RESUMEN
Para evaluar el desarrollo de la vellosidad de anclaje, en desórdenes hipertensivos del embarazo, asociados con desprendimiento prematuro grave de placenta normoinserta (DPGPN), en el laboratorio de microscopía electrónica de la Facultad de Ciencias de la Salud. Universidad de Carabobo se examinaron 20 placentas, 17 con desórdenes hipertensivos y tres de embarazos normales, en el tercer trimestre, aplicándose protocolo con las variables que determinan tipos de vellosidades según su desarrollo y cambios degenerativos encontrados con microscopía de luz. Se encontró 91% de vellosidad troncal, 92% de intermedia madura, 28% de intermedia inmadura, 47% de terminales, 92% con membrana vásculosincitial periférica y 44% de membrana vásculosincitial central y notables cambios degenerativos como cambios fibrinoides en el 100%, igual la necrosis del trofoblasto, 96% de fibrosis estromal, 88% de edema y 74% de hemorragia; además 92% de trombosis, congestión vascular y cambios de la pared del vaso y más de seis vasos en las vellosidades en 52%. El espacio íntervelloso tiene importantes cambios como los depósitos de fibrina en 84%, la trombosis íntervellosa en 76% y los infartos en 56%, estos cambios degenerativos son estadísticamente significativos. Conclusión: un acelerado crecimiento de la vellosidad empotrada en la placa basal o cercana a ella se evidencia en los resultados con simultáneos procesos indicativos de degeneración y desarrollo anormal en un ambiente de daño velloso hipóxico extenso.
To evaluate the development of placental anchoring villi of the basal plate in hypertensive disorders of pregnancy associated with abruption placentae severe. Twenty placentas were examined. Seventeen patients with hypertensive disorders and three of normal pregnancy during the third trimester of gestation applying a protocol in order to determine types of villi according to their development and degenerative changes found with light microscopy. We found 91% of stem villi, 92% of intermediate mature villi, 28% of intermediate immature villi, 47% of terminal villi, 92% with peripheral and 44% vascular sincitial membrane and 44% central vascular sincitial membrane also remarkable degenerative changes, as fibrinoide deposits and trophoblastic necrosis in 100%, fibrous stroma 96%, edema 88% and hemorrhage 74%; moreover 92% off thrombosis, vascular congestion and changes vessel wall and mayor six vessel in 52%. Intervellous space have important changes as fibrin deposits in 84%, intervellous thrombosis 76% and intervellous attach 56%. All degenerative changes are statistically significant. Conclusion: An accelerated development of placental anchor villi or of other villous types near to basal plate were seen with simultaneous processes indicative of degeneration as extensive hypoxic villous damage and abnormal development.
RESUMEN
Objective To study the clinical characteristics, the outcome of pregnancy and the risk factors of uteroplacental apoplexy complicating severe placental abruption. Methods A retropectively study of the 52 cases of placental abruption who had delivered in our hospital from Jan. 2002 to Dec. 2006 was conducted. These cases were divided into 2 groups: 17 cases of uteroplacental apoplexy complicating placental abruption as observation group, the others with no uteroplacental apoplexy as control group. The risk factors of disease, clinical characteristics and the outcome of pregnancy between the two groups were compared. Results (1)The incidence of placental abruption was 0. 15% (52/35 049) among the total deliveries patients with uteroplacental apoplexy complicating placental abruption took up 0. 05% (17/35 049) of all deliveries and 33% (17/52) of all abruption cases. (2) General information and delivery : There were no significant differences ( P > 0. 05 ) regarding their mean age and BMI in two groups. All women in observation group had C-section delivery, which were 21 in control group. 14 women had vaginal delivery. The incidence of premature labour was 88% ( 15/17 ) in observation group, and 49% (17/35 ) women in control group delivered after 37 weeks. Significant differences were observed regarding delivery methods and gestational weeks(P <0. 01 ). (3)Risk factors: the incidence of preeclampsia, 71% (12/17), and the duration of disease, 6. 4 hours, in observation group were more than those in control group, 20% (7/35) and 4. 2 hours( P < 0.01 ). There were no significant differences between two groups in premature rupture, polyhydroamnions ( P > 0. 05 ). (4) Clinical characteristics in two groups : bloody amniotic fluid, fetal distress, hematometra and postpartum hemorrhage occurred in 82% (14/17) vs 26% (9/35), 65%(11/17) vs 29% (10/35), 35% (6/17) vs 6% (2/35), and 59% (10/17) vs 11% (4/35), with a significant difference (P <0. 01), but no statistical difference existed between indices such as abdominal pain, vaginal bleeding and abdominal tension ( P > 0. 05 ). (5) Placenta sites and abruption areas: placenta sites were distributed from anterior or posterior of uterine body 5/17 vs 24/35 , the fundus or cornu of uterus 12/17 vs 11/35 ( P < 0. 01 ). All cases in observation group presented abruption areas> 1/3, and 9 cases ≥2/3, 27 cases abruption areas < 1/3 and 8 cases abruption areas 1/3 -2/3 in control group (P<0.01). (6) Other complications and outcome: Hemorrhagic shock 3 vs 0, DIC 3 vs 0, hysterectomy 1 vs 0, intrauterine fetal death 3 vs 2, neonatal asphyxia 8 vs 5 and neonatal death 1 vs 0. There were significant differences ( P < 0. 01 ) between the two groups. Conclusions Preeclampsia, long duration of disease and fundal or cornual placenta a risk factors for uteroplacental apoplexy complicating placental abruption, which may lead to a poor maternal-fetal prognosis.