Introduction
Functional maturation disorder of the placenta is an unfavorable life-threatening factor in perinatal period and may cause a sudden antenatal fetal hypoxia in clinically normal pregnancies [1,2]. Further use of CD15 Immunscore in postnatal placental diagnostic contribute to a visualization of maturation disorder of placental endothelial progenitors (CD15+ EPCs) in respiratory-active capillaries of placental barrier (PB) and functional immaturity of fetoplacental respiratory surface [2]. The aim of this study was to perform comparative analysis of antenatal immaturity of fetoplacental PB-capillaries in normal and pathological term pregnancies with feto-maternal perinatal disorders.
Materials and methods
178 tissue samples of clinically normal (n-35) and pathological placentas (n-143) of gestational age 37-42 associated with small for gestational age (SGA, n-11) fetuses, intrauterine fetal growth restriction (IUGR, n-36), gestational Diabetes mellitus (GDM, n-28), preeclampsia (PE, n-34) and sudden fetal death (SIUD, n-48) were pathomorphologically and immunohistochemically analyzed. Immunohistochemical expression of CD15+ pEPCs in fetoplacental vessels was compared to clinical groups and structural placental phenotype. A relative amount of immature CD15+ PB-capillaries was determined. Intensity and intravascular expression of CD15+ pEPCs was assessed using the Immunoreactive Score (IRS).
Results
Antenatal functional CD15+ immaturity of PB-capillaries was noted in 124 (70%) placentas. Among them 12 (10%) placentas with normal structural maturity in pregnancies with SGA (n-3, 22,4±9,3%, IRS 4,2±0,9) and SIUD (n-9, 94,6±4,9%, IRS 10,4±0,9); 40 (32%) placentas with morphological features of utero-placental malperfusion and structural acceleration of villous development in pregnancies with PE (n-7, 29,4±12,3%, IRS 4,3±1,2), IUGR (n-22, 32,5±12,4%, IRS 5,2±1,4) and SIUD (n-11, 92,8±4,7%, IRS 10,8±1,2); 72 (58%) placentas were associated with morphological signs of feto-placental malperfusion and structural villous immaturity in pregnancies with IUGR (n-14, 29,4±16,3%, IRS 5,1±2,1), GDM (n-28, 26,4±15,3%, IRS 4,8±1,9) and SIUD (n-28, 94,9±6,4%, IRS 11,2±0,9).
Conclusion
We have shown, that pregnancies with antenatal functional CD15+ immaturity of respiratory-active fetoplacental capillaries correlate with chronic placental insufficiency and antenatal fetal hypoxia and clinically associated with IUGR and SIUD. We recommend the use of CD15 Immunscore of the term placenta as an additional method to identify immature for gestational age (IGA) pregnancies complicated by clinically latent diffusion immaturity of the placental barrier with fetal risk for clinically unexpected antenatal hypoxia.
Reference
- Seidmann L., Suhan T., Kamyshanskiy Y., Nevmerzhitskaya A., Gerein V., Kirkpatrick C.J. CD15 - a new marker of pathological villous immaturity of the term placenta. Placenta. 2014; 35(11): 925-31. Seidmann L., Kamyshanskiy Y., Martin S.Z., Fruth A, Roth W. Immaturity for gestational age of microvasculature and placental barrier in term placentas with high weight. Eur J Obstet Gynecol Reprod Biol. 2017; 15:134-140.