• Placental Pathomorphological Peculiarities in Parturient Women with the History of Endocrine Infertility

Placental Pathomorphological Peculiarities in Parturient Women with the History of Endocrine Infertility

PERINATOLOGIYA I PEDIATRIYA. 2017.2(70):84-90; doi 10.15574/PP.2017.70.84

Zadorozhna T. D., Tumanova L. E., Kolomiets О. V., Kylyhevych S. М., Stratiychuk H. H.
SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv

Objective — to conduct a morphological and morphometric analysis of the placental villous and chorionic structures in parturient women with the history of endocrine infertility, which is important for clarifying the pathogenetic mechanisms of placental dysfunction development.

Materials and methods. The study comprised the parturient women (n=34) with the history of endocrine infertility, which was provided with medical assistance during the period of 2015-2016 on the basis of the Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine. The research of placental structural and functional features included organometric, macroscopic, general histological methods. In total 34 placentas were investigated, 28 of which with hyperandrogenism were included in the 1st group; 6 placentas with hyperprolactinemia formed the 2nd group, and the 3rd (control) group was comprised of 10 placentas of parturient women who became pregnant naturally. The obtained morphological data compared with the control group indicated the placental dysfunction in parturient women of the 1st and 2nd groups.

Results. The critical impaired circulation was detected in the villi of all calibres of syncytiotrophoblast in both groups under investigation (the 1st and 2nd ones). In the 1st group, the changes were diffusive in all structures of both the maternal and the fetal surfaces. The most pronounced changes were observed in the placenta with a reduced mass: an increased number of infarctions, fibrosis of the villous chorion, and circulatory disturbances. In the 2nd group, the pathological changes prevailed in the decidual membrane: destructive changes, apoptosis and necrosis in structural cells and stroma of the decidual membrane. In the chorionic villi of the 2nd group, especially in the terminal ones, there was an increase in stromal fibrosis up to 90%.

Conclusions. Based on the performed morphological and morphometric placental analysis in the parturient women with hyperandrogenism and hyperprolactinemia before pregnancy, the important features of the development of placental dysfunction were revealed. The latter is known to be the main cause of antenatal developmental disturbances and fetal distress. It is interesting to know that in women with the history of endocrine infertility, the pathological changes in the placental villous and chorionic structures play a leading role in disturbing the endocrine function of placenta, in particular, in chorionic gonadotrophin, placental lactogen, etc. synthesis.

Key words: morphology and morphometry of placenta, pregnancy, a past medical history of endocrine infertility.

1. Antypkin YuH, Zadorozhna TD, Parnytska OI. (2016). Patolohiia platsenty (suchasni aspekty). Kyiv, DU «IPAH NAMN Ukrainy»: 124.

2. Ancheva IA. (2014). Patomorfolohichnyi substrat prohresuvannia dysfunktsiii platsenty u vahitnykh z proiavamy sydoropenichnoho syndromu. Visnyk morfolohii. 2; 20: 406—409.

3. Barinova IV, Kotov YuB. (2013). Sravnitelnyie aspektyi patogeneza fetoplatsentarnoy nedostatochnosti s antenatalnoy gibelyu ploda i s rozhdeniem zhivogo novorozhdennogo. Ross vestnik akushera-ginekologa. 4: 22—26.

4. Kulakov VI. (2005). Lechenie zhenskogo i muzhskogo besplodiya. Pod red VI Kulakova, BV Leonova, LN Kuzmicheva. Moskva, Med inf agentstvo: 592.

5. Milovanov AP. (1999). Patologiya sistemyi mat — platsenta — plod: rukovodstvo dlya vrachey. Moskva, Meditsina: 448.

6. Mintser OP, Voronenko YuV, Vlasov VV. (2003). Obroblennia klinichnykh i eksperymentalnykh danykh u medytsyni. Navch posibnyk. Kyiv, Vyshcha shkola: 350.

7. Zadorozhna TD, Tumanova LIe, Bannikov VI, Yeshchenko OI. (2008). Morfolohichni ta imunohistokhimichni osoblyvosti struktur platsent vid zhinok z EKZ. Svit medytsyny ta biolohii. 2: 94—96.

8. Davyidova IV, Zadorozhnaya TD, Butenko LP et al. (2016). Profilaktika gipoksicheskih fetalnih osloneniy u beremennyih s vrozhdennyimi porokami serdtsa i anemiey. Perinatologiya i pediatriya. 2(66): 43—47.

9. Sidelnikova VM. (2009). Endokrinologiya beremennosti v norme i pri patologi. Moskva, Medpress-inform: 351.

10. Bates GWJr, Ginsburg ES. (2002). Early pregnancy loss in in vitro fertilization (IVF) is a positive predictor of subsequent IVF success. Fertil Steril. 2: 337—341. https://doi.org/10.1016/S0015-0282(01)02988-0

11. Ramirez-Volez R, Bustamante J, Czerniczyniec A et al. (2013). Effect of exercise training on Enos expression, NO production and oxygen metabolism in human placenta. PLoS One. 8(11): е80225.

12. Longtine MS, Nelson DM. (2011). Placental dysfunction and fetal programming: the importance of placental size, shape, histopathology, and molecular composition. Semin Reprod Med. 29(3): 187—196. https://doi.org/10.1055/s-0031-1275515; PMid:21710395 PMCid:PMC3682832

13. Carolyn JP, Jones AM, Carter WR, Wilsher AAS. (2016). Morphology, histochemistry and glycosylation of the placenta and associated tissues in the European hedgehog (Erinaceus europaeus). Placenta. 48: 1—12. https://doi.org/10.1016/j.placenta.2016.09.010; PMid:27871459

14. Bukovsky A, Caudle MR, Cekanova M et al. (2003). Placental expression of estrogen receptor beta and its hormone binding variant comparison with estrogen receptor alpha and a role for estrogen receptors in asymmetric division and differentiation of estrogen-dependent cells. Reprod Biol Endocrinol. 1: 36. https://doi.org/10.1186/1477-7827-1-13; https://doi.org/10.1186/1477-7827-1-46; https://doi.org/10.1186/1477-7827-1-56; https://doi.org/10.1186/1477-7827-1-1; https://doi.org/10.1186/1477-7827-1-36; PMid:12740031 PMCid:PMC155643

15. Nijman AJT, van Vliet OGE, Benders JNM. (2016, Oct 13). Placental histology in spontaneous and indicated preterm birth: A case control study. Placenta. 56—62. https://doi.org/10.1016/j.placenta.2016.10.006; PMid:27871473

16. Baschat AA, Cosmi E, Bilardo CM et al. (2007). Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol. 109; 2; Pt 1: 253—261. https://doi.org/10.1097/01.AOG.0000253215.79121.75; PMid:17267821

17. Stanek J, Biesiada J, Trzeszcz M. (2014). Clinicoplacental phenotypes vary with gestational age: an analysis by classical and clustering methods. Acta Obst Gynecol Scand. 93(4): 392—398. https://doi.org/10.1111/aogs.12350; PMid:24506140

18. Zegers-Hochshild F, Nygren KG. (2006). The International Committee Monitoring Assisted Reproductive Technologies (ICMART) glossary on ART terminology. Fertil Steril. 86; 1: 16—19. https://doi.org/10.1016/j.fertnstert.2006.04.018; PMid:16762350

Содержание журнала Full text of article