PLACENTAL INSUFFICIENCY AS A RISK FACTOR FOR POST-TERM PREGNANCY
DOI:
https://doi.org/10.11603/24116-4944.2019.1.9871Keywords:
post-term pregnancy, placental insufficiency, risk factorsAbstract
The aim of the study – to investigate the morphology of the vessels of maternal and fetal part of placenta and its structural components under conditions of post-term pregnancy.
Materials and Methods. A dynamic observation of 15 pregnant women was conducted since their hospitalization till their discharge after delivery. Women were divided into 2 groups: the first group –10 women with a pregnancy ≥42+0 week; the second group – 5 women with a physiological course of pregnancy. Criteria for inclusion in the study: single-pregnancy, gestational age> 280 days, absence of severe extragenital pathology, post-term pregnancy in history. The placenta was taken after delivery, with further macroscopic and microscopic examination. The histological material was fixed in 4 % neutral formalin.
Results and Discussion. Our study of the morphofunctional features of the placenta during pregnancy showed destructive changes in the maternal part of the placenta, in particular, edema of the decidual cells, their apoptosis, lymphocyte infiltration, changes in the morphology of the vessel wall, especially endothelial cells, local fibrinoid detachment on the surface of the endometrium and, simultaneously, changes in the morphology of the villi of the chorion: detachment of syncytiotrofoblast, indicating a violation of components of the hematoplacental barrier, the formation of erythrocyte-leukocyte aggregates in blood capillaries of villi, which changes the microcirculation and transendothelial transport in maternal and the fetal part of the placenta.
Conclusion. Violation of microcirculation and transendothelial transport in the vessels of the microcirculatory bed of the maternal and fetal part of the placenta, that is manifested by the desolation of the vessels and their dilatation, by change in the morphology of the endothelium of their inner layer and destructive processes of the hemoplacental barrier, is a risk factor for post-term pregnancy, that negatively affects the condition of the fetus.
References
Yaremko, H.E., Zhabchenko, I.A., & Kovalenko, T.M. (2013). Suchasni aspekty problemy perenoshuvannia ta prolonhuvannia vahitnosti [Modern aspects of the problem of pregnancy transplantation and prolongation]. Zhinochyi likar – Female Doctor, (3), 5-9 [in Ukrainian].
Fedorova, M.V., & Smirnova, T.L. (2013). Immunogistokhimicheskie razlichiya platsent pri prolongirovannoy i istynno perenoshennoy beremennosti [Immunohistochemical differences
of the placenta with prolonged and true pregnancy]. Vestnik Chuvashskoho universiteta – Bulletin of Chuvash University, (3),560-563 [in Russian].
Markin, L.B., & Smutok, S.R. (2011). Dyferentsiiovanyi pidkhid do vedennia vahitnosti pislia 41-ho tyzhnia [Differentiated approach to pregnancy after the 41st week]. Meditsynskye aspekty zdorovya zhenshchiny – Medical Aspects of Women's Health, (2), 5-9 [in Ukrainian].
Markin, L.B., & Yashchenko, L.M. (2016). Kliniko-morfolohichni aspekty prolonhovanoi ta perenoshenoi vahitnosti [Clinical and morphological aspects of prolonged and long-term pregnancy]. Aktualni pytannia pediatrii akusherstva ta hinekolohii – Actual Questions of Pediatrics of Obstetrics and Gynecology, (1), 93-96 [in Ukrainian].
Benirschke, K., Burton, G.J., & Baergen, R.N. (2012). Pathology of the human placenta. 6th ed. Springer. DOI: https://doi.org/10.1007/978-3-642-23941-0
Olesen, A.W., Basso, O., & Olsen, J. (1999). An estimate of the tendency to repeat post-term delivery. Epidemiology, (10), 468-469. DOI: https://doi.org/10.1097/00001648-199907000-00026
Olesen, A.W., Basso, O., & Olsen, J. (2003). Risk of recurrence of prolonged pregnancy. Br. Med. J., (326), 476. DOI: https://doi.org/10.1136/bmj.326.7387.476
Mandruzzato, G., Alfirevic, Z., & Chervenak, F. (2010). Guidelines for the management of postterm pregnancy. J. Perinat. Med., 38 (2), 111-119. DOI: https://doi.org/10.1515/jpm.2010.057
Bennett, K.A., Crane, J.M., & Shea, P. (2004). First trimester ultrasound screening is effective in reducing postterm labor induction rates: a randomized controlled trial. Am. J. Obstet. Gynecol., (190), 1077-1081. DOI: https://doi.org/10.1016/j.ajog.2003.09.065
Guttmacher, A.E., Maddox, Y.T., & Spong, C.Y. (2014). The Human Placenta Project: placental structure, development, and function in real time. Placenta, (35), 303-304. DOI: https://doi.org/10.1016/j.placenta.2014.02.012
Galla, M., Symonds, I., Murray, H., Petraglia, F., & Smith, R.
(2012). Post-term pregnancy. Facts Views Vis., Obgyn., 4 (3), 175-187.
Morris, J.M., Thompson, K., & Smithey, J. (2003). The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: A prospective blinded observational study. BJOG, (110), 989-994. DOI: https://doi.org/10.1111/j.1471-0528.2003.02417.x
Kliman, H.J. (2000). Uteroplacental blood flow. The story of decidualization, menstruation, and trophoblast invasion. Am. J. Pathol., 157 (6), 1759. DOI: https://doi.org/10.1016/S0002-9440(10)64813-4
Baergen, R.N. (2011). Manual of pathology of the human placenta. Second Edition Foreword by Kurt Benirschke. DOI: https://doi.org/10.1007/978-1-4419-7494-5
Salafia, C., & Popek, E. (2008). Placental development and early pregnancy pathology. Glob. Libr. Women's Med. DOI 10.3843/GLOWM.10150. DOI: https://doi.org/10.3843/GLOWM.10150
Olesen, A.W., Westergaard, J.G., & Olsen, J. (2003). Perinatal and maternal complications related to postterm delivery. Am. J. Obstet. Gynecol., (189), 222-227. DOI: https://doi.org/10.1067/mob.2003.446
Milovanov, A.P. (1999). Patologiya sistemy mat-platsenta-plod [Pathology of mother-placenta-fetal system]. Moscow: Meditsyna [in Russian].
Davydenko, I.S. (2002). Mikroskopichna anatomiia khorialnoho dereva v zalezhnosti vid periodu hestatsii ta stupenia tiazhkosti anemii u vahitnykh [Microscopic anatomy of a choral tree depending on the period of gestation and severity of anemia in pregnant women]. Klininichna anatomiia ta operatyvna khirurhiia – Clinical Anatomy and Operative Surgery, 1 (1), 13-16 [in Ukrainian].
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
