Romanian Biotechnological Letters Vol. 15, No.3, 2010, Supplement Copyright © 2010 University of Bucharest Printed in Romania. All rights reserved

ORIGINAL PAPER

70

Positive correlation for decidual ischemic transformation in premature birth placenta

Received for publication, March 26, 2010

Accepted, May 19, 2010

CHIRCOR LIDIA, COJOCARU MIRELA Anatomy-Embryology Department of the Medicine Faculty, ’’Ovidius’’ University of Constanţa, Romania corresponding author address: Lidia Chircor Bdul Mamaia Nr. 66, Bl. LD5b, Ap 16, Constanta, Romania, Phone: 0723 994051 e-mail: lidia_chircor@yahoo.com

Abstract The increased incidence of the premature newborn (1) and premature mortality oblige to

sustained research of the placenta. The authors wish to explore possible the hypothesis that abnormal microscopical morphology of the placenta is seen more frequently in cases of premature new-born placenta. The study concernes 1360 premature birth registered at the Constanta Clinic County Hospital in the last four years 2006 – 2009, 12 consecutive preterm deliveries’ placenta of premature newborn with gestational age 28-32 weeks (premature group) and 20 placentas from consecutive normal weight newborn babies delivered at term (control group). The macroscopic examination of the placenta reveals significant statistic smaller size and weight of the premature newborn placenta. Posterior located placenta and III degree maturation placenta characterize the premature group. The premature newborn group present loose shine, friable and less consistent placenta than the control group

The placenta of the premature group is characterized by degenerative circulatory and inflammatory pathologic process. The chorionic villi present hyaline and fibrin dystrophy accompanied by angiomatosis and necrosis. Histologic examinations of the the placental reveals positive correlation for decidual ischemic transformation in premature bitrth. Diffuse decidual necrosis of the decidua basalis is relatively common in placentas of 23-32 week newborns. The acute, diffuse ischemic transformation of the chorion reflect the diminuation of the utero-placentar blood flow.

Keywords: preterm birth, placenta morphology, decidual ischemic transformation Introduction

Preterm birth range from 5% to 13% of deliveries in developed countries (FAYE-

PETERSEN O.M. [1] The increased incidence of the premature newborn and premature mortality oblige to sustained research of the placenta trophoblast changes.

The authors wish to explores the hypothesis that abnormal microscopical morphology of the placenta is seen more frequently in cases of premature new-born placenta than in control placentas, at Constanţa Clinical County Hospital in the last decades. Material and Method

The retrospective study concerne 1360 premature birth registered at the Constanta

Clinic County Hospital in the last four years 2006 – 2009. 12 consecutive preterm deliveries’ placenta of premature newborn with gestational age 28-32 weeks (premature group) and 20 placentas from consecutive normal weight newborn babies delivered at term (control group) registered at the Constanta County Clinic Hospital during 2009.

The processing of the material was made using the anamnesis and clinic exam, the esstimation of the fertilization age, gestational age, Sonographic evaluation of the placenta

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and fetal development Placenta’s macroscopic study including insertion, external aspect of fetal and maternal face, consistence, integrity, dimensions, central and peripheral height and weight. Placental histology was studied to identify the presence of inflammatory states (such as chorioamnionitis and deciduitis), necrosis, angiomatosis, fibrine depot etc. All data were analyzed using independent t tests.

Results and Discussions

The morphological evaluation of the placenta reveals pathologic abnormalities for the placentas submitted for pathology review (Table NR. 1).

Posterior located placenta and III degree maturation placenta characterize the premature group (Table NR. 1).

Sonographic evaluation of fetal development confirm the association of the placenta morphological changes with fetal hypotrophy (Table NR. 2).

The examination of the placenta reveals significant statistic smaller size and weight of the premature newborn placenta (Table NR. 3).

The macroscopic anatomic study of the premature group placenta reveals morphologic changes suggesting the precocity senescence (Table NR. 4).

The premature newborn group present loose shine, friable and less consistent placenta than the control group (Table NR. 4). Table 1. Sonographic evaluation of the placenta

Caracteristics

Premature Newborn

Control group t-student test

Posterior 5 cases

12 cases 0.846438 Placenta Localization

Anterior 1 case

8 cases 0.063278

I Degree 3 cases

0 case 0.488215

II Degree 3 cases

16 cases 0.098273

Degree of Placenta Senescence

III Degree 1 case

4 cases 0.047228*

t < 0.05** reveals statistic significant difference by comparison to the control group t < 0.005 reveals high statistic significant difference by comparison to the control group Table 2. Sonographic evaluation of the foetal development

Caracteristics

Premature Newborn

Control group

t-student test

Minim Biparietal Diameter 71 mm.

92 mm. 0.004659**

Maxim Biparietal Diameter 80 mm.

97 mm. 0.004852**

Medium Biparietal Diameter 74 mm.

95 mm. 0.004386**

t < 0.05** reveals statistic significant difference by comparison to the control group t < 0.005 reveals high statistic significant difference by comparison to the control group

Positive correlation for decidual ischemic transformation in premature birth placenta

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Table 3. Morphological evaluation of the placenta Placenta Caracteristics

Premature Newborn

Control group

t-student test

Normal Consistence 0 case 19 case 0.004688** Increased Consistence 1 case 1 case 5.986744 Decreased Consistence 5 cases 0 case 0.042853*

Preserved Integrity 8 cases 20 case 0.048702 Partial preserved Integrity 4 cases 0 case 0.051207

Minim 120mm 150mm 0.974014 Diameter Dimensions Maxim 180mm 200mm 0.047854

Maxim 46 mm 40 mm 0.142417 Medium 30 mm 40 mm 0.059735

Central Height

Minim 17 mm 28 mm 0.284834 Maxim 29 mm 24 mm 0393469 Medium 18 mm 22 mm 0.283961

Peripheral

Height Minim 12 mm 20 mm 0.059858 Maxim 490 g 612 g 0.003805 Medium 415 g 500 g 0.019611

Weight:

Minim 318 g 450 g 0.004873

t < 0.05** reveals statistic significant difference by comparison to the control group t < 0.005 reveals high statistic significant difference by comparison to the control group Table 4. Morphological aspect of the placenta

Caracteristics Nr. Cases (%) Preserved shine 3 cases (25%)

Loose shine 9 cases (75%)

FETAL FACE Fibrin depot 6 cases (50%)

Hemorrhagic necrosis area 12 cases (100%) Fibrin depot 5 cases (41.6%)

MATERNAL

FACE Limestone granulation depot 2 cases (16.7%)

The Microscopy exam of the placenta reveal hyaline and fibrinoid distrophy (figure 1, 2), Chorionic villi with increased angiomatosis and partial loosing of its histological structure (figure 3), necrosis (figure 4). Deciduas has chronic inflammatory infiltration (figure 5). They are clubbed decidual cells and hypertrophic trophoblast cells.

Figure 1. Premature group. Section cross placenta. Chorionic villi with hyaline and fibrinoid distrophy. H.E. Ob. 40 X 0.65

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Romanian Biotechnological Letters, Vol. 15, No. 3, Supplement (2010) 73

Figure 2. Premature group. Section cross placenta. Chorionic villi with angiomatosis and fibrinoid distrophy. H.E. Ob. 40 X 0.65

Figure 3. Premature group. Section cross placenta. Chorionic villi with increased angiomatosis and partial loosing of the histological structure. H. E. col. Ob. 40 X 0.65

Recent studies reveal that the acute, diffuse ischemic transformation of the chorion reflect the diminuation of the utero-placentar blood flow. Diffuse decidual necrosis of the decidua basalis is relatively common in placentas of 23-32 week newborns in our study (figure 4) and has been reported in the international literature (GOLDENBERG R & all, STARIBRATOVA D & all [2, 3].

Positive correlation for decidual ischemic transformation in premature birth placenta

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Figure 4. Premature group. Section cross placenta. Chorionic villi with necrosis. H. E. col. Ob. 40 X 0.3

Figure 5. Premature group. Cross section of premature placenta . Deciduas has chronic inflammatory infiltration. They are clubbed decidual cells and hyoertrophic trophoblast cells. H. E. Ob. 40 X 0.65 Chronic deciduitis is seen more frequently in cases of preterm labor than in control group. Our results overlaps with those of the Romanian (C D FRANDEŞ & all [4]) and international (RHONE SA, & all, WU H.C & all [5,6]) suggesting the association between maternal inflammation and preterm deliveries. Conclusions

The placenta of the premature group is characterized by degenerative circulatory and

inflammatory pathologic process. The chorionic villi present hyaline and fibrin dystrophy accompanied by angiomatosis

and necrosis. There is one marked involution of trophonlast villi because of prolonged fetal demise. The fibrosis of the placental villi is a consequence of fetal demise.

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These results support the view that the Histologic examinations of the the placenta reveals positive correlation for decidual ischemic transformation in premature birth. References

1. FAYE-PETERSEN O.M. The placenta in preterm birth. J Matern Fetal Neonatal Med. May;20(5):391-5.. (2007)

2. GOLDENBERG RL FAYE-PETERSEN O, ANDREWS WW, GOEPFERT AR, GOEPFERT, CLIVER SP, HAUTH JC. The Alabama Preterm Birth Study: diffuse decidual leukocytoclastic necrosis of the decidua basalis, a placental lesion associated with preeclampsia, indicated preterm birth and decreased fetal growth. Pediatr Dev Pathol. Jan-Feb;12(1):16-21. (2009)

3. STARIBRATOVA D, MILCHEV N. Histologic examinations prove unequivocal associations between placental findings and preterm delivery.; Akush Ginekol (Sofiia). Review. Bulgarian.PMID: 20198796 [PubMed - indexed for MEDLINE] 48(5):37-40. (2009)

4. CORINA DANIELA FRANDEŞ, D GRAŢIAN, S MIRCEA, LUMINIŢA PĂDURARU, Macroscopia placentei patologice din tulburaile de dezvoltare si prematuritate, revista de anatomie functionala: vol V. Nr. 4: 47-52. (2006)

5. RHONE SA, MAGEE F, REMPLE V., MONEY D. The association of placental abnormalities with maternal and neonatal clinical findings: a retrospective cohort study. J Obstet Gynaecol Can. Feb;25(2):123-8. (2003)

6. WU HC, SHEN CM, WU YY, YUH YS, KUA KE.Subclinical histologic chorioamnionitis and related clinical and laboratory parameters in preterm deliveries. Pediatr Neonatol. 50(5):217-21. (2009)