Placenta Hypertension, eclampsia, preeclampsia, intrauterine growth restriction can lead

Placenta
connects 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
major reason 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, and it may result into
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

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convulsions. Hypertension, eclampsia, preeclampsia,
intrauterine growth restriction can lead to preterm labor7.

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

Outcome
of pregnancy and abnormalities in placenta are closely related with each other.
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, 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&E) will be done and analyzed 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.

 

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.

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