Abstract

PLACENTAL PATHOLOGY IN WOMEN COMPLICATED BY GESTATIONAL DIABETES A THESIS

*Dr. Maha Radh Ismaiel and Dr. Sajwa Qais Mahmood

ABSTRACT

Back Around: Diabetes mellitus is major complication of pregnancy regardless of whether it is pre-pregnancy (overt)or gestational in onset. In such pregnancies, the fetus is exposed to increased morbidity & mortality associated with hypoxic stress & various metabolic abnormalities. Placentae from diabetic pregnancies present morphological abnormalities independent of the level of glycemic control. One may hypothesise that diabetes results in impaired placental function, weight, circulation& histology, accounting for these phenomena. Objectives: The objective of this study is to investigate the histopathological effect of diabetes on the placenta in pregnancies complicated by gestational diabetes compared to uncomplicated pregnancies (control). Study design: A Case — Control study. Settings: The study involve 40 singleton pregnancies complicated by gestational diabetes who are attending Al Yarmouk Teaching Hospital & compared with group of 40 uncomplicated pregnancies (control) over a period of 12 months from the first of April 2008 to the end of March 2009 by studying samples taken from their placentae & send for histopathological study with regard to the following changes chorangiosis, ischemia, infarction, fetal vessel thrombosis, villous immaturity, presence fetal nucleated red blood cells, vascular villi and lymphohistocytotic. Results: The presence of degenerative lesions such as fibrinoid necrosis and vascular lesions like chorangiosis was apparent, mainly in the diabetes group. Villous immaturity and the presence of NFRBC as an indication of chronic fetal hypoxia were significantly increased in the placentas of women with diabetes compared with the control group. Fetal/placental weight ratio was significantly lower in the diabetic group. Conclusion: Histological abnormalities were observed more frequently in the diabetic placentas compared to the controls. These findings support the hypothesis that impaired placental function is one of the main reasons for the increased frequency of fetal complications in diabetic pregnancies.

Keywords: Placenta; pathology; gestational diabetes; pregnancy.