Spectrum of morphological changes in the placenta of women with preeclampsia/eclampsia and correlation with neonatal morbidity.

Abstract

Background: Preeclampsia/eclampsia is a leading cause of maternal and perinatal mortality and morbidity; the prevailing theory is that it is a consequence of disordered placentation, with the resultant underperfusion of the placenta triggering the release of cytokines and vascular factors, which cause widespread endothelial damage. The objective of this study was to compare the gross and microscopic changes in the placentas of women with preeclampsia/eclampsia and neonatal outcome. Methodology: One hundred and forty-six (146) pregnant women were recruited; 73 were normotensive, while 73 were diagnosed with preeclampsia/eclampsia. The macroscopic and microscopic placental changes in the two groups were examined. Full-thickness sections were taken from the central areas and grossly abnormal areas. The sections were fixed in 10% neutral-buffered formalin and processed for Haematoxylin/Eosin, Masson’s trichrome, and Periodic Acid Schiff staining. The slides were reviewed to evaluate the pathologic changes and correlated with the birth weights and Apgar scores of the newborns. Results: 34%, 44%, and 22% of the women had preeclampsia without severe features, preeclampsia with severe features, and eclampsia, respectively. The placental weights were lower in the preeclampsia group compared to the control group. The major pathologic lesions with strong associations with preeclampsia/eclampsia were decidual vasculopathy, infarction, increased syncytial knots, accelerated villi maturity, stromal fibrosis, and microcalcifications. There was also a strong association between disease severity and Apgar scores in the 1st minute. The study group experienced an 11% neonatal mortality rate. Conclusion: There were distinct microscopic changes consistent with maternal vascular malperfusion changes in the placentas of mothers with preeclampsia/eclampsia and demonstrable neonatal morbidity depicted by a high incidence of preterm birth and low birth weights