Syncytial Knots Research Articles

Histopathologic characteristics of term placentas in singleton pregnancies in women with endometriosis-related infertility after ART treatment: case-control study

Objectives Endometriosis is one of the leading causes of infertility, due to negative impact on ovarian folliculogenesis and endometrial receptivity. Literature show that endometriosis could be associated with perinatal complications such as preterm birth (PTB) and preeclampsia (PE). Authors hypothesized that women with endometriosis-related infertility conceived by assisted reproductive technology (ART) treatment have higher frequency of placental disorders. Main outcome is the occurrence of histopathologic alterations of term placentas in singleton pregnancies of women with endometriosis conceived by ART treatment, compared to healthy women with infertility due to male factor (MF) conceived by ART and to healthy women with spontaneous pregnancies. Secondary outcome include the occurrence of perinatal complications and the relationship of endometriosis and placental histopathologic characteristics. Methods Single-center, case-control study of term placentas that were collected within Department of Obstetrics and Gynecology of University Hospital Center (UHC) Split and analyzed in the Pathology department of the same hospital, by one senior perinatal pathologist. Histopathologic analysis was reported using Amsterdam Placental Workshop Group Consensus. All the noted placental lesions were divided into following categories: anatomic, inflammatory, villous maturation and vascular malperfusion disorders. Required sample size was 80 placentas, and study results were reported with descriptives, and analyzed with chi-squared, Fisher’s exact test and Kruskal-Wallis ANOVA. Multivariate regression analysis was carried with adjustment for confounding factors. Ethics approval: Class n. 520-03/24-01/83. Results Study included term placentas of 107 women, of which 36 were women with endometriosis conceived by ART, 31 were healthy women with MF infertility conceived by ART and 40 healthy women with spontaneous pregnancies. Endometriosis women were predominantly primiparas, with longer infertility duration. Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Endometriosis and MF groups had higher occurrence of Cesarian delivery (CS), while endometriosis group had newborns with lowest birthweight. Endometriosis group had shorter placental cords (PC), higher rates of increased syncytial knotting and vascular malperfusion disorders (subchorionic and perivillous fibrin, intervillous thrombosis, high grade fetal vascular malperfusion). Finally, endometriosis is showed to be associated with increased syncytial knots’ formation and PC hypercoiling, after adjustment for confounding factors in the multivariate regression analysis. Conclusions Despite low rates of perinatal complications, we report endometriosis to have higher occurrence of increased syncytial knotting and vascular malperfusion placental disorders, compared to control groups. Endometriosis is also associated with increased syncytial knotting and PC hypercoiling. Further studies are needed to elucidate the endometriosis impact on endometrial receptivity and immunopathogenesis in placental disorders and perinatal complications. Highlights Endometriosis women were predominantly primiparas, with longer infertility duration. Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Moreover, endometriosis and MF groups had higher occurrence of Cesarian delivery, while endometriosis group had newborns with lowest birthweight. Endometriosis group had shorter placental cords, higher rates of increased syncytial knotting and vascular malperfusion lesions. Endometriosis is showed to be associated with increased syncytial knots formation and hypercoiling of placental cord, after adjustment for confounding factor.

Влияние непрерывного профилактического приема ацетилсалициловой кислоты на гистологическую картину плаценты у беременных группы высокого риска развития задержки роста плода

Background: fetal growth restriction (FGR) is the main cause of perinatal mortality. We have relatively effective methods of predicting and preventing this condition, however, it has not yet been possible to achieve a significant reduction of the FGR incidence. Acetylsalicylic acid (ASA) is the only effective pharmacological method for the prevention of FGR, but the mechanism of its action is still in doubt. Aim: to study the placental morphology in pregnant women at high risk of FGR according to the first trimester screening (FTS), depending on whether female patients took ASA for the FGR prevention or not. Patients and Methods: the study was conducted in 2019–2021. By that time, the clinical recommendations concerning «Insufficient fetal growth requiring the provision of medical care to the mother (fetal growth restriction)», developed by the Ministry of Health of the Russian Federation, had not yet come into effect. In a prospective analysis, the placental morphology of 125 pregnant women at high risk of FGR and 554 placentas of pregnant women at low risk was studied according to the FTS results. Pregnant women at high risk of FGR were divided into 2 groups: 51 female patients received ASA from 14 to 36 weeks pregnant, 74 did not receive ASA; the control group consisted of 554 pregnant women at low risk of FGR according to the FTS. The placenta was examined in 3 stages according to the conventional management scheme, including macroscopic analysis, material incisure and histology. Results: placental pathological changes (dystrophic changes, syncytial knots formation, fibrinoid deposition, disorders of placental villous maturation) in patients who did not receive ASA were significantly more common than in the control group and in the subgroup receiving ASA. Conclusion: FGR incidence decrease in patients receiving ASA was due to an improvement in the histological structure of the placenta. KEYWORDS: fetal growth restriction, small for gestational age, placenta, acetylsalicylic acid. FOR CITATION: Shamugiya V.V., Kuznetsov P.A., Dobrokhotova Yu.E. Effect of the continuous prophylaxis with acetylsalicylic acid on the placental histological image in pregnant women at high risk of fetal growth restriction. Russian Journal of Woman and Child Health. 2024;7(1):12–17 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-2.

Expression of androgen receptor in human placentas from normal and preeclamptic pregnancies

Background: Human placenta is a diary of all the prenatal events and it’s study may provide valuable insight into pathophysiology of many diseases. One such disease preeclampsia (PE) is a leading contributor of maternal/fetal mortality and morbidity. In a quest to improve the treatment protocols, newer etiologies are researched, the latest being Androgen Receptor (AR) expression in PE placentae. Methodology: Study was conducted in a tertiary care hospital in Bengaluru over a period of 18 months. Placentae (15) from singleton pregnancies with PE formed the study group while placentae (5) from normotensive pregnancies were the control group. Gross and histopathological findings followed by immunohistochemistry of AR was performed on all placentae and categorized based on the percentage of villi stained. Intracellular localisation and the type of cells staining were also recorded. Results: Mean age was 28 years, majority (73%) of PE were in 28-32 weeks gestation group, with 46% being primigravidae. Past history of PE was observed in 75% while 53% had family history of PE. Decreased placental weight, increased syncytial knots, accelerated villous maturation and stromal fibrosis, fibrinoid necrosis and mural hypertrophy of arterioles were statistically significant findings in PE group. AR staining was seen in 16/20 (80%) with 11/15 PE cases showing 2+ and 3+ staining. Cytoplasmic staining was commonly seen in Syncytiotrophoblast, Cytotrophoblast & stromal cells in both groups. Conclusion: AR expression was seen both in PE and non-PE placentae, although AR expression is increased in the former. Stillbirths were associated with positive AR despite clinically classified as mild PE, while negative AR was associated with live births. AR expression could be a new marker for PE with adverse outcome especially in recurrent cases.

Women with psychotic episodes during pregnancy show increased markers of placental damage with Tenney-Parker changes.

Psychosis is a hazardous and functionally disruptive psychiatric condition which may affect women in pregnancy, entailing negative consequences for maternofetal well-being. The precise pathophysiological basis and consequences of a psychotic episode in pregnancy remain to be further elucidated. The placenta is a pivotal tissue with many functions in the gestational period, critically influencing the fate and development of pregnancy. Although detrimental alterations have been observed in women undergoing severe psychiatric disorders in pregnancy, there are little studies evaluating the consequences of suffering from a psychotic episode in the placental tissue In this work, we have evaluated the histopathological consequences of a first episode of psychosis in pregnancy (FE-PW; N=22) and compare them with healthy pregnant women (HC-PW; N=20) by using histological, immunohistochemical and gene expression techniques. Our results define that the placental tissue of FE-PW display an increase in the number of placental villi, bridges, syncytial knots and syncytial knots/villi. Besides, we have also observed an enhanced gene and protein expression in FE-PW of the hypoxic marker HIF-1α, together with the apoptotic markers BAX and Bcl-2. To our knowledge, this is the first study demonstrating significant histopathological changes in the placenta of women suffering a new-onset psychotic episode in pregnancy. Further studies should be aimed at deepening the knowledge about the pernicious effects of psychosis in the maternofetal tissues, as well as the potential implications of these alterations.

EP18.04: Placental villous structure in pre‐eclampsia shows increased syncytial knot density using multiphoton microscopy

EP18.04: Placental villous structure in pre‐eclampsia shows increased syncytial knot density using multiphoton microscopy

Comparison of placental expression of basic fibroblast growth factor and insulin-like growth factor-1 in placentae of normal, pregnancy-induced hypertension, and preeclamptic pregnancies in Iraqi mothers

Abstract Background: Many pathological insults are associated with elevation of blood pressure levels during pregnancy resulting in a difficult pregnancy and a poor outcome on both mother and baby. Objective: In this study, we examine the histological and immunohistochemical markers of the placentae in cases of hypertension in pregnancy and preeclampsia and compared them to a placenta of normal pregnancy among a random sample of Iraqi pregnant women. Materials and Methods: Ninety women divided into three groups, 30 in each, selected with straightforward pregnancies (Group A), mothers with pregnancy-induced hypertension (Group B), and preeclamptic mothers (Group C) were chosen from the indoor patients of the gynecology and obstetrics department of Al-Khansaa teaching hospital in Mosul for placental tissues examination. Histological examination was done by using hematoxylin and eosin stain (H & E), and immunohistochemistry was achieved by using immunohistochemical markers named: insulin-like growth factor-1 (IGF-1) and basic fibroblast growth factor (b-FGF) markers, which are expressed in placental tissues. Results: Different changes were observed in the placentae affected when compared with normal one, such as syncytial knots formation, thickening of trophoblastic basement membrane, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, calcified and hyalinised villous spots, villous edema, and atherosis of the uteroplacental arteries. Significant immunohistochemical changes were obtained when compared with normal placentae where elevation of both b-FGF and IGF-1 in preeclamptic placentae was observed when compared to hypertensive and control cases. Conclusion: Significant changes appeared in the placentae of hypertensive and preeclamptic mothers, both in histological and immunohistochemical examinations.

Placental Lesions Associated With Stillbirth by Gestational Age, as Related to Cause of Death: Follow-Up Results From the Stillbirth Collaborative Research Network.

We previously identified placental lesions associated with stillbirths of varying gestational ages (GA) using advanced feature analysis. We further investigated the relationships between placental lesions and cause of death in stillbirths within these GA ranges. Using data from the Stillbirth Collaborative Research Network, we derived a sample of stillbirths who underwent placental examination and Initial Causes of Fetal Death (INCODE) evaluation for determining cause of death. We then compared the rates of causes of death within and among GA ranges (extreme preterm stillbirth [PTSB] [<28 weeks], early PTSB [28-336/7 weeks], late PTSB [34-366/7 weeks], term stillbirth [≥37 weeks]) according to the presence of these lesions. We evaluated 352 stillbirths. In extreme PTSB, obstetric complications and infections were associated with acute funisitis. In early PTSB, uteroplacental insufficiency was associated with parenchymal infarcts. In term stillbirth (vs early PTSB), increased syncytial knots were associated with umbilical cord causes and infection. Placental lesions of high importance in distinguishing stillbirths at different GAs are associated with specific causes of death. This information is important in relating the presence of placental lesions and fetal death and in helping to understand etiologies of stillbirths at different GAs.

Spontaneous massive fetomaternal hemorrhage: two case reports and a literature review of placental pathology

BackgroundMassive fetomaternal hemorrhage (FMH) is a rare event during pregnancy that may cause severe fetal anemia or death.Case presentationThis paper reports two cases of fetomaternal hemorrhage with unexplained reasons. Both cases required emergency caesarean sections for non-reassuring fetal status and were treated with neonatal blood transfusion. Fetomaternal hemorrhage was confirmed via maternal Kleihauer-Betke test.ConclusionWe found parenchymal pallor, increased nucleated red blood cells (nRBCs), and syncytial knots (SKs) in the placentas, which are compatible with fetal anemia. Immunohistochemical staining indicated VEGF, CD34, and CD31 expression in the endothelial cells of the capillaries, characteristic of massive FMH placenta. This article also reviews the particular histopathological changes in FHM placenta according to the placental lesion classification system.

THE HISTOPATHOLOGICAL CHANGES OF PLACENTA IN HYPERTENSIVE DISORDERS OF PREGNANCY AND THEIR CORRELATION WITH FETAL OUTCOME: A CROSS-SECTIONAL STUDY

Objectives: The objective of this study was to evaluate the histopathology and establish the correlation between placental changes in hypertensive disorders of pregnancy and fetal outcome. Methods: A cross-sectional study included 100 pregnant women with singletons admitted to the labor room with gestational ages &gt;30 weeks and 35 weeks with hypertensive disorders of pregnancy between December 2021 and November 2022, admitted to the Department of Obstetrics and Gynecology, Sardar Patel Medical College, Bikaner. Shape of placenta, weight in grams, size, diameter in centimeters, and deposition were examined. Fetomaternal outcome was also noted. Results: Eighty percent (80) were in the age group of 21–30 years, with a mean age of 25.01±4.56 (range: 18–44 years). Only 35% of females were booked, and 63% of cases belonged to G1. Maximum cases were of pregnancy-induced hypertension (42%), followed by eclampsia (36%) and pre-eclampsia (16%), and the minimum case belonged to HELLP (1%). Although cases of placental infarction were higher in neonatal intensive care unit (NICU) admitted cases as compared to non-admitted cases (61.19% vs. 45.45%, respectively), calcification was higher in NICU-admitting cases as compared to non-admitting cases (95.52% vs. 84 vs. 5%, respectively). Syncytial knots were 94.03% vs. 81.82%, respectively, and grade fibrosis was 44.78% vs. 27.27%. Fibrinoid necrosis (71.64% vs. 54.55%) and leukocytic infiltration (68.66% vs. 63.64%). Statistically, no significant difference was observed in all parameters. Conclusion: Placental morphology and histopathology are affected in hypertensive pregnancies, which might be the reason for placental insufficiency in these cases.

Immunoexpression of neuropilin-1 in the chorionic villi of HIV-infected preeclamptic South African women of African ancestry.

Neuropilin-1 (NRP-1) is an essential regulator of maternal immune tolerance, placentation, and angiogenesis. Its dysregulation in preeclampsia (PE) and human immunodeficiency virus (HIV) infection implicates NRP-1 in disease susceptibility and progression. Therefore, this study investigates placental NRP-1 immunoexpression in HIV-complicated preeclamptic pregnancies in South African women of African ancestry receiving antiretroviral therapy. Immunohistochemistry of recombinant anti-neuropilin-1 antibody was performed on placental tissue from 30 normotensive and 60 early onset (EOPE) and late-onset (LOPE) preeclamptic women stratified by HIV status. Qualitative analysis of NRP-1 immunostaining within the chorionic villi revealed a predominant localization in trophoblasts and syncytial knots as well as endothelial, fibroblast-like, and Hofbauer cells. Following morphometric evaluation, we report that PE and HIV infection and/or antiretroviral usage independently downregulate placental NRP-1 immunoexpression; however, as a comorbidity, this decline is further augmented within the conducting and exchange villi. Furthermore, reduced immunoexpression of NRP-1 in EOPE compared with LOPE villi may be due to maternal-fetal maladaptation. It is plausible that the decreased NRP-1 immunoexpression in PE placentae facilitates syncytiotrophoblast apoptosis and subsequent deportation of NRP-1 into the maternal circulation, contributing to the anti-angiogenic milieu of PE. We hypothesize that the intense NRP-1 immunoreactivity observed in Hofbauer cells at the maternal-fetal interface may contribute to the natural prevention mechanism of HIV vertical transmission.

Histo-morphometric vicissitudes in diet-controlled diabetic placenta: A quantitative stereological model

BackgroundAn affordable approach accepted worldwide to successfully treat mild maternal hyperglycemia in gestational diabetes (GDM), is diet-controlled therapy. As no elaborate research was available, this study was crafted to investigate morphometric stereological details and to determine the mean placental oxygen diffusion capacity for patients who were kept on diet therapy for mild gestational hyperglycemia. MethodsA clinical trial (NCT04907708) was conducted from January 2018 to February 2019. A total of 70 women completed the study, out of which 35 served as healthy controls as Group A and 35 were diagnosed as mild gestational diabetics according to WHO criteria (Group B). These patients were kept on a restricted calorie diet with light exercise during gestation and were followed regularly during gestation. Soon after delivery, conserved placentas underwent complete gross, microscopic, and stereological investigations with the point and intersection -counting methods. ResultsSignificant differences were observed for placental width and syncytial knots (p＜ ​0.010 and 0.025 respectively) between the groups on gross and light microscopy. Most of the parameters were non-significant, though numerically more in the GDM group. On stereological details, mean placental volume, mean placental components volumes (villi, inter-villous space, fetal capillary, and fetal connective tissue), mean villi and mean fetal capillary diameter, mean villi and capillary surface density and mean morphometric diffusing capacity of placenta showed non-significant results between the groups. ConclusionMinimal changes were observed in gross, microscopy, and morphometric stereological details in the placentae of GDM patients managed with nutritional therapy during gestation compared with the healthy controls.

Investigation of the Sox-9 and Cited-1 Immune Activity in Placentas of Women with Placenta Accreta

Aim: In this study, we investigated the immune activity of the Sox-9 and Cited-1 in women with placenta accreta. Material and Methods: 20 healthy and 20 placenta accreta were processed for routine histological tissue processing. Placentals samples were dissected and fixed in 10% formaldehyde solution. Samples were embedded in paraffin blocks. Clinical and biochemical parameters were recorded. Placental sections were cut from paraffin blocks and stained with Sox-9 and Cited-1 immunostaining. Results: In our study, control group showed negative Cited-1 expression in decidual cells, root villi and connective tissue areas in general. Placenta accreta group showed increased Cited-1 expression in degenerated decidual cells, fibroblastic cells and endothelium. In control group, Sox-9 expression was negative in the syncytial knots, in the vascular endothelial cells. In placenta accreta group, Sox-9 reaction was positive in the root villi, in the blood vessels, in the connective tissue. Conclusion: It was observed that the Sox-9 reaction was increased and inflammation was induced, depending on the differences in decidual cells, in the syncytial area and in the vascular endothelium in in placentas of women with placenta accreta. It is thought that Sox-9 signaling processes are being determined and Cited-1 may be stimulants that affect cell proliferation and angiogenesis regulation and affect placental development.

A spectrum of pathological changes induced by SARS-COV-2: An observational study in a cohort of pregnant women from Mizoram, India

BackgroundMaternal infection by SARS-CoV-2 may lead to adverse pregnancy outcomes and causes pathological changes in the placenta. However, consensus regarding characteristic pathological features is lacking. Researchof the placental histopathology in a cohort of women from Mizoram, India, was conducted to relate the SARS-CoV-2 infection's effectswith pregnancy and its outcome. Materials and methodsThe characteristics of 72 pregnant women diagnosed positive for SARS-CoV-2 who eventually delivered at Zoram Medical College Hospital, Mizoram, neonates’ well-being, and histopathological features of placentas were studied. ResultsOf 72 women in this study, 59 (81.9%) gave birth at full term. Among these births, 5 were normal vaginal deliveries, while the remaining 67 (93.1%) were delivered via cesarean section. The reasons for cesarean delivery were either related to SARS-CoV-2 infection (n ​= ​49), existing obstetric problems (n ​= ​15) or fetal-distress (n ​= ​5). All deliveries resulted in live births of COVID-negative babies, with 80.6% (n ​= ​58) of the newborns having a birth weight of over 2.5 ​kg. APGAR scores ranged from 4 to 6 in 61 (84.7%) of the babies, and 10 neonates required resuscitation, of which 8 were managed in the neonatal intensive care unit (NICU). The placental histopathology showed increased fibrin thrombi in 8 cases (11.1%), while 20 cases (28%) showed focal infarction, microcalcification levels were elevated in 16 cases (22.2%), and a small percentage of cases (1.4%) exhibited small fibrotic villi and inter-villus agglutination. Placental chorioangiosis was detected in 28 (38.9%) of the cases, while avascular villi were seen in 6 cases. Meconium-stained liquor was observed in a single case. Intervillous hemorrhage was found in 42 cases, whileintervillous inflammation and increased syncytial knots were present in 14 and 5 cases, respectively. The placenta pathology of 10 neonates who required resuscitation/NICU admission was not significantly different from that of the 62 neonates who did not require it. However, a higher proportion of placenta from the asymptomatic group showed no abnormality compared to the symptomatic group (p ​= ​0.046). ConclusionSARS-CoV-2 infection causes a range of morphological changes and lesions in the placenta, including chorangiosis, villositis, chorioamnionitis, fetal vascular malperfusion/thrombosis, fibrin-deposition, increased syncytial-knotting, increased microcalcification, increased villous agglutination, focal infarct, intervilloushemorrhage as well as inflammation. Placental histopathological findings from this study can provide additional information to the existing literature on the subject.

Histo-Morphogical Study of Full- Term Placenta in Selected Normotensive And Pre-eclamptic Women in Bangladesh

Pre–Eclampsia is a disorder in 2nd half of pregnancy, characterized by a combination of hypertension, proteinuria, and edema, secondary to decreased placental perfusion. Clinical studies suggest histo-morphological changes in the placenta of pre-eclamptic women compared to normotensive pregnant women. This study aimed to compare the histo- morphological changes of the placenta in selected pre-eclamptic and normotensive pregnant women. Methods: Two hundred twenty pregnant women were selected with inclusion and exclusion criteria from 3 different medical colleges and divided into two groups. A study group comprised 110 pre-eclamptic women, and a control group comprised 110 normotensive pregnant women. After delivery, tissue samples were collected from the placenta and prepared for histopathological studies by hematoxylin and eosin stain. The mean number of areas of syncytial knot formation, the mean number of areas of cytotrophoblast cell proliferation, the mean number of areas of fibrinoid necrosis, and the mean number of areas of hyalinized villi of pre-eclamptic and normal pregnant women were evaluated. We evaluated the morphology by weight, diameters, number of cotyledons, and placental infarcts. Results: The mean number of areas of syncytial knot formation, cytotrophoblastic cell proliferation, fibrinoid necrosis, and hyalinised villi were significantly higher in the study group compared to the control group. The mean weights, diameters, and the number of cotyledons were considerably lower in the study group compared to the control group. Moreover, the number of infarcted areas was significantly higher in the placentas of pre-eclamptic women. Conclusion: There are histomorphologic changes in the placenta of pre-eclamptic women. J Dhaka Med Coll. 2022; 31(1) : 37-45

Maternal and Placental Risk Factors for Small Gestational Age and Fetal Malnutrition.

This case-control study was conducted to identify maternal and placental risk factors of small-for-gestational-age (SGA) and fetal malnutrition. Cases comprised 104 consecutively delivered SGA neonates (determined as per INTERGROWTH- 21st standard). An equal number of next-born gestation and gender-matched appropriatefor- gestational age (AGA) neonates served as controls. Maternal risk factors were enquired, and placentae were evaluated by clinical and histopathological examination. Nutrition of the neonates was assessed by the clinical assessment of nutrition (CAN) score. Univariate and multivariate logistic regression analysis was done to identify the maternal and placental risk factors. The prevalence of SGA in the present study was 23.9%. Maternal fever [adjusted Odds Ratio (aOR), 95% confidence interval (CI), 16.3 (3.5-124.1); p = 0.001], presence of placental syncytial knots [aOR (95% CI), 2.9 (1.1-9.1); p = 0.04] and placental calcifications [aOR (95% CI), 3(1.1- 8.7); p = 0.03], were identified as independent predictors of SGA using multivariate logistic regression analysis. Malnutrition (SCORE <25) affected 64% of SGA and 16.3% of AGA neonates. The only risk factor significantly associated with malnourished SGA was prematurity, whereas malnourished AGA was significantly associated with prematurity and fetal distress. In-hospital morbidities significantly higher in SGA were perinatal asphyxia, respiratory distress, need for respiratory support, polycythemia, hypoglycemia, and feeding intolerance. Mortality before discharge was 4.8% and 3.8% in SGA and AGA population, respectively (p > 0.05). Neonatal outcomes were comparable among well-nourished, malnourished SGA and AGA groups. Maternal fever, placental syncytial knots, and calcifications were independent risk factors of SGA, whereas prematurity and fetal distress were responsible for malnutrition.

Histological and Morphological Study of the Placenta in Gestational: Pregestational Diabetic, and Normal Women’s

This study was aimed at comparing the morphometric and histological features of the placenta in gestational diabetes mellitus (GDM), pre-gestational diabetes mellitus (PGDM), and non-diabetic normal pregnant women. Twenty-four placentas were obtained from non-diabetic pregnant women (control group), ten from women with GDM, and ten from PGDM women. Segments from the central part of the placenta were taken and processed for paraffin blocks, sectioned, and stained with H&amp;E, Masson trichrome, and periodic acid-Schiff. The results of morphometric measurement revealed that the mean weight and diameter of GDM and PGDM placentae were significantly higher than in the control; placental thickness was a significant increase in PGDM; the number of cotyledons and fetal weights showed no significant difference in all these groups; the fetoplacental ratio was significantly higher in the PGDM; discoidal placenta shape, followed by irregular, oval, and kidney as the most common shapes recorded in these groups; the central umbilical cord insertion was most common in all three groups; followed by noncentral (eccentric) and marginal insertions. Diabetes caused several histopathological changes in the placenta, including an increase in the number of different sizes of villi with a decrease in the intervillous spaces, an increase in the: number of big syncytial knots, and fibrinoid necrosis; chronogenesis in the intervillous spaces and villous capillary congestion. Diabetic groups showed the presence of dense collagen fibers within the villous stroma (villous stromal fibrosis) and around fetal blood capillaries. GDM showed a mild thickening of the basement membrane (BM) of chorionic villi and a mild increase in the collagen in the villous stroma. While PGDM showed a moderate increase in the BM of syncytiotrophoblast and villous stroma and mild thickening of the BM of capillary blood vessels. In conclusion, both GDM and PGDM caused adverse effects on the histological and morphometrical features of the placenta. Keywords: Placenta; Diabetes Mellitus; Morphometric analysis; Histopathology, Masson trichrome stain; Periodic acid shift reaction. DOI: 10.7176/JBAH/13-6-03 Publication date: April 30 th 2023

Definition and Quantification of Three-Dimensional Imaging Targets to Phenotype Pre-Eclampsia Subtypes: An Exploratory Study

Pre-eclampsia is a severe placenta-related complication of pregnancy with limited early diagnostic and therapeutic options. Aetiological knowledge is controversial, and there is no universal consensus on what constitutes the early and late phenotypes of pre-eclampsia. Phenotyping of native placental three-dimensional (3D) morphology offers a novel approach to improve our understanding of the structural placental abnormalities in pre-eclampsia. Healthy and pre-eclamptic placental tissues were imaged with multiphoton microscopy (MPM). Imaging based on inherent signal (collagen, and cytoplasm) and fluorescent staining (nuclei, and blood vessels) enabled the visualization of placental villous tissue with subcellular resolution. Images were analysed with a combination of open source (FIJI, VMTK, Stardist, MATLAB, DBSCAN), and commercially (MATLAB) available software. Trophoblast organization, 3D-villous tree structure, syncytial knots, fibrosis, and 3D-vascular networks were identified as quantifiable imaging targets. Preliminary data indicate increased syncytial knot density with characteristic elongated shape, higher occurrence of paddle-like villous sprouts, abnormal villous volume-to-surface ratio, and decreased vascular density in pre-eclampsia compared to control placentas. The preliminary data presented indicate the potential of quantifying 3D microscopic images for identifying different morphological features and phenotyping pre-eclampsia in placental villous tissue.

Histopathological Study of Full-Term Placenta in Selected Normotensive And Pre-eclamptic Women in Bangladesh

Pre-eclampsia is a disorder of 2nd half of pregnancy, which is characterized by a combination of hypertension, proteinuria and edema, secondary to decreased placental perfusion. Clinical studies suggest that there are histopathological changes in the placenta of pre-eclamptic women, compared to normotensive pregnant women. In developing countries, pre-eclampsia causes an estimated 50,000 maternal deaths per year. Only a small number of studies have however, been conducted in Bangladesh. Objective: To compare the histopathology of placenta in selected pre-eclamptic and normotensive pregnant women. Methods: 220 pregnant women were selected with inclusion and exclusion criteria from 3 different medical colleges and divided into 2 groups – A study group, consisting of 110 pre-eclamptic women and a control group consisting of 110 normotensive pregnant women. Dietary information was collected by 7 days food frequency questionnaire and food score was determined. Anthropometric and biochemical tests were performed. To evaluate the histopathology of placenta, tissue samples were collected from the placenta after delivery, and were prepared for histopathological studies, by haemotoxylin and eosin stain method. The mean number of areas of syncytial knot formation, the mean number of areas of cytotrophoblastic cell proliferation, the mean number of areas of fibrinoid necrosis, and the mean number of areas of hyalinised villi of pre-eclamptic and normal pregnant women were evaluated. Results: The mean number of areas of syncytial knot formation, the mean number of areas of cytotrophoblastic cell proliferation, the mean number of areas of fibrinoid necrosis, and the mean number of areas of hyalinised villi were found to be significantly higher in the study group, compared to the control group. Conclusion: Therefore, mean number of areas of syncytial knot formation, the mean number of areas of cytotrophoblastic cell proliferation, the mean number of areas of fibrinoid necrosis is increased in the placenta of pre-eclamptic women, compared to normotensive pregnant women. J Dhaka Med Coll. 2021; 30(2) : 189-195

Histological alterations of the placenta in gestational diabetes mellitus: Implications for fetoplacental transport and fetal outcome

Background: The placenta is a pivotal medium for physiological exchanges between the maternal and fetal circulations. However, diabetic insults early in gestation can influence the placental barrier, potentially impacting fetal development and outcomes. This study sought to understand the histological changes in the placentae of gestational diabetes mellitus (GDM) cases, highlighting the significance of these alterations on fetal health. Aims and Objectives: The primary aim of this research was to elucidate the histological changes present in the placentae of women diagnosed with GDM. Furthermore, the study sought to determine the implications of these changes on the standard placental anatomy and its associated functionalities, thereby assessing potential impacts on fetal development and outcomes. Materials and Methods: A case–control study was conducted at MES Medical College, Perinthalmanna, Kerala, from October 2014 to December 2018. Inclusion criteria considered pregnant women aged 19–38 years diagnosed with GDM, among other factors. Exclusion criteria weeded out pre-diagnosed diabetes cases, unclear glycemic statuses, and a range of pregnancy complications. Placentae samples underwent meticulous histological and histochemical analyses, focusing on key histological features, including syncytiotrophoblastic knots, vasculosyncytial membranes, and chorangiosis. Results: Significant histological variations were observed in GDM cases compared to controls. Notably, there was an increased formation of syncytial knots and reduced vasculosyncytial membranes in GDM placentae. In addition, chorangiosis was more prevalent, suggesting potential chronic prenatal hypoxia. Marked thickening of the syncytiotrophoblast basement membrane, villous edema, and fibrinoid necrosis were other pertinent findings in GDM cases, each with statistical significance (P &lt; 0.001). Conclusion: The findings underscore the profound histological changes in the placenta associated with GDM, emphasizing the need for comprehensive maternal care and monitoring. These alterations can compromise fetoplacental transport and may have long-term implications on fetal health, highlighting the critical role of timely GDM diagnosis and intervention.

Histopathological Changes of Placenta in Maternal Hypertensive Disorders and its Association with Birth Weight: A Case-control Study

Introduction: One of the most common complications during pregnancy is hypertension. It leads to pathological changes which reduce the placental blood flow. Hypertensive disorders are strongly associated with foetal growth restriction, prematurity, lower foetal birth weights and contribute largely to perinatal mortality and morbidity. Aim: To study the histomorphological changes of placenta in cases of maternal hypertensive disorders and compare it with normal controls as well as find out its association with neonatal birth weight. Materials and Methods: A case-control study was conducted at the Department of Pathology of a Tertiary Care Hospital, Faridabad, Haryana, India. Duration of the study was 2 months from July to August 2018. This study is a part of Indian Council of Medical Research (ICMR) Short Term Studentship (STS) scheme for MBBS students. Control group was formed by 30 placenta of full term deliveries without any complications and 30 placenta of the females presenting with hypertensive pregnancies formed the case group. Specimens of placenta were studied in detail for morphological and histological changes. Neonatal Birth weight was recorded just after delivery of all the cases and controls. Analysis of statistical difference between the means of both groups was performed using student unpaired t-test. The data obtained was entered in Microsoft excel sheet and statistically analysed using Epi Info version 7. Results: Mean maternal age for cases was 28.60 years and controls were 25.23 years. This association was found to be significant. Mean for gestational weeks at the time of delivery was 34.93 weeks in cases and 37.20 weeks in controls (p-value &lt;0.0001). Average placental weight in cases was 410.20 grams and in controls was 480.80 grams (p-value &lt;0.001). Histopathological changes comprised of Syncytial knot formation, Cytotrophoblasts proliferation, proliferation of endothelial lining of capillaries, stromal fibrosis, calcification, hyalinisation of villi and infarction were comparatively more frequent in cases (n=30). Mean neonatal birth weight was found to be 2809.67±128.32 grams in control group as compared 2427.67±152.22 grams in cases (p-value &lt;0.001). Conclusion: During pregnancy significant histomorphological changes in placenta are caused due to hypertensive disorders which lead to harmful and severe foetal outcomes. A valuable insight into the mechanism of placental dysfunction can be achieved through a detailed examination after delivery.