ABSTRACT
Aims: To study the morphology and do the morphometric analysis of placenta and to correlate with the foetal parameters, in order to help in the assessment of the state of well being of foetus. To study the histomorphological features of placenta in various conditions complicating the pregnancy. Study Design: Descriptive type of study. Place and Duration of Study: Department of Pathology and Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College, Puducherry, between July 2013 and August 2013. Methodology: We included 51 fresh placentae. Gross examination including weight, shape, thickness, feto-placental ratio, placental co-efficient was calculated. Later, histo- morphological study was done. Results: Out of the 51 placentae, 48 were circular in shape and 3 were oval in shape. In the present study the mean (± SD) diameter of the placenta was 14.65 cm and thickness of the placenta was 1.42 cm. The thickness of placenta was reduced (<1.5cm) in all cases of Pregnancy induced hypertension (PIH), Isoimmunisation, twin pregnancy, prematurity and anemia. Placental weight was reduced in all cases of PIH, low birth weight baby, prematurity and Increased placental weight was seen in the gestational diabetes. Fetoplacental ratio was 5.39:1(both sexes considered together) and placental coefficient was 0.19. In PIH, the average foeto-placental ratio was 5.20:1and the average placental coefficient was 0.19. Gestational diabetes showed a foeto-placental ratio of 5.30:1, the placental coefficient being 0.18 with a considerable increase in the birth weight and in the placental weight. Anaemia showed a significant reduction in the placental weight, with a foeto-placental ratio of 5:1 and an increase in the number of ill-defined cotyledons. In prematurity, average foeto-placental ratio was 4.43:1, while Rh isoimmunisation did not show any decrease in the foeto- placental ratio. Conclusion: As anticipated, in case of PIH complicating pregnancies, the morphometric values of the placenta like the diameter, number of cotyledons and the average placental and foetal birth weights were found to be lower than that of the normal, uncomplicated pregnancies. At the same time, all these parameters were increased in cases of diabetes. So morphometric investigation of the placenta will be tremendously useful in the early assessment of placental insufficiency and also the state of foetal well being.
ABSTRACT
Introduction: Placenta “the vital organ” for maintaining healthy pregnancy is unique in its development, being derived from both mother and fetus. Thus hypertensive disorder affecting mother has a deleterious impact on placenta which may lead to poor fetal outcome. Aim: A cross-sectional descriptive study was undertaken to analyze and assess the morphological changes in hypertensive placentae and to clinically correlate it with fetal and maternal parameters. Materials and Methods: 50 placentae were freshly collected from pregnancy induced hypertension (PIH) cases (study group) and 50 from normal pregnancy (control group). Study group was divided into three categories depending upon severity of the disease. Observations and Results: 70% in study group were primigravida and were from rural area.46% were in age group of 15 – 20yrs.50% under low socio-economic status and 60% were without any regular antenatal checkup. Preterm, IUGR, still birth and neonatal death accounted to 10%, 12%, 18% and 10% respectively in study group. The average diameter, thickness, volume and number of cotyledons in study group were 15.91±2.11cm, 2.39±.54cm, 297.64±67.90ml and 10.02±4.13respectively. Mean placental weight was 376.41±17.198gm (mild PIH), 330.72±2.90gm (severe PIH), 329.73±3.19gm (eclampsia) and mean birth weight was 2680.29±198.46gm (mild PIH), 2212.06±36.41gm (severe PIH) and 2073.60±9.47gm (eclampsia) respectively in study group. Various pathological changes like retro placental hematoma, infarction and calcification had been noticed. Conclusion: Placental morphometric parameters were significantly reduced (<.001) in study group as compared to control group. Decreased placental weight was associated with reduced birth weight and feto-placental ratio with increase in severity of hypertension significantly (<.001). A significant increase (<.05) in incidence of preterm, IUGR, still birth and neonatal death were found in study group. Assessment of morphological changes and its clinical relevance can be correlated with transactional study so as to provide the safe confinement and reducing the fetal morbidity and mortality.