Abstract
The article discusses the use of atomic force microscopy in the study of changes in the histological structure of the tissues of the placenta and myometrium in various types of extragenital pathology in a pregnant woman. The results presented in the article demonstrate what structural changes in the vessels of the placenta and uterus occur in endocrine pathologies (thyroid disease, diabetes mellitus), as well as in preeclampsia.
Keywords: Atomic Force Microscopy; Placenta, Uterus; Extragenital Pathology; Diabetes Mellitus; Thyroid Gland; Preeclampsia
Introduction
Changes in the tissue characteristics of the placenta and uterus during pregnancy, occurring against the background of endocrine or other pathology are factors in the development of fetoplacental insufficiency [1]. Identifying patterns between specific changes in the mother-placenta-fetus system and the extragenital pathology that causes them (including using atomic force microscopy) [2] is necessary to develop methods for correcting changes at different stages of their pathogenesis.
Materials and Methods
During the study were examinated:
a) 10 women with eythyroidism
b) 45 with hypothyroidism
c) 10 with diffuse toxic goiter (DTG)
d) 16 with gestational diabetes mellitus (GDM)
e) 11 with DM I type
f) 15 with preeclampsia
g) and 10 were the control group
Tissue morphometric analysis was performed using the
“Ntegra-Aura” device, atomic force image analysis using standard
software NOVA and ImageAnalysis (“NT-MDT”). Statistical analyses
were performed using SPSS version 22.0 (IBM).
Results and Discussion
Change the configuration of the myometrial vessels in their
shape was detected during hypothyroidism, DTG, DM I and
preeclampsia. With maternal thyroid disease, endotheliocytes were
flatter and thinner due to an increase in vascular area. The greatest
changes in the folding of endotheliocytes were observed in groups with hypothyroidism, DTG, DM I and preeclampsia. The vascular
region free of erythrocytes, blood clots and fibrin decreased in
the following sequence of groups: №1 (35.6 ± 3.7 μm at 28 ± 2.4
μm in control), №5 (32.1 ± 2.6), №2 (12.6 ± 1.9 μm), №4 (11.2
± 1.4 μm), №3 (10.3 ± 1.6 μm), №6 (9.3 ± 1.5 μm). A decrease in
depth, indicating greater tortuosity of the vessels, was observed in
group №2 (7.9 ± 2.3 μm), №5 (7.1 ± 1.4 μm), №3 (6.8 ± 1.2 μm),
№5 (6.1 ± 1.3 μm), №6 (5.7 ± 1.9 μm). Herewith, in the endothelial
microstructure, cytoplasmic bridges and small porous deepenings
with blood clots and areas of necrosis are clearly manifested. It
was revealed that the greatest difference in the stem villis’ relief
is observed with euthyroidism (15.5 ± 4.5 μm) and this indicator
is close to that in the control group - 14.3 ± 6.5 μm. But with
hypothyroidism and DTG this indicator is less: 8.6 ± 0.5 μm and 7.5
± 0.4 μm, respectively in all groups, villi of the intermediate type
prevailed with a decrease in the number of lateral branches and
moderate stromal vascularization. Their length in the group with
the euthyroid state was 460 ± 36 μm, with hypothyroidism - 690 ±
48 μm, with DTG - 720 ± 55 μm, GDM - 420 ± 42 μm, DM I – 730 ±
95 μm, preeclampsia –710 ± 101 μm (in the control - 300 ± 30 μm).
The relief drop in all groups, respectively, was: 0.9 ± 0.3 μm, 0.7 ±
0.1 μm, 0.6 ± 0.2 μm, 0.8 ± 0.4 μm, 0.6 ± 0.3 μm, 0.6 ± 0.3 μm (control
- 0.7 ± 0.2 μm). The vast majority of vessels are full-blooded, with
an area of 35.6 ± 3.7 μm, 23.6 ± 3.2 μm, 39.2 ± 2.2 μm, 30.1 ± 3.1 μm,
33.6 ± 6, 1 μm, 49.3 ± 6.6 μm, respectively (control - 28.7 ± 2.4 μm).
In the research of terminal villi, the studied parameters (growth,
vascular zone) were located in the following sequence: GDM,
the state of euthyroidism in the mother with thyroid pathology,
hypothyroidism, DTG, preeclampsia and DM I. When calculating
the depth of the capillaries of the terminal section, the indicators
primarily reflected their tortuosity and were distributed as follows:
3.8 ± 0.9 μm, 3.7 ± 0.5 μm, 1.4 ± 0.1 μm 1.2 ± 0.2 μm, 3.6 ± 0.5 μm,
4.0 ± 0.6 μm, 4.3 ± 0.9 μm (4.1 ± 0.8 μm). With fetal hypotrophy and
hypoxia, the number of loops in vessels decreased, destruction of
erythrocytes and their active contact with villus endothelium were
observed.
Conclusion
It was found that in the mother-placenta-fetus structure with pathology of the TG, DM and preeclampsia, multiple structural changes in the villous tree’s and myometrium’s tissues are observed, which contribute to the progression of fetal hypoxia. These changes include changes in vascular tortuosity, their shape and lenght, decreased the free vascular region, prevailed intermediate type of villis with a decrease in the number of lateral branches, endotelional disfunction.
References
- Pavlova TV, Malyutina ES, Selivanova AV, Petrukhin VA, Kaplin AN, et al. (2020) New approaches in assessing the clinical and pathomorphological aspects of obstetric pathology in the structure of the mother-placenta-fetus using atomic force research. Systematic Reviews in Pharmacy 11(6): 21-25.
- Kolobov AV (2015) The morphogenesis of the human placenta and its morphofunctional state in the pathology of pregnancy. Vestnik SPbGU. Seriya 11. Medicina (2): 5-18.