Morphological changes in placentas of normal and high risk pregnancies - 2 years study in MGM hospital

Background: Placenta-related disorders of pregnancy are almost unique to human species. These disorders, which affect around a third of pregnancies, primarily include miscarriage and pre-eclampsia. Aim and objectives: The aim of the present study was to examine the morphological changes in placentas of normal and high risk pregnancies, and to evaluate the fetal outcome in these cases, which in turn will improve the quality of placental diagnosis. The objectives were to know the extent of the gross and microscopic placental changes that occur in normal pregnancies and to study the placentas of high risk pregnancies. Materials and methods: A study of 132 placentas in normal and high risk pregnancies was conducted in the Department of Pathology, Kakatiya Medical College, MGM Hospital, Warangal, from 1st September 2014 to 31st August 2016. The materials included in this study were placentas from thirty females with normal pregnancies (controls) and one hundred thirteen with high risk pregnancies (cases) comprising anemia (27), pregnancy-induced hypertension (38), intrauterine growth retardation (15), diabetes mellitus (13), and twins (9). Results: In high risk cases, women in the age group 21-25 years were 66.6% in anemia, 60.5% in PIH, and 60% in IUGR 69.2% in diabetes mellitus, and 33.3% in twin pregnancies. Only a few cases were seen in the age group of 26-30 in both controls and cases. Seventy percent of the controls belonged to primigravida and 30% were multiparous women. In high risk cases, 66.6% were primigravida and 33.3% multipara. Majority of the multiparous mothers were seen in anemia constituting 48.1%. High risk cases exhibited exaggerated changes, except for calcification, which was seen equally in both the groups. Infarction was seen in 50% cases of PIH. Single case of retroplacental hematoma was also observed in PIH. Subchorionic fibrinoid was seen in 53.4% of IUGR placentas. Maternal floor infarction was seen in 4 cases of PIH and 3 cases of IUGR placentas. Subchorionic hematoma was seen in 1 case of IUGR placenta. IUGR placentas were small in size and weight for the gestational age and twin placentas were of diamniotic dichorionic type. The most prominent microscopic features were syncytiotrophoblastic knot formation and calcification. The high risk groups were showing prominent infarcts, fibrinoid necrosis, and stromal fibrosis more than those of control group. Conclusion: The present study has highlighted the importance of examination of placenta in normal as well as high risk pregnancies. The placental changes are essential to correlate the fetal outcome, as it provides the information for the cause of death. Hence, it has an effective role in planning prenatal monitoring of a future pregnancy.