Last updated: July 17, 2019
Topic: FamilyBabies
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Placenta forms connection between fetus and the uterine wall of mother providing baby with appropriate nourishment, immunity and helping in elimination of waste products along with performing endocrine function. Umbilical cord forms a conduit between fetus and placenta. Thus, placenta plays an important role in pregnancy and its careful examination in many pregnancy related medical disorders can help us understanding their etiology. These disorders are the reasons for maternal and perinatal morbidity and mortality. Disorders like gestational diabetes, pregnancy induced hypertension, eclampsia, preeclampsia result in destruction of placenta and alteration in its functions causing placental insufficiency2,3.Pregnancy Induced Hypertension can cause distress and fatality in mother, fetus and newborn. Fetuses in these conditions are most likely to suffer from intrauterine growth retardation, prematurity and intrauterine death . It may also cause infarcts within the placenta due to decreased blood flow in those areas. Preeclempsia is the hypertensive condition to the extent of 140/90 mmHg along with edema and proteinuria. It occurs after 20th week of gestation. Eclampsia is condition in which preeclampsia is accompanied by the onset of convulsions. Hypertension, eclempsia, preeclampsia, intrauterine growth restriction can lead to preterm labor.Gestational diabetes mellitus (GDM) is a condition in which blood sugar level is increased and it occurs in the second part of the pregnancy and goes away once the baby is born. Babies born to women suffering from GDM are larger than normal and placenta also tends to be larger in size.As every perinatal outcome is associated with abnormal placenta and vice versa, placenta provides an accurate information about the child’s prenatal life experience. In this project gross and histopathological changes in placentas of the common disorders of pregnancy including  pregnancy induced hypertension, eclampsia, preeclampsia, gestational diabetes, anaemia, stillbirths, will be studied and compared with placentas of normal pregnancies.Aims and objectivesTo study pathology (morphology and histology) of placenta in medical disorders of pregnancy. To compare pathological changes of medical disorders of pregnancy with the normal placentas.3.       To establish possible correlation between placental abnormalities and outcome of pregnancy.4.       Changes specific to some particular medical disorder will be observed and studied. MethodologyPresent study  is a hospital based  prospective study which will be carried out at Department of Pathology  in collaboration with the Department of Obstetrics and Gynecology  of  Peoples  College  Of  Medical  Sciences & Research Centre, Bhopal in the given time period from February 2018 to August 2018. Placentas will be collected just after the delivery which will comprise of placentas associated with medical disorders of pregnancy and the placentas with no medical disorders of pregnancy during Anti natal period.Detailed obstetric and medical history will be recorded and informed consent will be obtained from all the patients.The placentas with attached membranes and umbilical cord will be collected soon after delivery, washed in phosphate buffer saline to remove blood contamination labeled, and then fixed with 10% l buffered formalin overnight. Then the gross examination of the placentas will be done.  Gross examination of placenta noting the weight, number of vessels in the cord, cord length and insertion point, meconium staining or any other discoloration of membranes, completeness of placenta and membranes, haematomas, multiple lobes or focal lesions along with  some detailed examination including colour, masses, fibrin, thrombi in the vessels of fetal surface, completeness, masses, haematomas of maternal surface, texture, colour, percentage of parenchyma occupied by lesion membrane will be taken into account.  Knots, tethering, hypocoiling or hypercoiling, strictures, ulcers or other lesions will also be noted.Sections will be taken from umblical cord, membrane, maternal surface of placenta and feal surface of placenta. For microscopic examinations placental tissues processing will be done to obtain 4?m thick paraffin sections for histopathological study. Sections will be deparaffinized, rehydrated in a graded series of ethanols, and stained with hematoxylin and eosin (H). Thesesections will be analyzed by light microscopy and in each of the placental slides, the 10 smallest terminal villi (each less than 80 ?m in diameter) in 10 different fields were examined (magnification ×400). Gross and microscopic findings will be then listed and correlated with the obstetric history.  ImplicationsThis study will help us in better understanding of the changes in placenta caused by medical disorders of pregnancy and role of placenta in the etiology of those. Proper differentiation of the changes specific to certain diseases would be possible. By comparing the placenta associated with medical disorders of pregnancy with placentas of normal pregnancy, we can have a better understanding of pathology of such disorders and factors responsible for them. It can prove to be of an utmost importance in improving management of subsequent pregnancies by diagnosis of pregnancy related diseases that may have tendency of reoccurrence or might be preventable and treatable. Placental studies can be used to plan the future care of the mother and child