PLACENTAL DIAMETER AND THICKNESS AND NUMBER OF COTYLEDONS IN MILD AND SEVERE PREGNANCY INDUCED HYPERTENSIVE WOMEN VERSUS NORMOTENSIVE WOMEN OF DISTRICT D.I.KHAN, PAKISTAN

Shehla Aman; Sarah Arif; Amir Amanullah; Jamshed Khan; Sarah Yunus; Usman Ullah

doi:10.46903/gjms/18.04.839

PLACENTAL DIAMETER AND THICKNESS AND NUMBER OF COTYLEDONS IN MILD AND SEVERE PREGNANCY INDUCED HYPERTENSIVE WOMEN VERSUS NORMOTENSIVE WOMEN OF DISTRICT D.I.KHAN, PAKISTAN

Shehla Aman, Sarah Arif, Amir Amanullah, Jamshed Khan, Sarah Yunus, Usman Ullah

Abstract

Background: Pregnancy induced hypertension (PIH) adversely affects the development of placenta and growth of fetus. The objectives of this study were to compare the placental diameter, placental thickness and number of cotyledons in mild PIH and severe PIH women versus normotensive women of District D.I.Khan, Pakistan.

Material & Methods: This comparative cross-sectional study was conducted in Department of Anatomy, Gomal Medical College, D.I.Khan, Pakistan from January to October 2014. Three samples were selected; each of size 50, group 1 normotensive/ control, group 2 with mild PIH and group 3 with severe PIH. Three research variables; placental diameter (cm), thickness (mm) and number of cotyledons were measured on ratio scale for three groups. Descriptive analysis included mean± SD with 95% confidence intervals for each group separately. With three groups on ratio data, one way-ANOVA test was applied to see significance of difference between three groups. Post hoc Dunnett’s t test was applied at alpha 0.05 to see difference of mild PIH group 2 to normotensive/ control group 1 and of severe PIH group 3 to normotensive/ control group 1separately.

Results: Mean placental diameter was 18.28±2.15, 16.57±1.94 and 16.18±1.75 cm and mean placental thickness was 19.33 ±3.70, 19.18±2.78 and 17.60±3.52 mm in group 1, 2 and 3 respectively. Mean number of cotyledons was 14.42±2.25, 14.08±2.30 and 13.16±2.15 in group 1, 2, and 3 respectively. Placental diameter was statistically significantly lower in group 2 (p=<.00001) and 3 (p=<.00001) than group 1. Placental thickness in group 2 (p=.957) was similar to group 1, while in group 3 (p=<.019) it was lower than group 1. Number of cotyledons in group 2 (p=.666) was similar to group 1, while in group 3 (p=<.011) it was lower than group 1.

Conclusion: In mild pregnancy induced hypertension (PIH), placental diameter was lower than normotensives, while placental thickness and number of cotyledons were similar to normotensives. In severe PIH, placental diameter, placental thickness and number of cotyledons were all lower than normotensives. It is concluded that in mild PIH, the development of placenta is mildly affected, while in severe PIH, the development of placenta is severely affected.

Keywords

Placenta; Morphology; Hypertension; Pregnancy Induced Hypertension Pregnancy; Women; Cotyledons; Maternal Mortality.

Full Text:

PDF

References

Londhe PS, Mane AB. Morphometric study of placenta and its correlation in normal and hypertensive pregnancies. Int J Pharma Bio Sci 2011; 2(4):429-7.

Knofler M, Pollheimer J. Human placental trophoblast invasion and differentiation a particular focus on Wnt signaling. Front Genet 2013;4(190):1-14. https://doi.org/10.3389/fgene.2013.00190

Baloch AH, Memon SF, Ansari AK. Comparison of placentae from hypertension associated pregnancies and normal pregnancies. J Liaqat Uni Health Med Sci 2012 April;11(1):3-6.

Kvåle G, Olsen BE, Hinderaker SG, Ulstein M, Bergsjø P. Maternal deaths in developing countries: A preventable tragedy [review article]. Norsk Epidemiologi 2005; 15(2):141-9. https://doi.org/10.5324/nje.v15i2.212

Backes CH, Markham K, Moorehead P, Cordero L, Nankervis CA, Giannone PJ. Maternal preeclampsia and neonatal outcomes. J Pregnancy 2011;1-7. https://doi.org/10.1155/2011/214365

Riaz S, Habib S, Jabeen A. Frequency of maternal mortality and morbidity in pregnancy induced hypertension. J Ayub Med Coll Abbottabad 2011; 23(4):61-3.

Anorlu RI, Odum CU. Risk factors for pre-eclampsia in Lagos, Nigeria. Aus N Z J Obstet Gynaecol 2005 Aug; 45:78-82. https://doi.org/10.1111/j.1479-828X.2005.00411.x

Akhtar F, Ferdousi R, Sultana R. Gross morphological variation in preterm placenta in gestational diabetes mellitus and pregnancy induced hypertension. J Enam Med Coll 2011; 1(2):71-5. https://doi.org/10.3329/jemc.v1i2.11466

Kishwara S, Ara S, Rayhan KA, Begum M. Morphological changes of placenta in preeclampsia. Bangladesh J Anat 2009; 7(1):49-54. https://doi.org/10.3329/bja.v7i1.3026

NIC guideline [NG 133]. Hypertension In pregnancy: diagnosis and management. [published 2019 Jun 25, cited 2020 July 14]. Available at: https://www.nice.org.uk/guidance/ng133

Hargitai B, Marton T, Cox PM. Examination of human placenta. J Clin Pathol 2004; 57:785-92. https://doi.org/10.1136/jcp.2003.014217

Un Nisa S, Shaikh A A, Kumar R. Maternal and fetal outcomes of pregnancy-related hypertensive disorders in a tertiary care hospital in Sukkur, Pakistan. Cureus 2019 Aug 28;11(8): e5507. https://doi.org/10.7759/cureus.5507

Raosoft® sample size calculator. [accessed 2020 May 14]. Available at: http://www.raosoft.com/samplesize.html

Jeremy Stangroom. Single-Sample Confidence Interval Calculator. Social Science Statistics. [accessed 2020 Apr 24]. Available at: https://www.socscistatistics.com/confidenceinterval/default2.aspx

Dunnett CW. A multiple comparison procedure for comparing several treatments with a control. J American Statistical Assoc 1955; 50(272): 1096-1121. https://doi.org/10.1080/01621459.1955.10501294

Dunnett C W. New tables for multiple comparisons with a control. Biometrics 1964 Sep; 20(3): 482-91. http://www.jstor.org/stable/2528485

Goswami P, Lata H, Memon S, Khaskheli LB. Excessive placental calcification observed in PIH patients and its relation to fetal outcome. J Liaqat Uni Health Med Sci 2012 Dec; 11(03):143-8.

Agrawal P, Agrawal SK, Singh S. A comparative study on placental changes in uncomplicated pregnancies with pre-eclamptic women. J Med Sci Clin Res 2018; 6(2):1291-6. https://doi.org/10.18535/jmscr/v6i2.203

Chhatwal J, Chaudhary DN, Chauhan N. Placental changes in hypertensive pregnancy: a comparison with normotensive pregnancy. Int J Reprod Contracept Obstet Gynecol 2018; 7:3808-13. https://doi.org/10.18203/2320-1770.ijrcog20183799

Khaleel GH, Barwari SSM. Placentas changes in gestational hypertensive women in Duhok. Duhok Medical Journal 2019 May; 13(1):96-11. https://doi.org/10.31386/dmj.2019.13.1.10

Nahar L, Nahar K, Hossain MI, Jahan S, Rahman MM. Placental changes in pregnancy induced hypertension. Mymensingh Med J. 2013 Oct; 22(4):684-93.

Ghori MR, Khan H, Marwat M. Distribution of non-malignant hematological disorders by sex, age groups and type of disease based on bone marrow aspiration in population of Khyber Pakhtunkhwa, Pakistan. Gomal J Med Sci 2019 Apr-Jun; 17 (2): 29-36. https://doi.org/10.46903/ gjms/17.02.1926

Ain N, Khan S, Marwat M, Khan N, Ahmad I, Ramzan F, et al. Frequency, distribution and determinants of hypertension in adult stroke population of D.I.Khan Division, Pakistan. Gomal J Med Sci 2019 Jul-Sep; 17 (3):81-9. https://doi. org/10.46903/gjms/17.03.2076

Marwat M, Ahmad I, Ashiq F, Ali S, Zamir S, Rehman MU, et al. Frequency, distribution and determinants of diabetes mellitus in adult acute coronary syndrome population of D.I.Khan Division, Pakistan. Gomal J Med Sci 2019 Oct-Dec; 17 (4):131-43. https://doi.org/10.46903/gjms/17.04.2106

Khalid MK, Ahmad I, Khan MA, Sharjeel M, Irfan M. Marwat M. Distribution of pediatric cataracts by sex, age groups, laterality, type and presentation in population of D.I.Khan District, Pakistan. Gomal J Med Sci 2019 Oct-Dec; 17 (3):123-30. https://doi.org/10.46903/gjms/17.04.2025

DOI: https://doi.org/10.46903/gjms/18.04.839