Study of Correlation of Placental Morphology with Morphometrical features of Fetus in High Risk Pregnancy

Haretha, A (2020) Study of Correlation of Placental Morphology with Morphometrical features of Fetus in High Risk Pregnancy. Masters thesis, Trichy SRM Medical College Hospital and Research Centre, Trichy.

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Abstract

INTRODUCTION: The fetus, mother and placenta constitute the triad of dynamic equilibrium in reproduction. Placenta is readily evaluable and easily accessible component of triad Placental study gives information of both infant and mother. Placenta is regarded as the diary of fetus developing inutero. It helps in maintaining and promoting normal development of fetus. It connects the fetus to uterine wall thereby allowing exchange of gasses, nutrient uptake and waste elimination and via maternal blood supply. A well nourished newborn is the best evidence of adequate placental circulation. It is a vital organ for continuation of pregnancy and nutrition of fetus. It has evoked great interest among pathologist and obstetrician to understand the unique biological status of this complex organ. Any disturbances in maternal health affects placenta, leading to decreased placental perfusion and cause fetal mortality and morbidity. Disturbance in the placental function itself affect the fetal growth. Therefore the study of changes that occur in placenta and extent of lesion will help in assessment of the degree of fetal insult inutero. AIMS & OBJECTIVES: 1. To study the histomorphological features of placenta in high risk pregnancy. 2. To analysis and correlate the morphology of placenta with fetal parameters. 3. To use Histochemical staining (Periodic Acid Schiff) and Immunohistochemistry (CD34) for demonstrating features in few groups of high risk pregnancy. MATERIALS AND METHODS: The present study was conducted in Department of Pathology, Trichy SRM medical college hospital and research center, Irungalur. DURATION OF STUDY: 2017-2019, a two year prospective study. SAMPLE SIZE: 100 cases. INCLUSION CRITERIA: Placentas of singleton pregnancy in Anemia, Gestational Diabetes Mellitus, Pregnancy induced Hypertension, preterm pregnancy, Rh negative pregnancy, Intrauterine Growth Retardation, Intrauterine Death, hypothyroid and infection (Syphilis) were taken for study. EXCLUSION CRITERIA: ◈ Placenta of non-viable fetus (< 20 weeks of gestation) ◈ Placenta of uncomplicated pregnancy. ◈ Associated obstetric complications of pregnancy. ◈ Multiple pregnancies (eg. twins etc.) were excluded. MATERIALS AND METHOD: All the placentas were collected immediately after delivery, both from normal deliveries and Caesarean sections. The placentas along with the cords were collected in 10% formalin filled plastic containers. The collected placentas were washed in running tap water. The cords and membranes were examined for any abnormalities. The membranes were grossed by Swiss-roll technique. Bits of placenta were taken from the maternal surface, membranes, cord and from other representative areas. The tissues were then processed, embedded and block out with paraffin wax. Multiple thin sections of 5 microns were cut from paraffin blocks. Haematoxylin and eosin stains were used and the slides were examined under a light microscope. Special stain PAS (Periodic Acid Schiff) and Immunohistochemistry with CD34 were done on few high risk group placentas. Details of baby collected whose placentas were utilized: Weight and sex of the baby. Parameters of placenta: Weight of placenta, shape of placenta. Diameter and thickness of placenta, number of cotyledons, umbilical cord insertion. Calculated parameters: Feto-placental ratio = Ratio of placental weight to birth weight (in grams). Feto-placental coefficient = Weight of placenta (in grams) / weight of baby (in grams). RESULT: In the present study, the majority of multiparous mothers belonged to anemia group. Therefore multiparous women are more prone to anemia than primigravida. Macroscopy: In the present study, the most common insertion of umbilical cord in placenta was central type. However, the predominant type of insertion in the placentas of anemia group was eccentric. Marginal type of insertion was more commonly observed in PIH group. The most common shape of placenta observed in the present study was circular. The predominant shape of placenta in anemia group was oval. In our study, the fetoplacental ratio was increased in PIH and hypothyroid. The fetoplacental ratio was normal in Rh negative pregnancy, hypothyroid and syphilis. However placentas in Rh negative group were heavier and paler than normal. In the present study, hypothyroid placenta had normal average weight and other morphometrical features of placenta in contrast to the previous study which showed reduced placental weight. This might be due to well controlled thyroid status during antenatal period noted in our study. In our study, preterm pregnancy, IUGR and IUD showed increased fetoplacental coefficient. Microscopy: There is significant basement membrane thickening observed in Rh negative and Gestational Diabetes Mellitus placenta. Increased villous vascularity was seen in GDM placentas. Decreased villous vascularity was seen in anemia cases and 75% of Rh negative cases. The vasculosyncytial membrane formation is higher in our anemia cases indicating the severity of anemia. Increased calcification was seen in all cases of IUGR in our study. When compared to other previous studies, increased perivillous fibrin deposition was seen in our study which acts as the barrier between fetal and maternal circulation, therefore indicating increased severity of growth retardation in our study. CONCLUSION: The current study has highlighted the importance of placental examination in high risk pregnancies. As it acts as diagnostic tool to understand the pathophysiology of different conditions in the mother, fetus and placenta itself, the standardization of examination of placenta is mandatory to obtain maximum benefits for better clinical outcome. It has an important role in planning the monitoring of perinatal period as well as neonatal care in future pregnancy. Disorders such as anemia, gestational diabetes, hypertension, hypothyroidism in pregnancy alter the morphology of placenta if left untreated. Hence, early recognition of such disorders in pregnancy and proper management are crucial for normal development and functioning of the placenta.

Item Type: Thesis (Masters)
Additional Information: 201713601
Uncontrolled Keywords: Fetoplacental ratio, Fetoplacental coefficient, Morphometry of placenta, Histomorphology of placenta, High risk pregnancy.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 29 Jan 2021 18:45
Last Modified: 29 Jan 2021 18:45
URI: http://repository-tnmgrmu.ac.in/id/eprint/13442

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