Placenta alteration in its functions causing placental

Placenta
forms connection between fetus and the uterine wall of mother. It plays the
role of excretory, hepatic, gastrointestinal,
endocrine, respiratory and immune system1 . Umbilical cord
forms a conduit between fetus and placenta. Thus, placenta plays an important
role in pregnancy and its careful examination in many pregnancy related medical
disorders can help us understanding their etiology. These disorders are the
reasons for maternal and perinatal morbidity and mortality. Disorders like
gestational diabetes, pregnancy induced hypertension, eclampsia, preeclampsia
result in destruction of placenta and alteration in its functions causing
placental insufficiency2.

Pregnancy Induced Hypertension can cause distress
and fatality in mother, fetus and newborn3. Fetuses in these
conditions are most likely to suffer from intrauterine growth retardation,
prematurity and intrauterine death. It causes decrease in size and weight of
placenta4. It may also cause infarcts within the placenta and fetal
death due to decreased blood flow5. Preeclampsia is the hypertensive
condition to the extent of 140/90 mmHg along with edema and proteinuria. It
occurs after 20th week of gestation6.
Eclampsia is condition in which preeclampsia is accompanied by the onset of
convulsions. Hypertension, eclampsia, preeclampsia, intrauterine growth
restriction can lead to preterm labor7.

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Gestational diabetes mellitus (GDM) is a condition in which
blood sugar level is increased and it occurs in the second part of the
pregnancy. Most women do not have hyperglycemia after delivery8. Babies
born to GDM mothers suffer from fetal macrosomia ( birth weight >4000g )9.

As
every perinatal outcome is associated with abnormal placenta and vice versa,
placenta provides information about child’s prenatal life. In this project gross
and histopathological changes in placentas of the common disorders of pregnancy
including pregnancy induced hypertension, eclampsia, preeclampsia, gestational
diabetes, anaemia, stillbirths, will be studied and compared with placentas of
normal pregnancies.

 

To study pathology (morphology and histology) of
placenta in medical disorders of pregnancy.
 To compare
pathological changes of medical disorders of pregnancy with the normal
placentas.

3.       To
establish possible correlation between placental abnormalities and outcome of
pregnancy.

4.       Changes
specific to some particular medical disorder will be observed and studied.

 

 

 

 

Present study  is a hospital based  prospective study which will be carried out at
Department of Pathology  in collaboration
with the Department of Obstetrics and Gynecology  of  Peoples 
College  Of  Medical 
Sciences & Research Centre, Bhopal over the span of given time
period.

 Placentas will be
collected just after the delivery which will comprise of placentas associated
with medical disorders of pregnancy and the normal placentas during Antenatal
period.
Detailed obstetric and medical history will be recorded and informed consent
will be obtained from all the patients.

The placentas with attached membranes and
umbilical cord will be collected soon after delivery, washed in phosphate
buffer saline to remove blood contamination, labeled, and then fixed with 10%  buffered formalin overnight. The blood clots will
be removed if present. Gross examination of  placenta would be done including :-

Length, width, thickness in cm
Weight
Shape
Length, diameter of umbilical cord
Knots in umbilical cord
Insertion, twists, knots in umbilical cord
Insertion, color, hematomas in membranes
Number of vessels and presence of masses,
thrombi, fibrin
Infarction at fetal surface
Calcification, infarction, strictures,
ulcers, hyper/hypocoiling, present of masses or other  abnormalities

  Sections
will be taken from umbilical cord, membrane, maternal surface of placenta and
fetal surface of placenta. For microscopic examination placental tissue will be
processed and 4µm thick sections would be obtained for histopathological
examination. Rehydration with ethanol series and staining with hematoxylin and
eosin (H) will be done. Analyses will be done by light microscopy. In
each placental slide. 10 smallest terminal villi be observed in 10 different
fields (magnification × 400). Microscopic examination will include examination
of following :-

Trophoblast abnormalities
Stromal abnormalities
Villous vessels abnormalities
Infarction
Calcification
Other abnormalities

Gross and microscopic findings will be then
listed and correlated with the obstetric history.

 

Keywords.

Eclampsia, Preeclampsia, PIH (Pregnancy Induced
Hypertension), GDM (Gestational Diabetes Mellitus), Placental insufficiency

 

This
study will help us in better understanding of the changes in placenta caused by
medical disorders of pregnancy and role of placenta in the etiology of those.
Proper differentiation of the changes specific to certain diseases would be
possible. By comparing the placenta associated with medical disorders of
pregnancy with placentas of normal pregnancy, we can have a better understanding
of pathology of such disorders and factors responsible for them. It can prove
to be of an utmost importance in improving management of subsequent pregnancies
by diagnosis of pregnancy related diseases that may have tendency of
reoccurrence or might be preventable and treatable. Placental studies can be
used to plan the future care for the mother and child.