Morphological Features of Placentas in Chronic Arterial Hypertension and Associated Preeclampsia

 Introduction. Preeclampsia (PE) is serious complication of gestation, the central place in the pathogenesis of which is placental dysfunction. The similarity of the pathogenetic mechanisms of chronic arterial hypertension (CAH) and PE determines interest in studying the morphological features of placentas in these patients.

Materials and methods. Histological and immunohistochemical (IHC) study of placentas was performed, assessing expression levels of VEGF, PlGF, angiotensinogen. Group 1 included placentas from women with CAH (n = 24), Group 2 — from women with CAH and PE (SPE) (n = 26), and Group 3 included placentas from patients without hypertensive disorders of pregnancy (HDP) (n = 20).

Results. Histological examination revealed statistically significant increase in the incidence of decidual arteriopathy (p = 0.007) and villous edema (p = 0.005) in Group 2 compared with Group 1. Group 1 had significantly higher incidence of villous necrosis (p = 0.005) and fibrinoid deposition (p = 0.016) compared with Group 3. When assessing expression level of IHC markers, highest levels of VEGF and PlGF expression were observed in group of patients without HDP (p_{1 : 3} < 0.0001 and p_{2 : 3} < 0.0001), while level of angiotensinogen expression, in contrast, was lower in pregnant women from Group 3 (p_{1 : 3} < 0.0001 and p_{2 : 3} < 0.0001). The expression levels of VEGF, PlGF, and angiotensinogen were statistically significantly higher in Group 2 compared to Group 1 (p < 0.0001).

Discussion. This study demonstrates different morphological profiles of placental tissue in CAH and SPE: isolated CAH is characterized by signs of chronic placental insufficiency, while SPE is dominated by markers of acute endotheliopathy and impaired placentation. IHC data demonstrate dysregulated angiogenesis and vasoconstriction in placenta, as well as significant endothelial dysfunction in HDP. 

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