Department of Histology, Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy of Craiova, Romania;
Rom J Morphol Embryol. 2022 Apr-Jun;63(2):357-367. doi: 10.47162/RJME.63.2.07.
This study aims to establish a correlation between placental histopathological and immunohistochemical (IHC) changes and preterm birth with fetal growth restriction (FGR, formerly called intrauterine growth restriction - IUGR).
PATIENTS, MATERIALS, AND METHODS: This prospective study was performed on a group of 30 parturients, with singleton gestation, of which 15 patients gave birth at term, and the other 15 patients gave birth prematurely. After the statistical correlation of the clinical and demographic data with premature birth (PB) and term birth (TB), we performed histological and IHC research on the respective placentae. To observe normal and pathological microscopic placental structures, we used the Hematoxylin-Eosin (HE) and Periodic Acid Schiff-Hematoxylin (PAS-H) classical stainings, but also special immunostaining with anti-cluster of differentiation 34 (CD34) and anti-vascular endothelial growth factor (VEGF) antibodies.
We found a statistically significant difference between the TB∕PB categories and the age of the patients, their antepartum weight, the weight of the newborns, and the placenta according to the sex of the newborn. Histological analysis revealed in the case of TB, small areas of perivillous amyloid deposition, with the significant extension of these areas both intravillous and perivillous in the case of PB. Massive intravillous calcifications, syncytial knots, and intravillous vascular thrombosis were also frequently present in PB. With PAS-H staining were highlighted the intra∕extravillous vascular basement membranes, but especially the massive fibrin deposits rich in glycosaminoglycans. By the IHC technique with the anti-CD34 antibody, we noticed the numerical vascular density, higher in the case of TB, but in the case of PB, there were large areas of placental infarction, with a lack of immunostaining in these areas. Through the anti-VEGF antibody, we observed the presence of signal proteins that determined and stimulated the formation of neoformation vessels in the areas affected by the lack of post-infarction placental vascularization. We observed a highly significant difference between placental vascular density between TB∕PB and newborn weight, sex, or placental weight.
Any direct proportional link between the clinical maternal-fetal and histological elements yet studied must be considered. Thus, establishing an antepartum risk group can prevent a poor pregnancy outcome.
本研究旨在建立胎盘组织病理学和免疫组织化学（IHC）变化与早产伴胎儿生长受限（FGR，以前称为宫内生长受限-IUGR）之间的相关性。
患者、材料和方法：本前瞻性研究对 30 名单胎妊娠产妇进行，其中 15 名患者足月分娩，15 名患者早产。在对早产（PB）和足月产（TB）与临床和人口统计学数据进行统计相关性分析后，我们对各自的胎盘进行了组织学和 IHC 研究。为了观察正常和病理性微小胎盘结构，我们使用了苏木精-伊红（HE）和过碘酸雪夫-苏木精（PAS-H）经典染色，但也使用了抗分化簇 34（CD34）和抗血管内皮生长因子（VEGF）抗体的特殊免疫染色。
我们发现 TB∕PB 类别与患者年龄、产前体重、新生儿体重以及根据新生儿性别分类的胎盘之间存在统计学显著差异。组织学分析显示，TB 病例中存在小面积的绒毛膜血管周围淀粉样沉积，而 PB 病例中这些区域在绒毛内和绒毛膜血管周围明显延伸。大量绒毛内钙化、合体结节和绒毛内血管血栓形成在 PB 中也经常出现。PAS-H 染色突出了绒毛内∕绒毛膜血管基底膜，但特别是富含糖胺聚糖的大量纤维蛋白沉积。通过抗 CD34 抗体的 IHC 技术，我们注意到 TB 病例中的血管密度数值较高，但在 PB 病例中，存在大面积的胎盘梗死，这些区域缺乏免疫染色。通过抗 VEGF 抗体，我们观察到信号蛋白的存在，这些信号蛋白决定并刺激了缺乏梗死性胎盘血管化的区域中新血管的形成。我们观察到 TB∕PB 与新生儿体重、性别或胎盘重量之间的胎盘血管密度存在高度显著差异。
必须考虑到任何与已研究的临床母婴和组织学因素之间的直接比例关系。因此，建立产前风险组可以预防不良的妊娠结局。
