The determination of normal percentages of syncytiotrophoblastic knots in various regions of placenta: where to count the syncytial knots

Abstract

Objective: The marginal, basal and subchorial regions of the placenta are considered to be more hypoxic than other regions. Therefore, it is not recommended to determine the increase in syncytiotrophoblast knots, based on the major morphological change in placental hypoxia, from the samples taken from these regions. However, the normal count of knots at various regions of placenta is not investigated. Material and Method:In this study we have sampled morphologically and clinically normal placenta with eccentric cord insertion from various sites, either close to cord entrance or away from it (marginal, non-marginal basal, non-marginal subchorial, and nonmarginal midparanchymal). The number of knots was calculated on a total of at least 100 villi for each placental sample. The normal amount of knots in different regions and comparison between them were investigated. Twenty-eight placentas with eccentric cord insertion were sampled in the same manner. Hot spots from the above mentioned regions were counted in a total of 100 villi.Results: No significant difference was found between the dual comparison of the mean percentages of different regions (p: 0.148). The variety of hypoxia in different regions of the placenta could not be demonstrated in this study. Conclusion:It is found that there is no difference in perfusion that can be morphologically demonstrated with increase in syncytiotrophoblast knot, between different regions of placenta.

May the morphological findings in the first‐trimester abortion materials be indicative of inherited thrombophilia?

“…This evidence is well‐documented in pre‐eclampsia, diabetic pregnancies and also intrauterine growth retardation when it is widespread 16 . Syncytial knotting, also known as TPC, is a determinant of placental ischemia and detected particularly in pre‐eclampsia, besides, it has been found correlated with Factor V mutation in the recent times 17 . Likewise, Many et al .…”

“…16 Syncytial knotting, also known as TPC, is a determinant of placental ischemia and detected particularly in pre-eclampsia, besides, it has been found correlated with Factor V mutation in the recent times. 17 Likewise, Many et al have analyzed 68 female patients with thrombophilia in their study and demonstrated a high incidence of increased syncytiotrophoblast knotting in the placentae of all those patients. 18 In contrast, we have found similar rates of 69.7% and 66.1% for syncytial knotting in both groups with and without thrombophilia, respectively.…”

Correlation of placental histomorphology with doppler velocimetry in preeclampsia and IUGR and their perinatal outcome

“…2 Also these changes are very nonspecific and tend to occur even in the normal pregnancies to some degree leading to diagnostic dilemma. 3 Different descriptions are used to identify similar placental "lesions" and their grading is equally non-uniform. Present study is an attempt to overcome all the above problems and formulate a new grading system for placental dysfunction and to find its clinical correlation that could possibly help improve perinatal outcome Abnormal doppler helps to detect those pregnancies clinically at risk, however the correlation between abnormal doppler velocimetry and the degree of placental dysmorphology is not well established.…”