Romero GG, Velásquez MHA, Méndez SP, Horna LA, Cortés SP, Ponce PAL

Language: Spanish
References: 16
Page: 673-678
PDF size: 244.32 Kb.

ABSTRACT

Background: Preeclampsia develops after a partial disorder in the process of placental formation, perhaps due to a deficiency of the trophoblast invasion by its spiral arteries and acute aterosis in its miometrial segments. It has not been reported if these changes also appear in placentas of women with gestational hypertension without proteinuria.
Objective: To describe histopathological changes in the placenta of patients with hypertensive disorders during pregnancy.
Material and methods: Cross-sectional study carried out in 138 patients divided into three groups: 46 with normotensive pregnancy (A group or control), 46 with gestational hypertension (group B), and 46 with preeclampsia (group C). There were registered sociodemographic and clinical variables; and the histopathological study of the placenta was performed. Mean, standard error and percentages were used. We calculated analysis of variance for comparing groups and linear regression for determining correlation between histopathological changes and blood pressure (it was assigned an α value of 0.05).
Results: There were more histopathological changes in groups of gestational hypertension and preeclampsia compared with controls (p ‹ 0.01). Most frequent changes in all groups were: sincitial hyperplasia and fibrin deposits around the villi. There was correlation between histopathological changes and blood pressure (r = 0.27, p ‹ 0.01).
Conclusion: There are more histopathological changes in placentas of women with hypertensive disease; number of histopathological changes is correlated with the severity of hypertension.

REFERENCES

1. Soma H, Yoshida K, Mukaida T, Tabuchi Y. Morphologic changes in the hypertensive placenta. Contrib Gynecol Obstet 1982;9:58-75.

2. Leung DN, Smith SC, Sahota DS, Baker PN. Increased placental apoptosis in pregnancies complicated by preeclampsia. Am J Obstet Gynecol 2001;184:1249-50.

3. Stanek J, Al-Ahmadie HA. Laminar necrosis of placental membranes: a histological sign of uteroplacental hypoxia. Pediatr Dev Pathol 2005;8:32-42.

4. Tjoa ML, Oudejans CB, van Vugt JM, Blankesntein MA, van Wijk IJ. Markers of presymptomatic prediction of preeclampsia and intrauterine growth restriction. Hypertens Pregnancy 2004;23:171-89.

5. Austgulen R, Isaksen CV, Chedwick L, Romundstad P, et al. Pre-eclampsia: associated with increased syncytial apoptosis when the infant is small-for-gestational-age. J Reprod Inmunol 2004;61:39-50.

6. Cortés H, Muñoz H. Utilidad clínica del estudio anatomopatológico de la placenta en el Hospital Universitario San Vicente de Paúl. Rev Colomb Obstet Ginecol 2007;58:60-64.

7. Zhang P, Schmidt M, Cook L. Maternal vasculopathy and histologic diagnosis of preeclampsia: poor correlation of histologic changes and clinical manifestation. Am J Obstet Gynecol 2006;194:1050-6.

8. Silvera ALA, Manjarrez C, Peñuela ME, Villalba DH y col. Caracterización anatomohisto-patológica de la placenta y correlación clínica en la enfermedad hipertensiva inducida por el embarazo en pacientes de Barranquilla (Colombia). Salud Uninorte. Barranquilla (Col.) 2005;21:41-54.

9. Coelho TM, Sass N, Camano L, Moron AF, et al. Microvessel density in the placental bed among preeclampsia patients. Sao Paulo Med J 2006;124:96-100.

10. Moldenhauer JS, Stanek J, Warshak C, Khoury J, Sibai B. The frequency and severity of placental findings in women with preeclampsia are gestational age dependent. Am J Obstet Gynecol 2003;189:1173-7.

11. Bdolah Y, Lam C, Rajakumar A, Shivalingappa V, et al. Twin pregnancy and the risk of preeclampsia: bigger placenta or relative ischemia? Am J Obstet Gynecol 2008;198:428,e1-6.

12. Dokras A, Hoffmann DS, Eastvold JS, Kienzle MF, et al. Severe feto-placental abnormalities precede the onset of hypertension and proteinuria in a mouse model of preeclampsia. Biol Reprod 2006;75:899-907.

13. Centlow M, Carninci P, Nemeth K, Mezey E, et al. Placental expression profiling in preeclampsia: local overproduction of hemoglobin may drive pathological changes. Fertil Steril 2007; Dec 29 (Epub ahead of print).

14. Than NG, Erz O, Wildman DE, Tarca AL, et al. Severe preeclampsia is characterized by increased placental expression of galectin-1. J Matern Fetal Neonatal Med 2008;21:429-42.

15. Maly A, Goshen G, Sela J, Pinelis A, et al. Histomorphometric study of placenta villi vascular volume in toxemia and diabetes. Hum Pathol 2005;36:1074-9.

16. Correa RR, Gilio DB, Cavellani CL, Paschoini MC, et al. Placental morphometrical and histopathology changes in the different clinical presentations of hypertensive syndromes in pregnancy. Arch Gynecol Obstet 2008;277:201-6.