Abstract
Background
Preeclampsia/eclampsia is a leading cause of maternal and perinatal mortality; the prevailing theory is that it is a consequence of disordered placentation with the resultant underperfusion of the placenta triggering release of cytokines and vascular factors which cause widespread endothelial damage. The placental changes are manifested as vascular and villous abnormalities with consequences in the developing foetus. The objective of this study was to compare the gross and microscopic changes in the placentas of women with preeclampsia/eclampsia and healthy mothers.
Methods
146 pregnant women were recruited; 73 were normotensive (control group) while 73 were diagnosed with preeclampsia/eclampsia (study group). The macroscopic and microscopic placental changes in the two groups were further examined.
Results
34% of the women in the study group had mild-moderate preeclampsia, 44% had severe preeclampsia and 22% had eclampsia. The placental weights were lower in the study group than the controls (556.82 grams ± 169.72 vs. 649.93 grams ± 116.38, p < 0.001). The major pathologic lesions with strong associations with preeclampsia/eclampsia in this study were decidual vasculopathy, infarction, increased syncytial knots (Tenney-Parker changes), accelerated villi maturity, stromal fibrosis and microcalcifications (p < 0.001). There was also a strong association between disease severity and Apgar scores in the 1st minute. The study group had 11% neonatal mortality.
Conclusion
There were distinct microscopic changes consistent with maternal vascular malperfusion changes in the placentas of mothers with preeclampsia/eclampsia and demonstrable neonatal morbidity depicted by high incidence of preterm birth and low birth weights.