PLACENTAL PATHOLOGY IN INTRA UTERINE GROWTH RETARDATION

Abstract

The placental development is an essential step in developing effective strategies or the prediction of various maternal and fetal medical and developmental problems. Oxygen transfer and nutrients to the fetus will be actively regulated by the placenta. AIM AND OBJECTIVE: To study morphological changes of placenta in Intrauterine growth Retardation and to correlate morphological changes of placenta with fetal outcome. MATERIALS AND METHODS: Placental tissue samples were obtained from 50 pregnancies complicated by IUGR and 50 normal uncomplicated pregnancies with gestational age between 28 to 42 weeks attending King George hospital Visakhapatnam. INCLUSIVE CRITERIA: An IUGR fetuses whose estimated fetal weight less than those in 10 th percentile are included in the study. Birth weight percentiles were determined by previously published normal curves. EXCLUSIVE CRITERIA: fetuses with known syndromes, chromosomal anomalies and twins. For all patients included in the data set gestational age was estimated from the last menstrual period or early ultra-sonogram before the 12 th week of gestation. The final data set was composed of 50pregnancies complicated by IUGR and APGAR scores. Because preeclampsia is an important maternal factor associated with IUGR, these cases were further divided into two subgroups according to presence of hypertension. Samples were taken both from vaginal deliveries and caesarean sections. All the placentas were examined by pathologists. The placentas were weighed. For each case one or two samples from the umbilical cords, extra placental membrane, and parenchyma were taken. Gross pathological findings were confirmed by histology. Histological data included are ischemic necrosis, decidual vascularity, acute chorioamnionitis, fibrinoid necrosis and choriangiosis. Appropriate statistical parameters were used. Chi-square test was conducted to compare placental pathological changes between case and control groups. RESULTS: In current study, 60% of the cases are with IUGR due to Hypertensive disorders and 40% are normotensives and 50 women with appropriate for gestational age in control group. Hypertensive IUGR cases were delivered at preterm than appropriate for gestational age and normotensive IUGR group. The birth weights are lower in hypertensive group compared to those of AGA and normotensive group [Pvalue 0. 9] Most of the cases with IUGR are primi gravida. The fetal outcome in women with appropriate for gestational age is good whereas with IUGR the fetal outcome is poor. Incidence of intrauterine deaths, stillbirths, perinatal deaths and babies with low apgar are more in hypertensive group when compared normotensive IUGR group [p value0. 8]. 40% of the babies with hypertensive IUGR were delivered by caesarean operation [p value 0.147]. Mean placental weights were lower in IUGR group when compared to AGA group. But no significant change in thickness of placenta. Incidence of placental infarction and retroplacental haematoma was more in IUGR group when compared to AGA group[p value 0. 2] Out of 19 cases of bad perinatal outcome 10 cases had feature of ischemic necrosis (pvalue-o. oo5) and placental infarcts (p value o. ooo1) had significantly associated with bad perinatal outcome CONCLUSION: the abnormal uteroplacental vasculature, chronic uteroplacental insufficiency coagulation pathology in uteroplacental, intervillous and fetoplacental vasculature and