Morphological Features of Placenta from Pregnant Women with Placental Dysfunction due to Diabetes Mellitus

Abstract

The purpose of the study was to conduct a comparative analysis of morphological examination of the placenta depending on the type of diabetes in pregnant women with placental dysfunction. Materials and methods. To analyze the morphological changes of the placenta in pregnant women with various forms of diabetes, 50 placentas were studied. The age of patients ranged from 22 to 39 years. All placentas were divided into three groups according to the objectives of the study: group I – 20 placentas, after childbirth in women with pre-gestational diabetes; group II – 20 placentas, after childbirth in women with gestational diabetes; group III (control) – 10 placentas, after childbirth in women with physiological course of pregnancy. The presence of placental dysfunction in pregnant women was determined using ultrasound and Doppler examination of the fetoplacental complex, the data of hormonal and immunological studies. After delivery, the placentas were weighed, thickness and diameter were measured, an external evaluation was carried out, attention was paid to the presence of infarctions, the development of connective tissue, the number of cotyledons, and the features of umbilical cord attachment. In histological preparations, the diameter of villi, the number of capillaries, syncytial nodules, the number of capillaries in villi were calculated, focusing on the methods described for assessing the placentas in diabetes mellitus. Results and discussion. Macroscopic examination in the control group showed that 90% of placentas did not have pathological changes, cotyledons were clearly separated, umbilical cord discharge in 7 placentas was central; infarctions and thinning of some cotyledons were visualized in 1 (10%) placenta. Macroscopic examination of the placentas of women with pre-gestational diabetes showed increased weight compared to the control group (748.8±48.5 g versus 643.2±57.0 g, p <0.05) and diameter (25.5±2.3 cm versus 22.8±2.1, p> 0.05) of placentas, which is a characteristic manifestation of diabetic pathology. The average number of cotyledons also differed significantly from the indicators of the control group (12.8±3.2 and 9.3±1.2, respectively, p <0.05). The number of visible infarctions and thinning of individual cotyledons of the placentas did not exceed 20%. Macroscopic examination of the placentas after childbirth in women with gestational diabetes revealed changes similar to group I, but less pronounced: the weight of the placenta was significantly higher compared to the control group (720.2±20.5 and 643.2±57.0, respectively, p <0.05), the number of cotyledons exceeded the control indicators, but this difference was not significant, and the number of infarctions and thickenings did not differ from the control group. Conclusion. Morphological examination of the placentas revealed typical changes for diabetes, which are the result of hypoxia and prolonged dyscirculation: an increase in weight, placenta size, the number of cotyledons at the macroscopic level. Microscopic examination revealed an increase in villi, vessels in villi, thinning of the placental barrier, fibrinoid deposition. The changes were more pronounced in placentas obtained after childbirth in women with pre-gestational diabetes, which is a more severe pathology. Stimulation of childbirth led to minor dyscirculatory disorders in some placentas (vasodilation and plethora)