fibrin and Diabetes--Gestational

To determine the fibrinoid necrosis and hyalinization extent in placenta observed in normal, diabetic and hypertensive pregnancies.. Comparative cross-sectional study.. Institute of Basic Medical Sciences, Dow University of Health Sciences, Karachi, from 2008-2010.. One hundred and fifty placentae were divided in three groups on the basis of their histories and clinical examination. Group A (control), Group B (Diabetic) and Group C (Hypertensive), each consisted of 50 samples. The samples were transferred to Dow Diagnostic Reference and Research Laboratory for histopathology and gross examination. The tissue samples were taken from different sites, processed and routine staining done. The slides were then examined under light microscope for hyalinization and fibrinoid necrosis. The data was analyzed by applying ANOVA and post-hoc Tukey at 95% confidence interval. Mean ± standard deviations (SD) were computed.. The mean number of hyalinized villi in control group was 0.54 ± 0.908, 1.18 ± 1.9540 in the diabetic group and 2.14 ± 1.863 in the hypertensive group. The difference in their average turned out to be statistically significant (p-value < 0.001). Mean number of villi having fibrinoid necrosis was statistically significant in both the diabetic and hypertensive groups as compared to the control group i.e. 13.98 vs. 4.02 and 10.08 vs. 4.02 respectively (p-value < 0.001).. There was significantly greater fibrinoid necrosis and hyalinization in placentae from mothers having diabetes and hypertension. The fibrinoid necrosis was seen more in diabetic group as compared to hypertensive and control, while hyalinization was observed more frequently in hypertensive group as compared to the other groups. Placental changes as seen in examination of delivered placentae will be helpful in preventing the adverse effects in successive pregnancies.

Topics: Analysis of Variance; Chorionic Villi; Cross-Sectional Studies; Diabetes, Gestational; Female; Fibrin; Gestational Age; Humans; Hypertension; Hypertension, Pregnancy-Induced; Microscopy; Necrosis; Organ Size; Pakistan; Placenta; Pregnancy; Pregnancy in Diabetics

Placentae from control and diabetic patients were used to test three null hypothesis: (1) there are no significant group differences in the volumes of villous syncytiotrophoblast compartments or intervillous fibrin-type fibrinoid, (2) perivillous fibrin-type fibrinoid is deposited randomly at the surface of trophoblast, and (3) amounts and deposition patterns of perivillous fibrin-type fibrinoid do not vary between groups. Term placentae were collected from non-diabetic subjects and five groups of diabetic women classified according to duration, severity and insulin dependence. Tissue specimens and sections were obtained by uniform random sampling. Volumes and surface areas of fibrin-type fibrinoid and trophoblast compartments (thin, syncytial knot, syncytial bridge and denuded regions) were estimated stereologically and compared using variance, chi-squared and contingency table analyses. As to null hypothesis (1), no group differences in volumes of trophoblast compartments were found but volumes of intervillous fibrin-type fibrinoid were greater in the non-insulin-dependent diabetic group. As to null hypothesis (2), regardless of group, fibrin-type fibrinoid was deposited preferentially at sites of denudation in every placenta examined. As to null hypothesis (3), villous surface areas occupied by perivillous fibrin-type fibrinoid were greater in type 1 (insulin-dependent) diabetics with complications (diabetic nephropathy or retinopathy). The surfaces of trophoblast occupied by fibrin-type fibrinoid were also notably larger in non-insulin-dependent diabetics and type 1 diabetics with complications. Except for the surface of denudation sites (which also increased in diabetes), there were no differences in the surfaces of trophoblast regions. These results confirm that the haemostatic steady state is perturbed in the diabetic placenta, that perivillous fibrin-type fibrinoid is deposited preferentially at sites of epithelial loss/damage, and that some diabetic groups are affected differentially.

Topics: Adult; Chorionic Villi; Diabetes, Gestational; Female; Fibrin; Humans; Infant, Newborn; Labor, Obstetric; Pregnancy; Pregnancy in Diabetics; Trophoblasts