Publication:

Placental morphological and histopathological changes in preeclampsia and eclampsia: a prospective case-control study using an objective scoring system

Background The hypertensive disorders of pregnancy (HDP), particularly preeclampsia (PE) and eclampsia (EC) play a major role in maternal and perinatal morbidity. Despite extensive descriptive work on placental lesions in these conditions, only a few studies have attempted to objectively quantify the morphological damage. This study was undertaken to apply a structured histopathological scoring system to placental lesions in PE and EC and to determine whether the scores correlate with the severity of disease and adverse fetal outcome.

Methods This prospective case-control study included 100 placentas: 50 from PE, 25 from EC, and 25 from normotensive pregnancies as controls. Gross and microscopic features were assessed using a semi-quantitative histopathological scoring system evaluating fibrin deposition, maternal floor infarction, syncytial knot, calcification, and villous basement membrane thickening. Scores were correlated with placental weight and fetal outcome, indicating uteroplacental insufficiency.

Results Placenta; weight and thickness were significantly reduced in hypertensive cases compared with controls (p<0.001). Histological lesions such as fibrin deposition, maternal floor infarction, and syncytial knotting were markedly increased in the PE and EC groups (p<0.001). The median composite histopathological score was 4 in controls, 6 in PE, and 8 in EC. Higher scores were significantly associated with low placental weight and adverse fetal outcome.

Conclusions Placental histopathological scoring offers an objective and reproducible approach to quantity morphological damage in PE and EC. The scoring system correlates with disease severity and fetal outcome, underscoring its potential value as a morphological marker of uteroplacental insufficiency.