HISTOPATHOLOGICAL CHANGES OF THE UMBILICAL CORD IN COMPLİCATED PREGNANCIES

Year 2019, Volume: 4 Issue: 1, 43 - 54, 01.04.2019

Seval Kaya , Yusuf Nergiz , A. Kadir Turgut

https://doi.org/10.23884/ijhsrp.2019.4.1.05

Abstract

Preeclampsia, hellp
syndrome and gestational diabetes are quite common complication in pregnancy. In this study,ıt is aimed to compare the thickness  of
 basal  lamina
and vascular structure of umbilical cord. by
comparing preeclampsia,
hellp syndrome, gestational diabetes and normal pregnant women.
In
the study, sanples were taken from postpartium
umbilical cords of
normal pregnant
women, preeclampsia, gestational diabetes and pregnant women diagnosed
with
hellp syndrome. Umblical cord samples taken during maternity, followed by routine paraffin through fixing 10% neutral formalin. In this performed as totally sixty
facts through
taking fifteen
umbilical cords from each of four groups, Hematoxyline-eosin, Masson trichrom, periodic
acid Schiff,
and toluidine
blue stain were applied
on to the serial histological sections obtained from paraffin blocks. The obtained slides
were evaluated
with
Zeiss Imager 2 Microscope by taking micrographs. Morphometric measurements were statistically analyzed with SPSS software. In cases of gestational diabetes due to increased collagen production, thickening and excessive narrowing of the lumen and differentiation of Wharton jelly were observed in the umbilical artery. Differentiations are observed in the vacuolization of smooth muscle cells and muscle fibers that make up the media while camber and damage are observed in
endothelial. The most significant structural changes of preeclamptic placentas are obtained
as
the thickening
and
the endothelial injury. In the umbilical cord artery medial layer, due to
the
growth of collagen fiber. In HELLP
cases due to the increase in media diffuse edema
between muscle fibers and in collagen,
the
thickening of umbilical
artery wall and the
narrowing of luminal are seen
as extremely significant. Another striking symptom
with HELLP cases is the observing of
intramuscular hemorrhages in the umbilical artery wall as an
unattained case in preeclampsia and gestational diabetes. In most of the cases, differentiation in Wharton jelly, metaplastic changes in the amniotic epithelium and thickening
of the basal
lamina are observed. 

Keywords

Umbilical cord, Preeclampsia, Gestational diabetes, Hellp syndrome

References

• [1] Çiftçioğlu MA, Kanadalı S., et al. Histopathologic changes of umbilical cord in preeclamptic pregnant women. MJAU, 28, 216-219, 1996.
• [2] Turok DK, Ratcliffe SD., et al. Management of gestational diabetes mellitus. Am Fam Physician, 68, 1760-1772, 2003.
• [3] Hauth JC, Ewell MG., et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calsium for Preeklampsia Prevention Study Group. Obstet Gynecol., 95, 24-28, 2000.
• [4] Vigil-De-Gracia P. Pregnancy complicated by preeclampsia-eclampsia with help syndrome. Int J Gynaecol Obstet., 72, 17-23, 2001.
• [5] Martin JN Jr, Blake PG., et al. Pregnancy complicated by preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver enzymes and low platelet count: How rapid is postpartum recovery? Obstet Gynecol., 76, 737-741, 1990.
• [6] Weissman A, Jakobi P. Sonographic measurements of the umbilical cord in pregnancy complicated by gestational diabetes. J Ultrasound Med, 16, 691-694, 1997.
• [7] Nadkarni BB. Congenital anomalies of the human umbilical cord and their clinical significance: alight and electron microscope study. Indian J Med Res., 57,1018-1057, 1999.
• [8] Sepulveda W, Dezerega V. Fused umblical arteries. J Ultrasound Med., 20, 59-62, 2001.
• [9]. Abuhamad A, Sclater AJ., et al. Umbilical artery Doppler waveform notching: is it a marker for cord and placental abnormalities? J Ultrasound Med., 21, 857-860, 2002.
• [10] Sullivan JB, Charles D., et al. Gestational diabetes and perinatal mortality. Am J Obstet Gynecol., 116,901-904, 1973.
• [11] Stocker TJ, Dehner LP. Pediatric Pathology, JB Lippincott, Philedelphia, 1992.
• [12]. Junek T, Baum O., et al. Preeclampsia associated alterations of the elastin fibre system in umbilical cord vessels. Anat Embryol., 4, 291-303, 2001.
• [13] Bertrand C, Duperron L., et al. Umbilical and placental vessels: Modification of their mechanical properties in preeclampsia. Am J Obstret Gynecol., 168, 1537-1546, 1993.
• [14] Barnwal M, Rathi SK., et al. Histomorphometry of umbilical cord and its vessels in preeclampsia as compared to normal pregnancies. NJOG., 7, 28-32, 2012.
• [15]. Romanowicz L and Sobolewski K. Extracellular matrix components of the wall of umbilical cord vein and their alterations in preeclampsia. J Perinat Med., 28, 140-146, 2000.
• [16] Halim A, Kanayama N., et al. Hellp syndrome-like biochemical parameters obtained with endothelin-1 injections in rabbits. Gynecol Obstet Inverst., 35, 193-198, 1993.