A comparative morphological study was carried out to analyze the number of syncytial knots and VEGF expression in placental villi in parturient women with COVID-19 categorized by the disease severity. The number of syncytial knots was assessed on specimens stained with hematoxylin and eosin. VEGF expression was determined by immunohistochemical analysis in syncytiotrophoblast and villous endothelial cells. Morphological study of the placenta tissue of parturient women with COVID-19 showed increased numbers of syncytial knots in the villi, indicating the development of preplacental hypoxia. High VEGF expression in syncytiotrophoblast and vascular endotheliocytes reflects a stereotyped response to hypoxia and can underlie the development of a preeclampsia-like syndrome. The number of syncytial knots and VEGF expression in placental villi in parturient women with COVID-19 depended on the disease severity.

Comparative morphological study of the placentas in women with preeclampsia and small-for-date fetuses was carried out. Expression of insulin-like growth factor-1 (IGF-1), insulin-like growth factor-2 (IGF-2), and insulin-like growth factor binding protein-3 (IGFBP-3) was detected by immunohistochemical methods. Low expression of IGF-1 and high expression of IGF-2 and IGFBP-3 in the placental tissue depending on preeclampsia severity were detected. The most pronounced changes were found in preeclampsia associated with small-for-date fetuses.

It was determined that there was a preponderance of branching angiogenesis in the preeclamptic chorionic villi and an increase in the number of syncytial nodules and microcysts in the septae in late-onset preeclampsia. Morphometric analysis of immunohistochemical placental specimens established a reduction in the sizes and vascularization indicators of terminal villi that determine the development of placental hypoxia and are more pronounced in cases of early-onset preeclampsia.

Comparative morphological study of the placentas from women with pre-eclampsia of different severity was carried out. The expression of vascular endothelial growth factor and its receptors (VEGFR-1, VEGFR-2, VEGFR-3) was studied by immunohistochemical methods. Branched angiogenesis processes predominated in the placentas of patients with pre-eclampsia. The syncytiocapillary membranes were thickened, the number of syncytial buds was greater than normally. Immunohistochemical studies showed high expression of VEGF and VEGFR-1 and low expression of VEGFR-2 in the placental villous structures.

We studied the expression of TLR4 (Toll-like receptor 4) in the syncytiotrophoblast and vascular endothelial cells of terminal and stem placental villi in severe preeclampsia and normal pregnancy. In women of both groups, the expression of TLR4 was higher in the syncytiotrophoblast that in placental endothelial cells. In patients with severe preeclampsia, TLR4 expression in endothelial cells of terminal villi was 1.3-fold lower than in normal pregnancy. Lower TLR4 expression in the terminal villi endothelium in preeclampsia can underlie impaired recognition of damaging molecules with subsequent development of endothelial dysfunction and changes in immunological tolerance.