Classification of human placental villi. I. Histology

Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor

OBJECTIVES

Spontaneous preterm labor is an obstetrical syndrome accounting for approximately 65-70% of preterm births, the latter being the most frequent cause of neonatal death and the second most frequent cause of death in children less than five years of age worldwide. The purpose of this study was to determine and compare to uncomplicated pregnancies (1) the frequency of placental disorders of villous maturation in spontaneous preterm labor; (2) the frequency of other placental morphologic characteristics associated with the preterm labor syndrome; and (3) the distribution of these lesions according to gestational age at delivery and their severity.

METHODS

A case-control study of singleton pregnant women was conducted that included (1) uncomplicated pregnancies (controls, n=944) and (2) pregnancies with spontaneous preterm labor (cases, n=438). All placentas underwent histopathologic examination. Patients with chronic maternal diseases (e.g., chronic hypertension, diabetes mellitus, renal disease, thyroid disease, asthma, autoimmune disease, and coagulopathies), fetal malformations, chromosomal abnormalities, multifetal gestation, preeclampsia, eclampsia, preterm prelabor rupture of the fetal membranes, gestational hypertension, gestational diabetes mellitus, and HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome were excluded from the study.

RESULTS

Compared to the controls, the most prevalent placental lesions among the cases were the disorders of villous maturation (31.8% [106/333] including delayed villous maturation 18.6% [62/333] vs. 1.4% [6/442], q<0.0001, prevalence ratio 13.7; and accelerated villous maturation 13.2% [44/333] vs. 0% [0/442], q<0.001). Other lesions in decreasing order of prevalence included hypercapillarized villi (15.6% [68/435] vs. 3.5% [33/938], q<0.001, prevalence ratio 4.4); nucleated red blood cells (1.1% [5/437] vs. 0% [0/938], q<0.01); chronic inflammatory lesions (47.9% [210/438] vs. 29.9% [282/944], q<0.0001, prevalence ratio 1.6); fetal inflammatory response (30.1% [132/438] vs. 23.2% [219/944], q<0.05, prevalence ratio 1.3); maternal inflammatory response (45.5% [195/438] vs. 36.1% [341/944], q<0.01, prevalence ratio 1.2); and maternal vascular malperfusion (44.5% [195/438] vs. 35.7% [337/944], q<0.01, prevalence ratio 1.2). Accelerated villous maturation did not show gestational age-dependent association with any other placental lesion while delayed villous maturation showed a gestational age-dependent association with acute placental inflammation (q-value=0.005).

CONCLUSIONS

Disorders of villous maturation are present in nearly one-third of the cases of spontaneous preterm labor.

SARS-CoV-2 and Placenta: New Insights and Perspectives

The study of SARS-CoV-2 positive pregnant women is of some importance for gynecologists, obstetricians, neonatologists and women themselves. In recent months, new works have tried to clarify what happens at the fetal-placental level in women positive for the virus, and different pathogenesis mechanisms have been proposed. Here, we present the results of a large series of placentas of Coronavirus disease (COVID) positive women, in a reference center for COVID-positive pregnancies, on which we conducted histological, immunohistochemical and electron microscopy investigations. A case-control study was conducted in order to highlight any histopathological alterations attributable to SARS-CoV-2. The prevalence of maternal vascular malperfusion was not significantly different between cases and controls (54.3% vs. 43.7% p = 0.19), whereas the differences with regard to fetal vascular malperfusion (21.1% vs. 4.2% p < 0.001) were significant. More frequent in cases with respect to controls were decidual arteriopathy (40.9% vs. 1.4% p < 0.0001), decidual inflammation (32.4% vs. 0.7% p < 0.0001), perivillous fibrin deposition (36.6% vs. 3.5% p < 0.0001) and fetal vessel thrombi (22.5% vs. 0.7% p < 0.0001). No significant differences in the percentage of terminal villous hyperplasia and chorioamnionitis were observed between the two groups. As the pandemic continues, these studies will become more urgent in order to clarify the possible mechanism of maternal-fetal transmission of the virus.

Growth restricted placentas show severely reduced volume of villous components with perivascular myofibroblasts

INTRODUCTION

The restricted placental growth in IUGR is associated with a simultaneous weight and volume restriction for the placental villous tree. It is unknown whether the whole villous tree or only specific parts of it are growth restricted in IUGR. In the case of uniform growth restriction of the villous tree, IUGR placentas could be interpreted as symmetrically smaller versions of normal placentas. Otherwise, IUGR placentas would be morphologically, developmentally and, therefore, functionally different from normal placentas.

METHODS

We investigated ten normal and eleven IUGR placentas with quantitative microscopic techniques. Using immunohistochemical detection of placental myofibroblasts (γ-sm-actin) and foetoplacental endothelium (CD34), we distinguished between more centrally located villi showing the presence of myofibroblasts (contractile villi; C-villi) and more peripherally located villi showing the absence of myofibroblasts (noncontractile villi; NC-villi).

RESULTS

Compared to normal placentas, IUGR placentas showed significantly reduced mean volume of C-villi, but not of NC-villi. The volume of vessels in both, C-villi and NC-villi, was significantly reduced in IUGR. Additional stereologic estimates confirmed the known alterations in the morphology of NC-villi in IUGR.

DISCUSSION

Our results suggest that IUGR placentas are not just smaller but morphologically (and therefore functionally) different from normal placentas. We propose that the reduced volume of C-villi and vessels in C-villi reflects a developmental disturbance in the formation of C-villi, which are mostly composed of stem villi. As such, key pathological villous alterations in IUGR placentas could begin before the formation of intermediate and terminal villi, possibly already in the late first trimester of pregnancy.

Does exercise during pregnancy impact organs or structures of the maternal-fetal interface?

Exercise during pregnancy has been shown to be associated with improved health outcomes both during and after pregnancy for mother and fetus across the lifespan. Increasing physical activity and reducing sedentary behaviour during pregnancy have been recommended by many researchers and clinicians-alike. It is thought that the placenta plays a central role in mediating any positive or negative pregnancy outcomes. The positive outcomes obtained through prenatal exercise are postulated to result from exercise-induced regulation of maternal physiology and placental development. Considerable research has been performed to understand the placenta's role in pregnancy-related diseases, such as preeclampsia, fetal growth restriction, and gestational diabetes mellitus. However, little research has examined the potential for healthy lifestyle and behavioural changes to improve placental growth, development, and function. While the placenta represents the critical maternal-fetal interface responsible for all gas, nutrient, and waste exchange between the mother and fetus, the impact of exercise during pregnancy on placental biology and function is not well known. This review will focus on prenatal exercise and its promising influence on the structures of the maternal-fetal interface, with particular emphasis on the placenta. Potential molecular mechanistic hypotheses are presented to aid future investigations of prenatal exercise and placental health.

Advances in imaging feto-placental vasculature: new tools to elucidate the early life origins of health and disease

Optimal placental function is critical for fetal development, and therefore a crucial consideration for understanding the developmental origins of health and disease (DOHaD). The structure of the fetal side of the placental vasculature is an important determinant of fetal growth and cardiovascular development. There are several imaging modalities for assessing feto-placental structure including stereology, electron microscopy, confocal microscopy, micro-computed tomography, light-sheet microscopy, ultrasonography and magnetic resonance imaging. In this review, we present current methodologies for imaging feto-placental vasculature morphology ex vivo and in vivo in human and experimental models, their advantages and limitations and how these provide insight into placental function and fetal outcomes. These imaging approaches add important perspective to our understanding of placental biology and have potential to be new tools to elucidate a deeper understanding of DOHaD.

Disorders of placental villous maturation in fetal death

Objective The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. Methods This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women's Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks' gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37-42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Results Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. Conclusion This study demonstrates that placentas of women with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.

Three-dimensional morphological analysis of placental terminal villi

Transport of nutrients and waste between the maternal and fetal circulations during pregnancy takes place at the final branches of the placental villous trees. Therefore, and unsurprisingly, pregnancy complications have been related to the maldevelopment of terminal villi. However, a deep analysis of placental villous morphology has been limited by tissue processing and imaging techniques. In this proof-of-principle study, placental lobules were fixed by perfusion and small clumps of villi were stained, sectioned optically and reconstructed. Morphological and network analyses were suggested and demonstrated on samples of normal placentas. The results show that most parameters are almost constant within a placenta but that there exists an inter-individual variation. Network analysis suggests that the feto-placental capillary network has several paths within an individual villus, serving as an efficient transport system. Three-dimensional reconstruction from confocal laser scanning microscopy images is a potent technique able to quantify placental architecture and capture the significant irregularities in vessel diameter and membrane thickness. This approach has the potential to become a powerful tool to further our understanding of the differences in placental structure which may underlie pregnancy complications.

The volume of villi with γ-sm-actin positive perivascular cells correlates with placental weight and thickness

INTRODUCTION

The classification of histologically stained villous cross sections in villous types (terminal, intermediate and stem villi) by stromal peculiarities is known to be observer predicated. Therefore, quantitative histology of villous trees has not become a routine endpoint of studies on the role of the placenta in prenatal programming, as opposed to the gross placental parameters weight and thickness. The classification of villous cross sections in central (stem) and peripheral (terminal) parts based on the presence or absence, respectively, of immunohistochemical detection of myofibroblasts in perivascular position is less observer dependent. We hypothesized that it will, possibly, identify microscopic correlates of placental weight and thickness within the villous tree.

METHODS

50 placentas from clinically normal pregnancies were processed for the present study. Thin villous cross sections, obtained in a systematic random manner, were stained immunohistochemically to detect γ-smooth muscle (sm) actin and to classify them subsequently as part of central or peripheral villous tree. The volume fractions of histological structures visible in villous cross sections (stroma, lumen, endothelium and syncytium) were estimated by design-based stereology.

RESULTS

The present study reveals a significant correlation of placental weight and thickness with the volume estimate of stroma that have myofibroblasts in perivascular position.

DISCUSSION

The positive linear correlation between the volume of central parts of villous trees and the placental weight and thickness is new. Surprisingly, the volume of more peripheral parts of villous trees, which is the main site of materno-fetal exchange does not correlate with placental weight and thickness.

Villous Tree Model with Active Contractions for Estimating Blood Flow Conditions in the Human Placenta

Background:

In the human placenta, maternal and fetal bloods exchange substances through the surface of the villous trees: the fetal blood circulates in the villous trees, around which the maternal blood circulates. The blood flows directly influence fetal growth. Stem villi, the main supports of the villous tree, have contractile cells along the axes, whose contractions are expected to influence the blood circulations in the placenta. The displacement is neither measurable nor predictable while non-invasive measurements such as umbilical Doppler waveforms are helpful to predict the histological changes of the villous trees and vascularization in the placenta.

Objective:

The displacement caused by the contraction of the villous tree is necessary to predict the blood flows in the placenta. Hence, a computational villous tree model, which actively contracts, was developed in this study.

Method:

The villous tree model was based on the previous reports: shear moduli of the human placenta; branching patterns in the stem villi. The displacement pattern in the placenta was estimated by the computational model when the shear elastic moduli were changed.

Results:

The results show that the displacement caused by the contraction was influenced by the shear elastic moduli, but kept useful for the blood flows in the placenta. The characteristics agreed with the robustness of the blood flows in the placenta.

Conclusion:

The villous tree model, which actively contracts, was developed in this study. The combination of this computational model and non-invasive measurements will be useful to evaluate the condition of the placenta.

The role of morphology in mathematical models of placental gas exchange

The performance of the placenta as a gas exchanger has a direct impact on the future health of the newborn. To provide accurate estimates of respiratory gas exchange rates, placenta models need to account for both the physiology of exchange and the organ morphology. While the former has been extensively studied, accounting for the latter is still a challenge. The geometrical complexity of placental structure requires use of carefully crafted approximations. We present here the state of the art of respiratory gas exchange placenta modeling and demonstrate the influence of the morphology description on model predictions. Advantages and shortcomings of various classes of models are discussed, and experimental techniques that may be used for model validation are summarized. Several directions for future development are suggested.

Does 2D-Histologic identification of villous types of human placentas at birth enable sensitive and reliable interpretation of 3D structure?

INTRODUCTION

The villous tree of human placentas is a complex three-dimensional (3D) structure which enables fetomaternal exchange. Current concepts of microscopic analyses are based on the analysis of two-dimensional (2D) histologic sections. For this approach, the assessment of the stromal core of sectioned villi is of key importance. The classification of stromal properties of sectioned villi allows allocation of villous sections to villous types which are named by their expected position in villous trees (terminal, intermediate, and stem villi).

METHOD

The present study takes these current concepts of placental histology as hypothesis and validates them against predetermined 3D positions of branches of villous trees. The 3D positions were determined prior to histologic sectioning using a recently introduced 3D-microscopic approach. Individual histologic sections of villi were classified by their stromal structures and inter rater variability of these histologic assessments were determined.

RESULTS/DISSCUSSION

Inter rater variability was high and indicates substantial observer influence on the outcome of histologic assessments. Cross-match of villous types with the predetermined positions of villous branches of villous trees revealed substantial mismatch between the outcome of stromal classification and 3D-position of the sectioned villi in the placental villous trees.

Novel 3D microscopic analysis of human placental villous trees reveals unexpected significance of branching angles

The villous trees of human placentas delineate the fetomaternal border and are complex three-dimensional (3D) structures. Thus far, they have primarily been analyzed as thin, two-dimensional (2D) histological sections. However, 2D sections cannot provide access to key aspects such as branching nodes and branch order. Using samples taken from 50 normal human placentas at birth, in the present study we show that analysis procedures for 3D reconstruction of neuronal dendritic trees can also be used for analyzing trees of human placentas. Nodes and their branches (e.g., branching hierarchy, branching angles, diameters, and lengths of branches) can be efficiently measured in whole-mount preparations of isolated villous trees using high-end light microscopy. Such data differ qualitatively from the data obtainable from histological sections and go substantially beyond the morphological horizon of such histological data. Unexpectedly, branching angles of terminal branches of villous trees varied inversely with the fetoplacental weight ratio, a widely used clinical parameter. Since branching angles have never before been determined in the human placenta, this result requires further detailed studies in order to fully understand its impact.

Differences in gene expression between first and third trimester human placenta: a microarray study

BACKGROUND

The human placenta is a rapidly developing organ that undergoes structural and functional changes throughout the pregnancy. Our objectives were to investigate the differences in global gene expression profile, the expression of imprinted genes and the effect of smoking in first and third trimester normal human placentas.

MATERIALS AND METHODS

Placental samples were collected from 21 women with uncomplicated pregnancies delivered at term and 16 healthy women undergoing termination of pregnancy at 9-12 weeks gestation. Placental gene expression profile was evaluated by Human Genome Survey Microarray v.2.0 (Applied Biosystems) and real-time polymerase chain reaction.

RESULTS

Almost 25% of the genes spotted on the array (n = 7519) were differentially expressed between first and third trimester placentas. Genes regulating biological processes involved in cell proliferation, cell differentiation and angiogenesis were up-regulated in the first trimester; whereas cell surface receptor mediated signal transduction, G-protein mediated signalling, ion transport, neuronal activities and chemosensory perception were up-regulated in the third trimester. Pathway analysis showed that brain and placenta might share common developmental routes. Principal component analysis based on the expression of 17 imprinted genes showed a clear separation of first and third trimester placentas, indicating that epigenetic modifications occur throughout pregnancy. In smokers, a set of genes encoding oxidoreductases were differentially expressed in both trimesters.

CONCLUSIONS

Differences in global gene expression profile between first and third trimester human placenta reflect temporal changes in placental structure and function. Epigenetic rearrangements in the human placenta seem to occur across gestation, indicating the importance of environmental influence in the developing feto-placental unit.

Modeling the variability of shapes of a human placenta

BACKGROUND

Placentas are generally round/oval in shape, but "irregular" shapes are common. In the Collaborative Perinatal Project data, irregular shapes were associated with lower birth weight for placental weight, suggesting variably shaped placentas have altered function.

METHODS

(I) Using a 3D one-parameter model of placental vascular growth based on Diffusion Limited Aggregation (an accepted model for generating highly branched fractals), models were run with a branching density growth parameter either fixed or perturbed at either 5-7% or 50% of model growth. (II) In a data set with detailed measures of 1207 placental perimeters, radial standard deviations of placental shapes were calculated from the umbilical cord insertion, and from the centroid of the shape (a biologically arbitrary point). These two were compared to the difference between the observed scaling exponent and the Kleiber scaling exponent (0.75), considered optimal for vascular fractal transport systems. Spearman's rank correlation considered p<0.05 significant.

RESULTS

(I) Unperturbed, random values of the growth parameter created round/oval fractal shapes. Perturbation at 5-7% of model growth created multilobate shapes, while perturbation at 50% of model growth created "star-shaped" fractals. (II) The radial standard deviation of the perimeter from the umbilical cord (but not from the centroid) was associated with differences from the Kleiber exponent (p=0.006).

CONCLUSIONS

A dynamical DLA model recapitulates multilobate and "star" placental shapes via changing fractal branching density. We suggest that (1) irregular placental outlines reflect deformation of the underlying placental fractal vascular network, (2) such irregularities in placental outline indicate sub-optimal branching structure of the vascular tree, and (3) this accounts for the lower birth weight observed in non-round/oval placentas in the Collaborative Perinatal Project.

Cellular diversity of human placental stem villi: an ultrastructural and immunohistochemical study

The aim of the study was to investigate the distribution and differentiation of cell types in the stroma of human placental stem villi (SV). A total of 14 human term placental tissues were studied. Double immunolabeling was performed for desmin-vimentin, desmin-alpha-smooth actin and vimentin-alpha-smooth actin. Cytokeratin 7, proliferating cell nuclear antigen immunolabeling was also performed. Parallel tissue samples were examined by transmission electron microscopy. HSCORE was performed for the semi-quantitative analysis of distribution of cells in the stroma of SV. Vimentin-labeled cells were mostly distributed in the subtrophoblastic area. Desmin-vimentin double immunolabeling was mainly localized in the triangular area and to a lesser degree in the perivascular area and vessel walls (p=or<0.001). However, desmin-alpha smooth actin labeling was observed predominantly in the vessel wall and perivascular area. Vimentin-alpha smooth actin immunoreactivity was significantly stronger in the triangular and perivascular areas compared to the vessel walls (p=0.003). Ultrastructurally, cells in the stroma of SV were mesenchyme cells, reticulum cells, fibroblasts, myofibroblasts, smooth muscle cells, and Hofbauer cells, filamented and vacuolated cells. The differentiation of myofibroblasts in the triangular and perivascular areas may play a role in maturation of SV and villous contractility, modulation of the intervillous space and this may have effects on maternofetal placental circulation.

Fetal hypertension and abnormal Doppler velocimetry in an ovine model of intrauterine growth restriction

OBJECTIVE

Our objective was to test the hypothesis that systemic blood pressure (BP) is increased above normal in intrauterine growth restricted (IUGR) fetal lambs with elevated umbilical artery (UmA) Doppler indices.

STUDY DESIGN

Five pregnant ewes were exposed to hyperthermic conditions for 80 days beginning at 40 days' gestation (dGA) to induce IUGR. They were then placed in ambient conditions with 6 additional ewes that served as controls. Doppler indices were calculated from UmA Doppler flow velocity waveforms. At 128 dGA, fetal catheters were placed for measurement of umbilical blood flow (UBF) by an ethyl alcohol steady-state diffusion technique and for aortic BP measurements. At 132 dGA, fetal mean systemic BP and blood flow were determined. At necropsy the placental and fetal weights were recorded. UBF was normalized for fetal weight. Linear regression, F tests and t tests were performed as appropriate. P < .05 was considered significant.

RESULTS

Compared with control pregnancies, the IUGR pregnancies showed: (1) reduced fetal and placental weights, (2) elevated systemic BP, (3) reduced UBF, (4) elevated UmA and aortic Doppler velocimetry indices, (5) increased resistance per 100 g placenta, and (6) decreased UmA oxygenation and increased lactic academia. The UmA Doppler index of resistance (systolic/diastolic ratio) correlated strongly with calculated resistance (R2 = 0.7). Doppler indices also correlated with systemic BP (R2 = 0.5).

CONCLUSION

Ovine IUGR fetuses with high UmA Doppler indices have elevated systemic BPs. UmA Doppler indices of resistance correlate well with (1) fetal systemic BPs and (2) resistance as calculated by pressure/flow. This whole animal study shows that IUGR fetuses are hypertensive and that increased UmA Doppler resistance indices are consistent with a fetal-placental hypertensive state.

The phenotype of the human materno-fetal endothelial barrier: molecular occupancy of paracellular junctions dictate permeability and angiogenic plasticity

In vitro models predict that molecular occupancy of endothelial junctions may regulate both barrier function and angiogenesis. Whether this is true in human vascular beds undergoing physiological angiogenesis has not been shown. This review presents data which demonstrate there are two distinct junctional phenotypes, 'activated' and 'stable', present in the vascular tree of the human placenta taken from two distinct highly angiogenic gestational periods (first and last trimester). Stability is conferred by the presence of occludin in tight junctions and plakoglobin in adherens junctions. Their localization may be influenced by vascular endothelial growth factor and angiopoietins 1 and 2 that have a similar temporal and site-specific differential expression. The junctional phenotypes are reversible, as shown in studies with endothelial cells isolated from placental microvessels and grown in the presence/absence of cAMP-enhancing agents. Reductions in protein levels and loss of junctional localization of adhesion molecules result in increased permeability to macromolecules, whilst up-regulation and re-targeting of these molecules inhibit cell proliferation and increase transendothelial resistance. These studies suggest junctional adhesion molecules can regulate physiological angiogenesis and vascular re-modelling. Moreover, the activated junctional phenotype of placental microvessels allows them to participate in increased growth and proliferation. This junctional immaturity appears to be at the expense of barrier function resulting in sites of maximal materno-fetal solute exchange.

Placental development in normal and compromised pregnancies-- a review

Intrauterine growth restriction (IUGR) is a significant cause of infant mortality and morbidity. It is now clear that IUGR infants exhibit higher rates of coronary heart disease, type 2-diabetes, hypertension and stroke as adults. Therefore, fetal growth not only impacts the outcome of the perinatal period, but also impacts adult well-being. The etiologies of IUGR are numerous, but are often associated with abnormalities in placental structure and function. The process of implantation and placentation requires the production of a plethora of growth factors, cell-adhesion molecules, extracellular matrix proteins, hormones and transcription factors. Many of these exhibit altered expression within the placenta of IUGR pregnancies. However, it has been difficult to fully assess their role during the development of placental insufficiency (PI) in the human, underscoring the need for animal models. Using an ovine model of PI-IUGR we have observed changes in the expression of vascular endothelial growth factor, placental growth factor, their common receptors, as well as angiopoietin 2 and its receptor, Tie 2. We found that changes in these growth factors can be associated with both acute and chronic changes in placental vascular structure and function. These studies and others are providing needed insight into the developmental chronology of placental insufficiency.

Molecular organization of tight and adherens junctions in the human placental vascular tree

Tight and adherens junctions are major determinants of endothelial integrity. Molecules present therein have been implicated in vascular permeability, stability of junctions, angiogenesis and intracellular signalling. Using immunofluorescence and confocal scanning microscopy, the adherens junctions (AJs) in human placental vessels were found to contain the entire cadherin-catenin complex predicted from in vitro studies. Vascular endothelial cadherin (VE-cadherin) clusters were co-localized with beta-catenin, an important signal transduction ligand, and with alpha-catenin, which is thought to link the complex to the peri-junctional actin. Antibodies to plakoglobin, a molecule shown to be a component of stable adherens junctions, revealed immunoreactivity in clefts of stromal villous vessels, but weak or negative immunoreactivity in intermediate and terminal villi. Tight junctional molecules demonstrated a differential surface expression. Within the same villous tree, arteries, veins and arterioles contained occludin but the exchange vessels in terminal villi were immunonegative. ZO-1, however, was present throughout. Ultrastructurally, there were no differences in frequency, position or dimension of tight junctions in these vessels. They showed a consistent 4 nm separation between outer membrane leaflets regardless of their location in the vascular tree. Occludin is not necessary for formation of tight junctions in the placenta; it may have an accessory role providing stability or added adhesiveness to tight junctions of large vessels. Its absence in terminal villous microvessels, along with the weak plakoglobin immunoreactivity in AJs, suggest that the junctions here are less stable. This may allow the increased plasticity necessary in terminal villi for continual growth, proliferation and solute exchange.

Thy-1 differentiation protein and monocyte-derived cells during regeneration and aging of human placental villi

PROBLEM

The classification of placental villi was reviewed, and regeneration of villous trees in mature human placentae was examined.

METHOD OF STUDY

Expression of Thy-1 by placental fibroblasts and pericytes, and markers of endothelial cells and monocyte-derived cells were studied by immunohistochemistry and image analysis.

RESULTS

Villous regeneration consists of: (i) dedifferentiation of mature ramuli into young stem villi producing mesenchymal villi; (ii) differentiation of mesenchymal villi into immature intermediate villi; and (iii) differentiation of immature intermediate villi into transitory intermediate villi, branching into the precursors of mature intermediate and terminal villi. These processes are associated with dedifferentiation and redifferentiation of placental monocyte-derived cells. Significant changes of Thy-1 expression by fibroblasts and pericytes accompany aging and degeneration, as well as regeneration of placental villi.

CONCLUSIONS

Villous aging and degeneration in normal mature human placenta is compensated by regeneration of villous trees. Lack of villous regeneration may cause chronic fetal distress, due to the increasing demands of the growing fetus on the remaining terminal villi.

Immunohistochemical examination of trophoblast populations in human first trimester and term placentae and of first trimester spiral arteries with the monoclonal antibody GZ 112

This paper presents an immunohistochemical study with a monoclonal mouse antibody GZ 112, an IgG1 kappa, which is directed against an antigen expressed in first trimester placenta by all proliferative and invasive extravillous trophoblast populations including a population of Langhans cells that represent extravillous stem cells. Additionally, the GZ 112 antigen is associated with morphological changes of spiral arteries preceding local trophoblast invasion. In term placentae, GZ 112 also strongly reacts with all extravillous trophoblast populations, but additionally recognizes partly villous cytotrophoblast and syncytiotrophoblast too, displaying a heterogeneous staining pattern. GZ 112 is directed against a 42-KDa antigen. Intracytoplasmic network-like staining and cross-reactivity with various human surface and glandular epithelia indicate a cytokeratin intermediate filament or a cytokeratin intermediate filament associated molecule as antigen.

Classification of human placental stem villi: review of structural and functional aspects

The stem villi of the human placenta represent the central branches of the villous trees. They are characterized by a condensed fibrous stroma in which the fetal arteries and veins as well as the arterioles and venules are embedded. Functionally they are accepted as the mechanically supporting structures of the villous trees, and they are supposed to control fetal blood flow to the maternofetal exchange area, which is located in the peripheral villi. To obtain further insights into the functions of the stem villi, the recent literature has been reviewed, and some immunohistochemical, ultrastructural, and reconstruction studies have been added. These new studies were aimed at identifying immunohistochemically different subtypes of stem villi, their branching patterns, the distribution of macrophages, the stromal proliferation patterns, and the differentiation of extravascular stromal cells. Our findings demonstrate that the stem villi and their precursors, the immature intermediate villi, can selectively be identified by anti-gamma-smooth muscle (sm) actin staining. Furthermore, the existence of three different subtypes of stem villi is shown; these differ regarding the presence and distribution of gamma-sm actin-positive cells. These cells were immunohistochemically and ultrastructurally identified as smooth muscle cells and myofibroblasts. Increasingly complex coexpression patterns of cytoskeletal proteins reflect a clearly defined differentiation gradient of extravascular stromal cells, which covers the whole range of an undifferentiated germinative layer beneath the trophoblast to highly differentiated myofibroblasts surrounding the medias of the stem vessels. Possible functions of the extravascular contractile system include the regulation of villous turgor and the control of intervillous blood flow impedance.

Stereology and its impact on our understanding of human placental functional morphology

The new stereology permits the objective, quantitative description of morphology by efficient and design-based methods. Applications to placentas in normal and abnormal pregnancies have proved of great value for challenging earlier misconceptions and interpreting better the processes of growth, morphogenesis, adaptation, and functioning at the whole-organ level. This contribution reviews the essential features of the stereological approach, identifies useful structural quantities, and provides examples of their application in various experiments of nature. We focus particularly on normal gestation and the effects of pregnancies associated with high altitude, maternal diabetes mellitus, preeclampsia, and maternal smoking.

Placental vascular corrosion cast studies: a comparison between ruminants and humans

The microvasculature of both the ruminant placentomes of cattle, sheep, and goats and the human placenta were compared, using corrosion casts of blood vessels and scanning electron microscopy. The fetal vascular trees of ruminant and human placenta differ in form and size, which correlates with the degree of ramification; however, their architecture of stem, intermediate, and terminal villi is similar. In the human, the system of serially linked capillary convolutions of terminal villi is longer than that in ruminants. Therefore, in guaranteeing blood flow against flow resistance, the human vessels particularly need a straight course, anastomoses, and sinusoidal dilations. Specifically in the ruminants studied, the venous vessels outweigh the arterial ones by volume and by number. They are suggested to be absorptive for substances metabolized in the zone of the capillary complex. The most extreme interspecies difference relates to the maternal vasculature, which, in contrast to the fetal system, is a closed system in the ruminant septas and an open lacunal intervillous space in the human. Converging and differing morphological vascular phenomena of ruminants and human placenta are discussed in terms of maternofetal exchange related to placental efficiency. In summary, the ruminant placenta, concerning the fetal vascular tree, in many aspects is workable as a model for the human.

Umbilical Doppler velocimetry in fetuses with trisomy 18 at 10-18 weeks' gestation

The aim of our study was to obtain measurements of the umbilical artery pulsatility index (PI) in pregnancies before invasive procedures for prenatal diagnosis, in order to investigate its potential prognostic value in predicting trisomy 18. We performed a prospective study including 1785 consecutive women from 10 to 18 weeks with singleton pregnancies undergoing chorionic villus sampling (n = 559) or genetic amniocentesis (n = 1226) in our unit. Doppler measurements were performed transvaginally (tenth to 13th week of gestation) or transabdominally (14th to 18th week of gestation) immediately before the invasive procedure. In 7 out of 10 fetuses subsequently diagnosed as trisomy 18, the PI was above the 95th centile, providing a detection rate of 70 per cent, a specificity of 95.1 per cent, a positive predictive value of 7.7 per cent, and a negative predictive value of 99.8 per cent. When the 90th percentile was assayed as a cut-off, the efficacy of PI as a marker of trisomy 18 yielded a sensitivity of 90 per cent and a specificity of 90.4 per cent, with a positive predictive value of 5.2 per cent and a negative predictive value of 99.9 per cent. We suggest that although the use of a single PI measurement for screening purposes needs to be confirmed by further investigation, trisomy 18 fetuses show an abnormal increase in umbilical PI in the first half of pregnancy, and its relation to the early onset of fetal growth retardation needs to be further explored.

Placental villous stroma as a model system for myofibroblast differentiation

Different subtypes of myofibroblasts have been described according to their cytoskeletal protein patterns. It is quite likely that these different subtypes represent distinct steps of differentiation. We propose the human placental stem villi as a particularly suitable model to study this differentiation process. During the course of pregnancy, different types of placental villi develop by differentiation of the mesenchymal stroma surrounding the fetal blood vessels. In order to characterise the differentiation of placental stromal cells in the human placenta, the expression patterns of the cytoskeletal proteins vimentin, desmin, alpha- and gamma-smooth muscle actin, pan-actin, smooth muscle myosin, and the monoclonal antibody GB 42, a marker of myofibroblasts, were investigated on placental tissue of different gestational age (7th-40th week of gestation). Proliferation patterns were assessed with the proliferation markers MIB 1 and PCNA. Additionally, dipeptidyl peptidase IV distribution was studied in term placenta and the ultrastructure of placental stromal cells was assessed by electron microscopy. Different subpopulations of extravascular stromal cells were distinguished according to typical co-expression patterns of cytoskeletal proteins. Around the fetal stem vessels in term placental villi they were arranged as concentric layers with increasing stage of differentiation. A variable layer of extravascular stromal cells lying beneath the trophoblast expressed vimentin (V) or vimentin and desmin (VD). They were mitotically active. The next layer co-expressed vimentin, desmin, and alpha-smooth muscle actin (VDA). More centrally towards the fetal vessels, extravascular stromal cells co-expressed vimentin, desmin, alpha- and gamma-smooth muscle actin, and GB 42 (VDAG). Cells close to the fetal vessels additionally co-expressed smooth muscle myosin (VDAGM). Ultrastructurally, V cells resembled typical mesenchymal cells. VD cells corresponded to fibroblasts, while VDA and VDAG cells developed features of myofibroblasts. Cells of the VDAGM-type revealed a smooth muscle cell-related ultrastructure. In earlier stages of pregnancy, stromal cell types with less complex expression patterns prevailed. The media smooth muscle cells of the fetal vessels showed a mixture of different co-expression patterns. These cells were separated from extravascular stromal cells by a layer of collagen fibres. The results obtained indicate a clearly defined spatial differentiation gradient with increasing cytoskeletal complexity in human placental stromal cells from the superficial trophoblast towards the blood vessels in the centre of the stem villi. The spatial distribution of the various stages of differentiation suggests that human placental villi could be a useful model for the study of the differentiation of myofibroblasts.

Histochemical evaluation of placental angiotensinase A in pre-eclampsia: enzyme activity in villous trophoblast indicates an enhanced likelihood of gestational proteinuric hypertension

The aim of this study was to examine whether differences in placental angiotensinase A (glutamyl aminopeptidase, EC 3.4.11.7) activities occurred in hypertensive complications of pregnancy compared with uncomplicated pregnancies. Biochemical and semiquantitative histochemical methods were used and compared for their applicability. Angiotensinase A activity was detected using L-alpha glutamyl-4-methoxy-2-naphthylamide (alpha-Glu-MNA) as substrate and Fast Blue B salt for simultaneous azo-coupling in cryostat sections of placental tissue samples from 32 patients with pre-eclampsia, 11 patients with pregnancy-induced hypertension and 44 participants with uncomplicated pregnancies. The graduated intensity of reaction product in the villous trophoblast and in fetal blood vessels was evaluated semiquantitatively in a double-blind study by light microscopy (semiquantitative score method). Score levels were related to relative frequencies of hypertensive disorders (proportional odds model) and correlated to the severity of gestational hypertension (Spearman's rank correlation). After detection of enzyme activity, the same tissue samples were homogenized and used for kinetic fluorometric measurements under the same substrate and buffer conditions as in enzyme histochemistry. Enhanced villous trophoblastic angiotensinase A activity was significantly associated with an increased frequency of pre-eclampsia in pregnant women (cumulative odds ratio x 0(1) 6.37; P < 0.001) and showed significant correlations with the severity of gestational hypertensive disorders, represented by systolic (r = 0.31; P < 0.05) and diastolic (r = 0.34; P < 0.05 blood pressure and by concomitant proteinuria (r = 044; P < 0.01). Histochemical evaluation of fetal blood vessels and biochemical measurements revealed no statistically significant results. In conclusion this study demonstrates for the first time that increased villous trophoblastic angiotensinase A activity indicates an increased likelihood of the presence of pre-eclampsia and the severity of hypertensive disorders in pregnancy.

The effects of maternal aerobic exercise on human placental development: placental volumetric composition and surface areas

The histomorphometry of term placentae from women who exercised regularly throughout either the first half or all of pregnancy was compared to that of placentae from matched controls to determine if regular exercise during pregnancy produced histomorphometric evidence of altered development and transport capacity. Conventional stereological techniques were used to estimate placental volumetric composition, surface areas, and villous and vascular configurations in the three groups. Exercise confined to early pregnancy increased the parenchymal component of the placenta, total vascular volume and site-specific capillary volume and surface area. Exercise throughout pregnancy increased these and multiple other histomorphometric parameters associated with the rate of placental perfusion and transfer function. However, significant changes were confined to villi > 80 microns in diameter. The localization of both the timing of the stimulus and the anatomical sites affected indicates that regular, sustained exercise modifies placental development primarily in early and mid-pregnancy. We speculate that the lack of significant changes in the structure and configuration of the smaller villi indicates that other adaptive mechanisms, such as increased rates of placental blood flow, must be well developed by the latter portion of the mid-trimester and adequately maintain fetal oxygenation and substrate delivery throughout the third trimester.

A stereologic study of postmature placentas fixed by dual perfusion

OBJECTIVE

Placental insufficiency has been considered the cause of increased morbidity in infants delivered postmaturely. Former quantitative studies have indicated a decrease in some placental structures just before term. In this study we describe a method of dual perfusion fixation to provide tissue for stereologic examination. Postmature placentas were examined with this method.

STUDY DESIGN

Eleven postmature placentas and 14 placentas delivered at term were fixed by dual perfusion. The volume and the surface area of villi, the trophoblast volume, and the volume, surface area, and length of villous capillaries were estimated by stereologic examination. The Mann-Whitney test (p < or = 0.05) was used for statistical analysis.

RESULTS

Morphologic features were normal in all placentas. No significant differences were disclosed in the stereologic estimates of placentas delivered at term and postmature placentas.

CONCLUSION

No morphologic or significant quantitative changes were found in postmature placentas.

The extravascular contractile system in the human placenta. Morphological and immunocytochemical investigations

In the human placenta, besides the fetal blood vessel system a second extravascular contractile system exists. It is localized in the chorionic plate and runs in a longitudinal direction and adjacent to fetal blood vessels into the stem villi, where it forms perivascular contractile sheaths. Characteristically, cells of the extravascular contractile system are extremely long and spindle-shaped and give rise to fine cell processes, by which they obviously contact each other or insert into the basement membrane of the trophoblast. They show immunoreactivity with desmin, vimentin, alpha-actin, myosin, nitric oxide synthase type I (brain form) and dipeptidyl peptidase IV. The ultrastructure suggests that cells of the extravascular contractile system are related to smooth muscle cells, including subpopulations with myofibroblastic features. In stem villi a few cells are nitric oxide synthase type I immunoreactive. These cells are thought to be specialized smooth-muscle-like cells of the extravascular contractile system or cells of the extravascular contractile system related to paraneurons that generate nitric oxide, which, in turn, may modulate the tone of perivascular contractile sheaths. The high dipeptidyl peptidase IV activity suggests that modulation of the extravascular contractile system may also occur by substance P.

Changes in oxygen diffusive conductances of human placentae during gestation (10-41 weeks) are commensurate with the gain in fetal weight

Evidence is adduced that the oxygen diffusive conductance of the human placenta increases during gestation. Results are based on placentae from 10 weeks to term. The diffusion pathway is analysed as six discrete tissue compartments arranged in series. Stereological and physicochemical data are used to determine partial, total and specific diffusive conductances for each organ and for its tissue compartments. During gestation, maternal and fetal vascular spaces became more voluminous and exchange surface areas of villi and capillaries expanded. Both were manifestations of placental growth and development. Maturation of villi was evident as decreases in effective diffusion distances across the trophoblast and villous stroma. These alterations contributed to improvements in partial and total conductances which continued towards term. Changes within the trophoblast and stroma were particularly influential in determining total conductance. Those on maternal and fetal sides of the diffusion pathway were less important. The rise in total conductance was related directly to the rise in fetal weight. Specific diffusive conductance was constant throughout gestation.

Quantitative description of the elaboration and maturation of villi from 10 weeks of gestation to term

Stereological methods have been applied to a cross-sectional sample of human placentae collected at 10-41 weeks of gestation in order to provide a quantitative description of the growth and maturation of villi. Random tissue sections were analysed to derive volumes, surface areas, lengths, diameters and membrane thicknesses for villi and their fetal capillaries. Expansion of the total volume and surface area of villi can be explained by a dramatic linear growth of terminal villi which begins at about the middle of the second trimester. Growth of intermediate villi also occurs but to a more limited extent. Linear growth is accompanied by villous maturation which involves increases in the relative volume of capillaries and in villous capillarization coupled with decreases in villous diameter, capillary diameter and harmonic thickness of the villous membrane. These findings confirm that placental growth and development depend greatly on growth and maturation of terminal villi. They do not confirm sinusoidal dilation of fetal vessels as a generalized phenomenon. They also support the contention that changes in effective diffusion distances across the villous membrane have real adaptive significance.

Fine structure of the paracellular junctions of terminal villous capillaries in the perfused human placenta

Selected lobules of human term placentae were extracorporeally perfused for a recovery period of 20 min, fixed by perfusion and mordanted with ferrocyanide prior to processing for transmission electron microscopy. The lateral membranes of the endothelial cells of the terminal villous capillaries were found to be separated by paracellular clefts of mean width 15.6 nm. At tight junctional regions (1-4 sites per cleft) the two membranes approached each other more closely and frequently appeared to fuse. However, tilting of the sections in the electron microscope stage showed that the membranes were separated by a gap of mean width 4.1 nm in at least 94% of tight junctional profiles. When individual tight junctions were studied by a combination of serial sectioning and goniometric tilting, they were seen to widen abruptly within a distance of three to seven consecutive thin sections, indicating they were not continuous throughout the axial length of the capillaries. The wide regions of the clefts usually showed linkers, strands of glycocalyx-like material spanning the gap. Linkers may contribute to cell adhesion and possibly form part of a filter within the tortuous paracellular pathway provided by the discontinuous network of tight junctional strands. Human term placental capillaries appear to resemble closely other continuous non-brain capillaries.

Confocal and conventional immunofluorescent and immunogold electron microscopic localization of collagen types III and IV in human placenta

Confocal and conventional indirect immunofluorescence and immunogold electron microscopic methods were applied to examine the distribution of extracellular matrix constituents (collagens types III and IV) in the villi of immature and term human placentae. The immunofluorescence study revealed that collagen type III is more distinct in the villous stroma of term placenta as compared with that of the first trimester. Collagen type IV was detected mainly in endothelial and epithelial basement membranes and interestingly also to a certain extent in the stroma. Results obtained using immunoelectron microscopy support the proposal that collagen types III and IV are characteristic of stromal and basement membranes, respectively. Stromal collagen type IV is apparently localized in association with the interstitial types of collagen (I and III), in the villous stroma of term placenta.

Placental morphometry using a computer assisted measuring programme: reference values for normal pregnancies at term

Using the principle that the human placenta is anatomically composed of fetomaternal flow units, we developed a computer-assisted measurement programme capable of recording complex histometric data about the characteristics of the maturation and structural differentiation of resorption villi, as well as subjecting the results to simultaneous statistical processing. Using 42 placentas obtained after normal pregnancies, reference values were derived for the five primary geometrical and six further arithmetical parameters. From these findings, we also calculated the total resorption villi surface area, the proportion of this surface area occupied by epithelial plates, and the resorption-villi surface are relative to the birth weight of the child. Our findings are compared with other available results, and the reasons for discrepancies between previously published measurements are discussed.

Villous composition and membrane thickness in the human placenta at term: a stereological study using unbiased estimators and optimal fixation techniques

The aim of this study was to obtain unbiased estimates of in vivo villous composition and membrane thickness in the human placenta at term. By taking biopsies of the placenta 1 min after separation during caesarean section, and at regular intervals thereafter, it was possible to extrapolate back to the time zero values. It was estimated that at term intermediate and terminal villi are composed of 25.3 per cent trophoblast, 36.2 per cent stromal core and 37.1 per cent fetal capillaries. The villous membrane, defined as the outer surface of the syncytiotrophoblast (excluding the microvilli) to the inner surface of the capillary endothelium, was estimated to have an arithmetic mean thickness of 4.53 microns and a harmonic mean thickness of 3.65 microns. Villous composition and membrane thickness were found to change rapidly after delivery, despite the umbilical cord remaining clamped, and these changes were believed to be predominantly due to leakage of fetal blood or plasma from sites of damage to the villous tree caused at the time of delivery. These estimates do not, and indeed cannot, take into account the fact that the villi sampled have been removed from their uterine environment, and thus from the influences of the maternal and fetal blood pressures. However, they are free from methodological errors that have detracted from previous studies, and thus allow the morphometric diffusing capacity of the placenta at term to be calculated more accurately. They also provide baseline data against which measurements obtained from pathological pregnancies can be compared.

Ultrastructure of the normal human placenta

In this review, the ultrastructure of the normal human chorionic villus is examined and illustrated. The outer covering of trophoblast, comprising the generative cytotrophoblast and the multinucleated syncytiotrophoblast which is derived from it, is described, including such features as the microvillous surface, vesicles and vacuoles, endoplasmic reticulum and secretory droplets. The structure, composition, development and inclusions of the trophoblastic basement membrane are discussed, and the ultrastructure of the various components of the stroma, including reticulum cells, fibroblasts, Hofbauer cells, capillaries and the non-cellular matrix are illustrated and described, with special reference to their inter-relationships and function.

Direct preparations from chorionic villi--relationship between villous morphology and mitotic index

It has been postulated that chorionic villi with abundant sprouts have a higher mitotic index and are therefore preferable for obtaining direct chromosome preparations from chorionic villus samples. This theory was tested by correlating villous morphology with mitotic index. Surprisingly, no statistically significant relationship was found. Choice of culture medium, however, was found to be important, with serum-free RPMI yielding a higher mitotic index than 40 per cent FCS in MEM. We conclude that villous morphology, as assessed in this study, is not a major factor in determining the success of direct chromosome preparations.

Methodological problems in placental morphometry: apologia for the use of stereology based on sound sampling practice

Several problem areas in morphometry of human and animal placentae are reviewed. Attention is given to methods of tissue processing (handling, mode of fixation, embedding, shrinkage) and sampling (of organs, tissue blocks, sections, micrographs). Principal sources of bias and sampling variability are identified and the crucial importance of randomized sampling is emphasized. Methods for obtaining structural quantities from sections are compared. The case is made for estimating absolute values (volumes, surface areas, lengths, numbers, thicknesses) using stereological principles rather than relying on planar data (profile areas, perimeter lengths, numbers, apparent thicknesses). Absolute values may be obtained simply and efficiently without resort to expensive measuring devices. Finally, morphological descriptors suitable for correlating with functional data or for comparing normal and diseased organs are surveyed.

Ultrastructure of first trimester chorionic villi with regard to the prenatal diagnosis of genodermatoses

Hopes are held out for chorion villus sampling, a technique which is gaining more and more importance for the first trimester prenatal diagnosis of chromosomal aberrations and metabolic abnormalities. A variety of inherited skin diseases can be diagnosed postnatally and prenatally (in the second trimester) by ultrastructural diagnostic markers. For evaluation of prenatal diagnosis in the first trimester, we investigated chorionic villi derived from the trophoblast layer of the early pregnancy by light microscopy and conventional electron microscopy. The ultrastructure of the cellular layers covering the villi, i.e., the inner cytotrophoblast and the outer syncytiotrophoblast, as well as that of the connective tissue of the inner extraembryonic mesoderm, are thoroughly described in relation to the ultrastructural changes in certain genodermatoses including epidermolyses and keratinization disorders. We found that chorionic villi have only a few of the characteristics differentiated in skin, and none of the structures which are relevant to the diagnosis of genodermatoses. In our view, the ultrastructural approach is not suitable for first trimester prenatal diagnosis of genodermatoses in chorionic villi.

Cross-sectional features and three-dimensional structure of human placental villi

Human placental villi from both normal and complicated pregnancies were examined by both light and scanning electron microscopy. The findings provide evidence that histological features such as syncytial sprouts, bridges, and a net-like arrangement of villi represent tangential sections of irregularly shaped villi rather than proliferative activity of the villous surface. Hence the two-dimensional appearance of paraffin and semithin sections has to be interpreted three-dimensionally in comparison with the respective scanning electron micrographs. In the light of these findings the various types of villous maldevelopment are summarized in a diagram which may be used as an aid for pathological diagnosis.

The influence of mode of fixation on morphometrical data derived from terminal villi in the human placenta at term: a comparison of immersion and perfusion fixation

The placenta is a highly vascular organ which is subjected to a variable degree of compression during delivery. Partial collapse of the fetal capillary network inevitably results, and this has significant effect upon the maternofetal diffusion distance. Fixation via a dual perfusion system operating at physiological pressures can redistend the vascular tree to its antenatal state. Morphometrical analysis provides a volume fraction for the fetal capillaries within the terminal villi of 38.4 per cent, a figure which approximates closely to values obtained from in situ biopsy of the placenta. The harmonic mean diffusion distance was found to be 3.6 micron. Perfusion fixation resulted in a lower coefficient of variation for many parameters compared with traditional immersion fixation. By negating the unpredictable influence of the placental transfusion, it is considered that perfusion fixation will make true interplacental variations easier to detect.

Immunohistochemical location of HPL, SP1 and beta-HCG in normal placentas of varying gestational age

Sixty-four placentas at various gestational ages were examined by immunohistochemical stains for HPL, SP1 and beta-HCG according to a modified PAP method (Sternberger 1970). Syncytiotrophoblast cell layer was identified as the main site of synthesis. Extravillous immunohistochemical reactions for HPL and SP1 (but not for beta-HCG) were found in X-cells of the basal plate and in the intervillous trophoblast islands. These cell types would thus seem to be derived from trophoblast. Hofbauer-cells of villous connective tissue stained specifically for beta-HCG apparently because of HCG phagocytosis. The intensity of staining for HPL, SP1 and beta-HCG was evaluated semiquantitatively in the syncytiotrophoblast cell layer at various gestational weeks. The maximum of staining for beta-HCG was found in the uniform syncytiotrophoblast layer of immature intermediate villi in early pregnancy (7-14 weeks), HPL and SP1 had their peak of staining reaction at 32-36 weeks of gestation. Increasing maturation results in a subspecialisation of the villous surface: epithelial plates (allowing feto maternal exchange) and nucleated portions of syncytiotrophoblast (which are the main site of hormone production and endocrine activity).

Morphology of placental villi after premature delivery and its clinical relevance

Based on a new concept of maturation of the placental villous tree and its disorders (synchronous and asynchronous immaturity, asynchronous maturity, hypermaturity, and terminal villi deficiency) we studied the possible effect of the placental villous tree on the premature onset of labour. In mature normal neonates irregular and asynchronous villous patterns were found in 50% of cases. In prematurely delivered neonates, only 33% of the corresponding placentas show synchronous immature villous patterns. Uterine bleeding in the first trimester was associated with a 42% of incidence of premature maturation of the villous tree. These findings strengthen the idea that hormonal imbalance in early pregnancy influenced villous development. In "prematurity without recognizable cause" there was a higher percentage of villous maldevelopment (33%) than that previously described in the literature. In severe pre-eclampsia combined with premature onset of labour, 60% of our cases showed hypermaturity of the villous trees. Synchronous immaturity was reduced to 15%. We conclude, that even a rather rough definition of the histological features of placental villi is sufficient to produce numerous correlations between clinical events preceding premature delivery and placental structure. So the influence of placenta on the premature onset of labour needs more attention.

Regional anatomy of the term human placenta

We have studied regional anatomical variability in four term placentae, comparing both whole placental regions and intralobar zones and plates. In addition, we have emphasized the need for careful selection of the area to be sampled, rather than strictly randomized sampling of the whole placenta. A unique contribution is our quantitative data for a number of structures of the several intralobar zones and plates. The data confirm the hypothesis that the area best suited to physiological exchange is the central region parabasal plate. The relative homogeneity of the intralobar zones in this area make it a representative area for sampling for various placental studies.