ABSTRACT: 

Background:
Hypertension represents one of the most prevalent complications encountered during pregnancy, significantly contributing to both maternal and perinatal morbidity and mortality. The placenta, acting as a crucial feto-maternal organ, plays a pivotal role in sustaining pregnancy and fostering the healthy development of the fetus. Notably, the weight of the placenta holds functional importance, as it correlates with the villous surface area and fetal metabolism. Motivated by this context, the present study endeavors to examine the morphological and histological alterations in the placenta associated with hypertensive disorders of pregnancy and to assess their correlation with maternal and fetal outcomes.
Methods: A prospective investigation encompassing 120 cases was conducted, comprising 60 normotensive mothers (Group A) and 60 mothers with hypertensive disorders of pregnancy (Group B). Placental specimens obtained from these participants were subjected to morphological and histological analyses, with subsequent correlation with maternal and fetal outcomes.
Results: Our findings revealed a notable reduction in placental weight and dimensions within Group B compared to Group A. Histopathological examination unveiled a significant increase in the incidence of syncytial knots, fibrinoid necrosis, hyalinization, and calcification in placentas from the hypertensive group, directly correlating with neonatal complications. Furthermore, the mean neonatal birth weight was significantly higher in Group A compared to Group B.
Conclusion: Hypertensive disorders of pregnancy exert a substantial impact on placental morphology, leading to diminished weight and dimensions, indicative of placental insufficiency attributable to compromised utero-placental blood flow. These alterations ultimately influence neonatal weight and overall neonatal outcomes. Our study underscores the presence of distinct morphological changes in the placenta that detrimentally affect fetal growth.

KEYWORDS:

Hypertensive disorder of pregnancy, Fibrinoid necrosis, Syncytial knots, Placental insufficiency, Intrauterine growth restriction

REFERENCES :

1) Cunningham FG; Leveno KJ, Bloom SL., Spong CY, Dashe JS, Hoffman BL, Casey BM; Sheffield JS. Williams Obstetrics.
24th ed. New York: McGraw Hill Education Medical; 2014: 1508-1613.
2) Salmani D, Purushothaman S, Somashekara SC, Gnanagurudasan E, Kampli S, Harikishan R,
Venkateshwarareddy M. Study of structural changes in placenta in pregnancy-induced hypertension. J Nat Sci Biol Med. 2014; 5(2): 352–355.
3) Huppertz B. The critical role of abnormal trophoblast development in the etiology of preeclampsia. Current pharmaceutical biotechnology. 2018 Sep 1;19(10):771-80.
4) DeWolf F, Brosens I, Renaer M. Fetal growth retatdation and the maternal arterial supply of the human placenta in the absence of sustained hypertension. Br J Obstet Gynaecol 1980; 87:678.
5) Robertson WB, Brosens I, Dixon HG. The pathological response of the placental bed to hypertensive pregnancy. J Pathol Bacterial 1967; 93:581.
6) Giles W, Trudinger B, Cook C. Placental microvascular changes in twin pregnancies with abnormal umbilical artery waveforms. Obstet Gynecol 1993; 81:556.
7) Los FJ, DeWolf BT, Huisjes HJ. Raised maternal serum alpha fetoprotein levels and spontaneous fetomaternal transfusion. Lancet 1979; 2:1210.
8) Wallace K, Wells A, Bennett W. African-Americans, preeclampsia and future cardiovascular disease: is nitric oxide the missing link? Presented at the 29th Annual Meeting of the Society for MaternalFetal Medicine, 2009 Jan; 827: 26–31.
9) Gant NF, Chand S, Worley RJ. A clinical test useful for predicting the development of acute hypertension in pregnancy. Am J Obstet Gynecol 1974; 120:1.
10) Boyd PA, Scott A. Quantitative structural studies on human placenta associated with preeclampsia essential hypertension and intrauterine growth retardation. Br J Obstet Gynaecol. 1985; 92:714–21.
11) Mallik GB, Mirchandani JJ, Chitra S. Placenta in intrauterine growth retardation. J Obstet Gynaecol India .1979; 29: 805-10.
12) Nobis P, Das U. Placental morphology in hypertensive pregnancy. J Obstet Gynecol. 1991;41:166–9.
13) Bhatia A, Sharma SD, Jalnawalla SF, Sagreiya K. A comparative study of placental and foetal outcome. Indian J Pathol Microbiol. 1981;24:277–83. [PubMed: 7338404]
14) Cibils LA. The placenta and newborn infant with hypertension conditions. Am J Obstet Gynaecol. 1974; 118:256–70.
15) Teasdale F. Gestational changes in functional structure of the human placenta in relation to foetal growth. Am J Obstet. 1980;137:560–2. 58)Zacutti A, Borruto F, Bottacci G, Giannoni ML, Manzin A, Pallini M, et al. Umbilical blood flow and placental pathology. Clin Exp Obstet Gynaecol. 1992;19:63–9
16) Salmani D, Purushothaman S, Somashekara SC,
Gnanagurudasan E, Sumangaladevi K, Harikishan R, Venkateshwarareddy M. Study of structural changes in placenta in pregnancy-induced hypertension. J Nat Sci Biol Med. 2014 Jul;5(2):352-5.