Shernik I.A., Lim A.I.

Kazakh National medical university named after S.D. Asfendiyarov, Almaty city

Morphology of placenta in women with preeclampsia at the term of gestation of 22-28 weeks

Placenta is the main organ, providing processes of adequate exchange between mother and fetus’ organisms. During pathological course of pregnancy placenta undergoes morphological violations which result in its insufficiency [1,2,3,4]. Placental insufficiency (PI) is a cause of intrauterine development delay of fetus, intrauterine hypotrophy and hypoxia and also its intrauterine death [5,6,7]. In gestosis pathomorphological picture of placenta is characterized by degenerative-dystrophic violations, impairment of uterine-placental and feto-placental blood circulation, signs of villi maturing disorders. There was marked the lowering of organometric parameters of placenta [8,5,6].

Material for study included 30 placentae at the term of gestation of 22-28 weeks of pregnancy.

The average age of women was 29,3±6,7 years, besides there were pregnant women for the second time (70,8%). Delivery was performed by induction of labor by intraamnial introduction of hypertonic solution or by itself. 50% of pregnant women were not examined. Anemia, acute respiratory viral infections, threaten of pregnancy interruption occurred in 20,9% of cases. In a half of cases there was burden obstetrical anamnesis. All placentae were divided into 2 subgroups according to gradual stage of development [6].

Table 1. Organometric indices of placentae at the term of gestation of 22-28 weeks.

Studied subgroups	I st subgroups (22-24 weeks)	II nd subgroups (25-28 weeks)
Number of studies	(n=15) (M±m)	(n=15) (M±m)
Mass of placenta	159,2±19,08	153,5±38,5
Mass of fetus	658,5±108,8	739,7±54,4
Square of placenta	138,9±28,6	126,5±36,5
Volume of placenta	118±21,3	142,5±36,2
Placental-fetal coefficient (PFC)	0,26±0,05	0,19±0,05

The studied placentae had rounded or oval forms in 83,3% of cases, incorrect form of placentae occurred in 16,7% of cases. Fetal surface was of grayish-blue colour, in most cases it was dim and with tint of yellow. In 30% of cases there were marked abnormalities such as accessorial lobes, thin border, roller, focal indurations of whitish-yeloow colour sized from 0,5x1,0 cm to 1,5x2,0 cm occurred frequently. Vessels of fetal surface had magistral type of branching in 13,3% of cases and diffuse one – 86,7% of cases. Abnormal type of umbilicus fixation (marginal) occurred in 26,7% of cases, but in the rest cases (73,3%) there were observed the central and intermediate types of fixation. Multiple whitish-yellow foci of induration sized from 0,5x0,5 cm to 2,5x3,0 cm occurred frequently on the maternal surface.

Table 2. Macroscopic characteristics of placenta at the term of gestation of 22-28 weeks

	Number of studies
Indices	(n=30) (M±m)
Form of placenta
Rounded	15 (50%)
Oval	10 (33,3%)
Incorrect	5 (16,7%)
Umbilicus fixation
Central	13 (43,3%)
Intermediate	9 (30%)
Marginal	8 (26,7%)
Type of vessels’ branching
Diffuse	26 (86,7%)
Magistral	4 (13,3%)
Abnormalities of development
Thin border, roller	8 (26,7)
Focal indurations foci	16 (53,3%)
Accessorial lobes	1 (3,3%)

On microscopic study analysis of the obtained data showed that in all cases there was impairment of uterine-placental blood circulation as presence of vast foci of afunctional parenchyma in the form of vera or spurious infarctions. The cause of vera infarctions of placentae parenchima was trombosis of vessels of supporting villi part and also the marked spasm of vessels of these villi. Besides there was marked the exceeded deposit of fibrinoid mass in intervillous space, covering groups of villi. Intervillous space was narrowed due to the nearest location of chorion’s villi, foci of bleedings and also presence of inflammatory infiltration. In women with preeclampsia there frequently occurred incomplete gestational reconstruction of spiral arteries of endometrium in placentae (52,3%). The structure of villous chorion in parts of placentae corresponded to that in norm which occurs in preeclampsia according to the data of literature. In some observations there was presence of a large number of intermediately unmatured chorion’s villi that term hadn’t to be observed at that term of gestation, at which intermediate matured villi had to be prevalent type of villi. Vascular component was marked irregularly, there was impairment of placental-fetal blood circulation, i.e. areas of hypovascularisation of villi combined with foci of angiomatosis. Venous vessels were paretically enlarged, that is the evidence of intrauterine fetal hypoxia, which was compensated by development of single syncytiocapillary membrane, a large number of syncytial nodes being frequently functionally inactive. In all cases there marked the presence of inflammatory process of focal, focal-diffuse character, frequently spereading on all structural components of purulent placentitis, membranitis. Focal inflammatory process occurred in 25% of cases, focal-diffuse character of inflammation – in 75% of cases. Dystrophic violatios were noted in all cases, only differing by degree of process markuess.

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