothers were tested for coronavirus through nasopharyngeal swab upon admission to labor and delivery. The placentas from mothers who tested negative for the virus were sent to Pathology for examination based on the obstetrician’s clinical judgment.ResultsFifty surgical specimens (49 placentas and one product of conception) from patients positive for COVID-19 were examined and compared with fifty placentas from women with negative COVID-19 test results, who delivered during the same period. Most of the neonates had Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores of 9 and 9 at 1 and 5 minutes, respectively. Increased incidence of the COVID-19 positivity was noted in individuals with Rh-positive blood group A and Jewish heritage. Compared to the control group, the COVID-19 positive placentas showed increased features of malperfusion (microcalcifications, fibrin thrombi, syncytial knotting, and villous agglutination). However, there was no significant dysregulation in other variables, such as inflammation or coagulation. There was no case of maternal or fetal death (greater than eight weeks) or evidence of worse fetal outcomes noted due to a mother's positive COVID-19 status. ConclusionsThe COVID-19 positive placentas showed an increased prevalence of microcalcifications and fibrin thrombi, which may reflect an underlying hypercoagulable state induced by COVID-19 infection or could be due to excessive syncytiotrophoblast injury.

Study of histological changes of placenta in pregnancy-induced hypertension in poorvanchal region of Uttar Pradesh, India

Introduction: The placenta is a fetomaternal organ. It is a connection of the fetus with the uterine wall of mother. Through the placenta, exchange of gases and nutrient supply takes place. Through the placenta, fetal blood tissue comes in direct contact with the maternal blood without any rejection. It is a special transient organ of pregnancy. In our study, we carried out the microscopic examination of the placenta in pregnancy-induced hypertension, i.e., syncytial knot, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, and calcified villous spot. Material and Methods: One hundred and fifty-two placentas of full-term pregnancy were collected from the labor room/operation theater of the Gynecology and Obstetrics Department of the Government Medical College and Superfacility Hospital Azamgarh. Out of one hundred and fifty-two placentas, 76 cases were controls from mothers with no known history of preexisting hypertension and 76 were collected from mothers with pregnancy-induced hypertension. Placentas were kept in 10% formalin for 24 h for fixation. After 24 h, tissues of placentas were passed through a series of the procedures from dehydration and clearing to wax impregnation before being sectioned from automated microtome. Time took for processing was 24 h. Five microns thick tissues sections were cut. Prepared slides were mounted in DPX and covered with the cover slip. Through binocular light, microscope slides were examined at ×10, ×40, and ×100 magnifications. Results: Histology in our study revealed that syncytial knots were present in placentas of all 100% of hypertensive and only 32.89% of normotensive mothers. Cytotrophoblastic proliferation was seen in 98.68% and 19.73% placentas of hypertensive and normotensive mothers, respectively. Fibrinoid necrosis of placenta was found in 88.15% of hypertensive and only 28.94% of normotensive mothers. The 100% placentas of the hypertensive mothers had endothelial proliferation as compared to controls. Calcified villous spots were seen in 84.21% and 31.57% of placentas of hypertensive and normotensive mothers, respectively. Discussion and Conclusion: Pregnancy-induced hypertension adversely affects the health of the fetus through its harmful effects on the placentas. Syncytial knots, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, and the calcified villous spots were present more in the placentas of hypertensive mothers in our study in comparison to the study of other authors. In our research, we found that endothelial proliferations were present in all placentas. If proper treatment is given to the mother in the early stage of pregnancy, it may prevent the death of a fetus. Hence, this study helps the clinician for early diagnosis and treatment of pregnancy-induced hypertension.

STUDY OF PLACENTAS OF HYPERTENSIVE MOTHERS ASSISTED IN TWO PUBLIC MATERNITIES OF RECIFE-PE

Objective: Perform the histomorphometric study of the following regions: areas of perivillous fibrin deposition; thickness of the endothelial layer of the vessels; analysis of Tenney-Parker changes. Analyze the Placental Index (IP). Results: It was seen that the weight of the placentas increased according to the weight of the newborn, however, when the variable PI was analyzed as being decisive for the development of a risk-free pregnancy, it was found that this parameter was not significant between the groups studied. (p <0.05). It was found that there is a significant difference in relation to the areas of fibrin deposition (P <0.05) between the groups and that it possibly converges with the data found in the literature in which it could be established that in the GrH there is a different relationship in this pattern. The findings of the thickness of the middle layer were significant in the GrH when compared to the GrN (p <0.05), when this parameter is compared between the Hypertensive Disorders of Pregnancy (HDP) groups, microscopically the PE cases showed prominent changes. I n the present study, Tenney-Parker changes were prominent and discreet in 75% of the GrH placentas versus 20% in the GrN. However, there are contradictions in the literature regarding the consideration of this finding seen only in Hematoxylin-Eosin staining. Conclusion: Given the above, the presence of syncytial knots, the difference between vessel thickness and areas of fibrin deposition are possibly involved in the pathogenesis of Hypertensive Syndromes, regardless of age and established classifications. In order to evaluate syncytial knots, further studies are needed in this population.

STUDY OF PLACENTAS OF HYPERTENSIVE MOTHERS ASSISTED IN TWO PUBLIC MATERNITIES OF RECIFE-PE

Objective: Perform the histomorphometric study of the following regions: areas of perivillous fibrin deposition; thickness of the endothelial layer of the vessels; analysis of Tenney-Parker changes. Analyze the Placental Index (IP). Results: It was seen that the weight of the placentas increased according to the weight of the newborn, however, when the variable PI was analyzed as being decisive for the development of a risk-free pregnancy, it was found that this parameter was not significant between the groups studied. (p <0.05). It was found that there is a significant difference in relation to the areas of fibrin deposition (P <0.05) between the groups and that it possibly converges with the data found in the literature in which it could be established that in the GrH there is a different relationship in this pattern. The findings of the thickness of the middle layer were significant in the GrH when compared to the GrN (p <0.05), when this parameter is compared between the Hypertensive Disorders of Pregnancy (HDP) groups, microscopically the PE cases showed prominent changes. I n the present study, Tenney-Parker changes were prominent and discreet in 75% of the GrH placentas versus 20% in the GrN. However, there are contradictions in the literature regarding the consideration of this finding seen only in Hematoxylin-Eosin staining. Conclusion: Given the above, the presence of syncytial knots, the difference between vessel thickness and areas of fibrin deposition are possibly involved in the pathogenesis of Hypertensive Syndromes, regardless of age and established classifications. In order to evaluate syncytial knots, further studies are needed in this population.

A clinicopathologic study of placentae of low birth weight and normal birth weight babies born at a tertiary care center in western India

Context: Low birth weight (LBW) of newborn is associated with various clinical parameters as well as with placental pathology. Aims: This study aims to assess and compare the clinical parameters and placental pathology in LBW infants with normal infants. Subjects and Methods: Thirty-four placentae of full-term babies weighing <2.5 kg were taken as cases and 34 placentae of newborns weighing more than 2.5 kg were taken as controls. Clinical data parity, maternal age, weight, height, body mass index (BMI), mode of delivery, and period of gestation were collected. Gross examination, placental parameters: attachment of cord, placental dimensions, placental weight, infarction, and hematoma were noted. Sections were studied for accelerated villous maturation (syncytial knots), developmental villous capillary lesion (chorangiosis), acute infectious inflammatory lesions (chorioamnionitis), chronic infectious inflammatory lesions (stromal fibrosis), and other placental processes (massive perivillous fibrin deposition [ MPVFD], fibrinoid necrosis, atherosis, and calcification). Statistical Analysis: Chi-square test and logistic regression were performed on dichotomous variables with SPSS 20 to find association. Quantitative variables were analyzed by Unpaired T-test and Mann–Whitney's test for significance. P < 0.05 was taken as statistically significant. Results: The mean maternal age (26.7 years) was higher (P = 0.039) than controls (24.8 years); mean maternal weight (P = 0.14)], BMI (P = 0.029), and period of gestation (P = 0.0) were lower in cases than in controls. Cases and controls showed significant difference in eccentric attachment of umbilical cord (61.76% vs. 32.35%, [P = 0.015*]). On microscopy cases showed significant MPFD (P = 0.015*). A significantly higher stromal fibrosis (P = 0.028), atherosis (P = 0.024), ST knots (P = 0.012), and chorangiosis (58.82% vs. 26.47% [P = 0.007]) were noted in cases. Conclusions: We conclude that all placentas should be examined thoroughly to look for associated characteristic histomorphologic and gross findings which reflect hypoxia and decreased maternal fetal nutrient transfer.

Histopathological Changes In Placentas Due To Pregnancy-Induced Hypertension And Gestational Diabetes Compared With Normal Term Placenta

Hypertension is the most commonly known problem of restoration during pregnancy, with up to 10% of pregnancies confused. Gestational diabetes mellitus is described as the occurrence or for the first time in pregnancy of a change in glucose levels to varying degrees. There are medical problems when diabetics and hypertension worsen pregnancy and affect maternal health. Objectives: Analysis of unexplained placenta changes in patients with concomitant hypertension and gestational diabetes caused by pregnancy. Materials and Methods: This study included forty placentas, twenty were collected from uncomplicated normotensive pregnant ladies, and the rest (20 placentas) were collected from ladies with concomitant gestational diabetes and pregnancy-induced hypertension. Histological sections were prepared using routine haemotoxyline and eosin staining. Results: The histomorphological study of placenta of patients with concomitant hypertension and diabetes mellitus showed a significant number of syncytial knots, stromal fibrosis, and the number of capillaries in terminal villi in Medium-sized diffusion areas of the vascular median cover. Conclusion: Placenta examination is very important for the diagnosis of various pathological conditions, mechanisms are still far from well understood, but there is a common consensus that the pathological level depends on the type of diabetes and hypertension during pregnancy. This study provides an opinion of previous studies with a great association placental changes in patients with concomitant pregnancy-induced hypertension and diabetes. The clinical appearance and the magnitude of placental pathological changes were strongly associated. There is a wide range of microscopical changes noted as increased the numbers of the syncytial ganglia, fibrosis and the number of capillaries in the peripheral appendages

Modulation of Telocytes in Women with Preeclampsia: A Prospective Comparative Study.

Background:Telocytes (TCs) are networking cells with enigmatic functions. Placenta is a noninnervated organ with the TCs could have function of signal transmission to placental myofibroblasts, being likely a regulator for maternal blood flow. Preeclampsia (PE) is a disease complicating the second half of pregnancy associated with hypoxia probably due to failure of vascular remodeling of spiral arteries resulting in poor placental perfusion. We hypothesized that disturbance in the morphology of TCs may have a role in the pathogenesis of PE.Materials and Methods:Women with normal or physiological pregnancy (Group I; 15 women) and with PE (Group II; 15 women) participated in this study. Specimens were obtained from the central cotyledons and the superficial myometrium beneath the implantation sites processed for light microscopy and stained with Hematoxylin and Eosin, toluidine blue, masson trichrome, and CD117.Results:The villi of group II has thick-walled blood vessels with increased peri-villous fibrinoid deposition, reduced areas of vasculosyncytial membrane and apparent increase in connective tissue density. Morphometric study and statistical analysis revealed a significant increase in the mean number of syncytial knots and significant decrease in placental (villous and decidual) and myometrial TCs and extravillous trophoblasts (EVTs) beneath the placental implantation site in Group II (P < 0.011) in comparison with group I.Conclusions:PE is associated with significantly low number of placental TCs interestingly with low number of EVTs. Further studies are needed to support our findings.

Выраженность синцитиальных узелков и экспрессии VEGF в ворсинах плаценты рожениц с COVID-19 зависит от степени её тяжести

Выраженность синцитиальных узелков и экспрессии VEGF в ворсинах плаценты рожениц с COVID-19 зависит от степени её тяжести

Clinicopathological study of annexin A5 & apelin in pre-eclamptic placentae with emphasis on foetal outcome.

Background & objectives:Pre-eclampsia has remained an elusive disease with serious impacts on both maternal and foetal health. Two novel markers, annexin A5 (ANXA5) and apelin are currently of considerable interest. The present study aimed to determine the placental expression of ANXA5 and apelin in pre-eclamptic placentae and also to elucidate if there is any correlation between the expression of these markers and the clinical features of both, mother and neonate. The comparison between gross and histopathological features of pre-eclamptic placentae and controls was another objective.Methods:A prospective, observational study was undertaken for one year. Placentae of pre-eclamptic patients and matched controls (matched for age, ethnic and socio-economic background) were collected along with the clinical data. Gross and histopathological analyses were done and immunohistochemical study of placental sections with ANXA5 and apelin was also undertaken.Results:79 pre-eclamptic patients and equal numbers of matched controls were included in the study. The difference in weight and dimensions of placentae between the pre-eclampsia group and matched controls was significant. Histopathological features noted in the pre-eclamptic placentae included decidual vasculopathy, infarction, perivillous fibrin deposition, increased syncytial knots and distal villous hypoplasia. There was a significant reduction in the expression of both ANXA5 and apelin in pre-eclamptic placentae compared to controls. Among pre-eclamptic patients, the intensity of ANXA5 and apelin expression showed a significant association with respect to neonatal resuscitation. Furthermore, the intensity of apelin showed expression a significant correlation with the requirement of sick neonatal care unit treatment.Interpretation & conclusions:The results of the present study suggest that both ANXA5 and apelin levels are reduced in pre-eclamptic placentae. Hence, it is recommended to further explore the impact of these markers on pregnancy outcomes by undertaking randomized controlled trials.

INVESTIGATION OF SFLT-1 AND VEGF EXPRESSION IN NORMOTENSIVE AND PREECLAMPTIC PLACENTA. AN IMMUNOHISTOCHEMICAL STUDY

Objectives: The pathogenesis of preeclampsia is still not clear, but endothelial dysfunction believed to be one of the most encountered problems during placenta development in preeclamptic patients. Both vascular endothelial growth factor (VEGF) and its antagonist, soluble Fms-Like tyrosine kinase-1 (sFlt-1), have roles in vascular function. In this study, we have investigated immunohistochemical expression of VEGF and sFlt-1 in term placenta of normotensive and preeclampsia patients. Methods: Totally twenty term placentas were obtained from pregnant women of which 10 preeclampsia patient and 10 normotensive. Placentas were dissected and tissue samples were subjected to routine tissue processing protocol, then embedded in paraffin blocks. Serial sections were obtained from paraffin blocks and stained with H&amp;amp;E and PAS for routine histopathology. VEGF and sFlt-1 immunohistochemistry was performed to the sections. Results: When compared to control group, severe pathological changes were observed in preeclamptic placentas. Increase in number of syncytial knots and intervillous bridges, hemorrhage in interstitium, dilatation and congestion in villous capillaries, increase in fibrin accumulation in villus stroma, and increase in thickening of basement membrane were very clear. VEGF expression was significantly higher in normotensive placentas compared to preeclamptic. On the other hand, sFlt-1 expression was significantly increased in preeclamptic placentas. Conclusions: When the VEGF and sFlt-1 expression was considered, higher expression of sFlt-1 at preeclampsia, but decrease in VEGF expression, might be related to endothelial dysfunction in preeclampsia. Overall, this study demonstrates, imbalance between VEGF and sFlt-1 is one of the major reason of endothelial dysfunction in preeclamptic placenta.