Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature

RBGO Gynecology & Obstetrics · 5 authors, 3 centres

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TL;DR

This integrative review compares placental pathological lesions between early-onset and late-onset preeclampsia.

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266 CHARS

These findings are consistent with the hypothesis of more severe placental hypoxia and hypoperfusion in early-onset disease. The review highlights the importance of standardized placental examination to inform diagnosis, predict outcomes, and assess recurrence risk.

STUDY TYPE

narrative_review

SPECIALTY

obstetrics and gynecology

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100% · A

ORIGINAL PAPER

PMC10301774

Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature

RBGO Gynecology & Obstetrics

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ABSTRACT

Introduction Preeclampsia (PE) is a pregnancy complication associated with increased maternal and perinatal morbidity and mortality. The disease presents with recent onset hypertension (after 20 weeks of gestation) and proteinuria, and can progress to multiple organ dysfunction, with worse outcomes among early onset preeclampsia (EOP) cases (< 34 weeks). The placenta is considered the root cause of PE; it represents the interface between the mother and the fetus, and acts as a macromembrane between the two circulations, due to its villous and vascular structures. Therefore, in pathological conditions, macroscopic and microscopic evaluation can provide clinically useful information that can confirm diagnosis and enlighten about outcomes and future therapeutic benefit. Objective To perform an integrative review of the literature on pathological placental findings associated to preeclampsia (comparing EOP and late onset preeclampsia [LOP]) and its impacts on clinical manifestations. Results: Cases of EOP presented worse maternal and perinatal outcomes, and pathophysiological and anatomopathological findings were different between EOP and LOP placentas, with less placental perfusion, greater placental pathological changes with less villous volume (villous hypoplasia), greater amount of trophoblastic debris, syncytial nodules, microcalcification, villous infarcts, decidual arteriolopathy in EOP placentas when compared with LOP placentas. Clinically, the use of low doses of aspirin has been shown to be effective in preventing PE, as well as magnesium sulfate in preventing seizures in cases of severe features. Conclusion The anatomopathological characteristics between EOP and LOP are significantly different, with large morphological changes in cases of EOP, such as hypoxia, villous infarctions, and hypoplasia, among others, most likely as an attempt to ascertain adequate blood flow to the fetus. Therefore, a better understanding of the basic macroscopic examination and histological patterns of the injury is important to help justify outcomes and to determine cases more prone to recurrence and long-term consequences.

CITATION EXPORT

Luciana Pietro, José Paulo de Siqueira Guida, Guilherme de Moraes Nobrega et al.. Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature. RBGO Gynecology & Obstetrics. (2021). https://doi.org/10.1055/s-0041-1730292

AUTHORS

5 · 3 CENTRES

Luciana Pietro, José Paulo de Siqueira Guida, Guilherme de Moraes Nobrega, Arthur Antolini-Tavares, Maria Laura Costa

1Institute of Health Sciences, Universidade Paulista, Campinas, SP, Brazil
2Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
3Department of Pathology, Universidade Estadual de Campinas, Campinas, SP, Brazil