A COMPARATIVE STUDY OF MORPHOLOGY OF PLACENTA IN NORMAL AND HIGH RISK PREGNANCIES

BACKGROUND Placenta forms a vital link between mother and fetus. Status of both maternal and fetal health is reflected in placenta. Complications of pregnancy and high risk pregnancies may lead to changes in placenta or vice versa. OBJECTIVE Evaluation of the morphology of placenta in various high risk groups and a control group. METHODOLOGY The study was conducted in the department of Gynecology and Obstetrics Government Medical College Srinagar over a period of two years and recruited 100 patients in the control group and 100 patients each in the three high risk groups vie Gestational Hypertension; Gestational Diabetes Mellitus and Intra Uterine Growth Retardation. After taking informed consent all patients were subjected to a detailed history taking and a thorough general, systemic and obstetric examination. Routine investigations were performed and examination of the placental morphology was undertaken .STATISTICAL ANALYSIS Statistical Data was described as mean±standard deviation and percentages. The parametric data was analyzed by student’s t-test whereas Mann-Whitney ‘U’ test and Chi square tests were applied for non-parametric data. All p-values of less than 0.05 were considered significant. Software used were Statistical Package for Social Sciences (SPSS 10; Chicago) software program. RESULTS The mean age among all groups was comparable (p >0.05). The gestational age at time of delivery was significantly higher in controls as compared to intra uterine growth retardation group and gestational diabetes (38.2 ± 1 vs. 37.3 ± 0.5 and 38.2 ± 1 vs. 37.2 ± 0.5; p < 0.001) insignificant difference in gestational age between controls and gestational hypertension group (38.2 ± 1 vs 37.7 ± 0.8; p < 0.05). 80% patients were primigravidas in gestational hypertension compared to 56%, 56% and 40% respectively in the controls, intra uterine growth retardation group and gestational diabetes (p < 0.05). Significant difference when gestational diabetic patients were compared to gestational hypertension patients (40% v/s 80%; p=0.004). The systolic and diastolic blood pressure was significantly higher in gestational hypertension group as compared to other groups (p <0.001). The incidence of edema was significantly higher (p =0.001) in gestational hypertension group (68%) as compared to controls (12%), intra uterine growth retardation (12%) and gestational diabetes patients (16%).The placental weight of controls was significantly more than IUGR (509 ± 38.6) vs. (426.2 ± 48.1) but less than gestational diabetes mellitus.( 509 ± 38.6) vs. (592 ± 66.1).The placental diameter in Gestational Diabetes was significantly more than all other groups (controls, gestational hypertension, and IUGR) (21.3 ± 2.9 vs. 17.4 ± 1.4 ; 17.8 ± 1.4 and 16.9 ± 1.3).(p<0.001), The thickness of placenta was comparable among controls and gestational hypertension (1.9 ± 0.2 vs. 1.9 ± 0.2) whereas significant difference was observed between IUGR and Gestational Diabetes (1.7 ± 0.2 vs. 2.3 ± 0.3). Multiple infarcts were significantly higher in IUGR patients compared to controls (p = 0.02).