Study the morphology and the morphometric measurements of placenta among normotensive and pregnancy-induced hypertension pregnancies

Abstract

Background: Placental pathology has undoubtedly received very little attention by both the obstetricians and pathologist. The various indications for placental examination are essentially any maternal disease or disorders of the infant or any other clinically accepted placental abnormality. The aim and objectives of the present study were study of the morphology, mophometry and site of umbilical cord insertion in the placenta of women with normal and PIH pregnancy and correlation of the changes observed in morphology, morphometric measurements and sites of umbilical cord insertion. Materials and Methods: The cases were then divided into two main groups: pregnancy cases without any complication or normal pregnancy (n=50) and pregnancy cases with PIH (n=50). Each group comprised of patients having known LMP (last menstrual period), EDD (expected date of delivery), blood pressure and gestational period ranging from 35 to 40 weeks. At labour room placentae were collected as fresh specimen after delivery and then examination was carried out in the following way: morphological and morphometrical. In the morphological study, following facts were kept in mind while examining the gross anatomical features of placenta like placental completeness, placental shape, placental consistency, placental parenchyma and umbilical cord insertion. For morphometric study: placental weight, volume, thickness, diameter, circumference, cord insertion percentage/site and area were noted. The diameter of placenta was measured with a measuring tape twice. The average of maximum and minimum diameter is the diameter of the placenta. Results: In the present study the mean placental weight seen in case of PIH pregnancy series was 486.9 ± 37.08 grams with a maximum weight of 566 grams and a minimum weight of 382 grams. In PIH case studies the maximum volume of placenta was 515 cc and minimum 302 cc with an average of 406.4 ± 36.77 cc. Maximum placental area was recorded in our studies was 249 sq.cc and minimum was 102.7 sq.cc, with an average of 172.5 ± 24.76 sq.cc. In our studies maximum thickness of placenta was observed 2.2 cm and minimum thickness was 0.9 cm with an average of 1.48 ± 0.15 cm. In our cases the maximum diameter was observed 17.8 cm and minimum was 10.8 cm with an average of 14.76 ± 0.33 cm. In this PIH case series the maximum placental circumference was 52.5 cm and minimum circumference was 31.6 cm with an average circumference was 45.66 ± 2.09 cm. In this study we found maximum ratio of 5.58 and minimum ratio of 4.2 with the average ratio of 4.65 ± 0.35. In normal pregnancy groups- 50 placentae were studied of which 16 (32%) had central type insertion, 14 (28%) had medial, 5 (10%) had lateral type and 165 (30%) had marginal type of cord insertion. In PIH pregnancy groups- 50 placentae were studied of which 19 (38%) had central type insertion, 11 (22%) had medial, 4 (8%) had lateral type and 16 (32%) had marginal type of cord insertion. Conclusion: In our study we found that hypertensive placentae tend to be slightly smaller in size, weight, volume, area, thickness, diameter, circumference and feto-placental ratio than normal placentae. Placenta undergoes different changes in weight, volume, structure, shape and function continuously throughout the gestation to support the prenatal life. Pregnancy complications like hypertension reflected macroscopically and microscopically in the placenta.