A COMPARATIVE CROSS-SECTIONAL STUDY OF ENDOTHELIAL PROLIFERATION, VILLOUS CONGESTION, AND INTERVILLOUS HEMORRHAGE IN NORMAL, DIABETIC, AND HYPERTENSIVE PREGNANCIES: INSIGHTS INTO PLACENTAL ANATOMY AND HISTOPATHOLOGY

Abstract

The placenta plays a critical role in fetal development, serving as the primary interface for nutrient exchange, hormonal regulation, and waste removal between mother and fetus. Its examination is pivotal in understanding pregnancy complications and guiding postnatal care, particularly in conditions such as diabetes mellitus, hypertension, intrauterine growth restriction (IUGR), and stillbirth. Previous studies indicate that up to 92% of placentas examined exhibit relevant pathological findings, emphasizing the value of histopathological analysis in predicting maternal and fetal outcomes.

This study focused on full-term placentas (37–40 weeks of gestation) from pregnancies affected by diabetes and hypertension, excluding cases with additional clinical complications. A total of 150 placentas were analyzed and divided into three groups: control (A), diabetic (B), and hypertensive (C), with 50 samples in each. Non-probability purposive sampling was used, and the sample size was calculated using OpenEpi software, based on hospital delivery records.

Significant histological findings included a strong association between maternal disease and endothelial proliferation in cord vessels. At 10x magnification, endothelial proliferation was observed in 22% of the control group, 60% of the diabetic group, and 52% of the hypertensive group (p < 0.005). In contrast, villous congestion showed no significant association with maternal conditions, occurring in 38% of both control and diabetic groups and 26% of the hypertensive group (p > 0.005). Similarly, intervillous hemorrhage occurred in 36% of controls, 50% of diabetics, and 42% of hypertensive cases, also without statistical significance (p > 0.005).

These findings underscore the significance of endothelial proliferation as a placental marker linked to maternal pathology, while also suggesting that villous congestion and intervillous hemorrhage may be less predictive of underlying maternal disease.