Histomorphometric measurements of the wall thickness and internal diameter of the macrovessels of the chorionic villi of placentas from pregnancies complicated by preeclampsia or fetal growth restriction in comparison with normotensive pregnancy. Methods: The research included placentas from singleton pregnancies complicated by preeclampsia and/or fetal growth restriction, women delivered in medical institutions in Karaganda city (Kazakhstan). Placentas were divided into three groups: PE (n = 59), isolated FGR (n = 24), and PE with FGR (n = 41). The control group consisted of normotensive pregnancies, compared by gestation period. Placental examination and selection of placental tissue fragments were carried out in accordance with the consensus recommendations of the Amsterdam Placental Workshop Group. The sections were stained with hematoxylin and eosin and Masson trichrome. Morphometric measurements were performed using ImageJ software version 1.52p. Results: Our data showed that, in the PE group, there was a significant decrease in the wall thickness of the proximal and distal vessels with an increase in internal diameter compared with the control group (p < 0.01). In the PE + FGR group, there was a thickening of the wall of the proximal part of the vessels with a decrease in their lumen and a decrease in the wall thickness of the vessels with an increase in the lumen in the distal part compared with the control group (p < 0.01). Conclusions: Two histopatterns of placental macrovessels in preeclampsia were revealed: the histophenotype of diffuse (proximal and distal) ectatic macroangiopathy with a thin vascular wall with a decrease in the thickness of the muscle layer and the histophenotype of proximal fibromuscular sclerosis with vascular obliteration/spasm and distal ectatic macroangiopathy. We believe that significant structural differences in vascular remodeling may reflect the different temporal and spatial nature of the pathological factor. Future research is needed to investigate the associations between histopatterns of placental vascular remodeling in preeclampsia and long-term perinatal/maternal outcomes.

Background/Objectives: Normal remodeling of the extracellular matrix of the endometrium is a necessary condition for the implantation of a blastocyst. We evaluated whether the use of histochemical reticulin–collagen staining can improve the assessment of the extracellular matrix of the mid-secretory endometrium in recrudescent clinical/biochemical pregnancy losses in comparison with ultrasound and routine histological examination. Methods: We compared the histochemical pattern of reticulin–collagen endometrial biopsy (21st day of the cycle) with ultrasonography and standard histological examination of the endometrium in the following groups: (1) fertile women with gravidity ≥ 2, (gravidity = parity) and (2) women with two or more clinical/biochemical pregnancy losses. Results: A normal pattern (NP) with ordered reticulin fibers forming cellular structures was determined in 92% of biopsies with physiological reproductive status and 44% of biopsies with recrudescent reproductive failure (p < 0.05), despite the fact that there were no differences in ultrasonography and standard histological examination between the groups (p > 0.05). A histochemical pattern of insufficient secretory endometrial transformation with abnormal noodle-like pattern (aNP) collagen fibers was more common in recrudescent reproductive failure (56%) than in women with physiological reproductive status (8%) (p < 0.001), despite the fact that insufficient secretory endometrial transformation with an abnormal noodle-like pattern with collagenization (aNPC) was detected only in recrudescent reproductive failure, and it was not detected in women with physiological reproductive status (p < 0.00001). Conclusions: We determined the histochemical pattern of the extracellular matrix of the endometrium in terms of the type of reticulin–collagen, associated in our study with recrudescent clinical/biochemical pregnancy loss, with improved predictability compared to ultrasonography and standard histological examination. We propose to use the method of histochemical evaluation of the reticulin–collagen pattern in order to stratify groups of women of fertile age at risk of reproductive failure.

Relevance: Preeclampsia is a common multisystem specific pregnancy disorder accompanied by remodeling of placental vessels. Vascular structural changes are influenced by both systemic factors and local anomalies, such as umbilical cord pathology. The large variability and inconsistency of histomorphometric changes in placental vessels as markers of placental dysfunction emphasize the need for their further research using standardized methods of morphometric analysis. The purpose of this work is to evaluate histomorphometric changes in the wall thickness and internal diameter of placental vessels during pregnancy with a different risk of preeclampsia based on screening in the first trimester and umbilical cord pathology. Materials and methods: A retrospective research included pregnant women grouped by preeclampsia risk (high and low) and additionally stratified by the presence of umbilical cord pathology. The placenta examination and the selection of fragments of placental tissue of the postpartum placenta were carried out in accordance with the consensus recommendations of the Amsterdam Placental Workshop Group. The sections were stained with hematoxylin and eosin and Masson trichrome. Morphometric measurements were performed using ImageJ software (version 1.52). The data were analyzed using the Mann-Whitney U-test with Bonferroni correction. Results: Systemic and local factors had an impact on vascular remodeling, manifested in changes in wall thickness and diameter of macrovessels. In the low–risk group without umbilical cord pathology, the average vascular wall thickness was 14.4(11.6 - 17.8)µm, and the diameter of the vascular lumen was 124.9(98.4 – 142.6)µm. In placentas with a high risk of preeclampsia without umbilical cord pathology, a significant decrease in the wall thickness of placental vessels was observed to an average of 8.1(6.3 – 8.8)µm, accompanied by a significant expansion of the vascular lumen to 167.7(128.4 – 189.7)µm. The presence of umbilical cord pathology led to thickening of the wall of the proximal vessels 29.1(24.1-37.1)µm with a decrease in the lumen diameter to 93.7(82.7-105-5 )µm. The differences between the groups reached statistical significance (p<0.001). Conclusion: This research highlights the combined effect of systemic factors (risk of preeclampsia) and local structural changes (umbilical cord pathology) on the remodeling of placental vessels. A decrease in the wall thickness of the placental vessels, accompanied by an increase in the internal diameter of the vessels, suggests significant structural changes that may be early diagnostic and prognostic markers of a newborn's predisposition to cardiovascular diseases.

Background/Objectives: Normal remodeling of the extracellular matrix of the endometrium is a necessary condition for implantation of a blastocyst. We evaluated whether the use of histochemical «reticulin-collagen» staining can improve the assessment of the extracellular matrix of the middle secretory endometrium in recrudescent clinical/biochemical pregnancy losses in comparison with ultrasound and routine histological examination. Methods: We compared the histochemical pattern of «reticulin-collagen» endometrial biopsy (21st day of the cycle) with ultrasonography and standard histological examination of the endometrium in groups: (1) fertile women with gravity≥2, (gravity=parity) and (2) women with two or more clinical/biochemical pregnancy losses. Results: NP with ordered reticulin fibers forming cellular structures was determined in 92% of biopsies with physiological reproductive status and 44% of biopsies with recrudescent reproductive failures (p0.05). Histochemical pattern with disordered abnormal noodle-like reticulin fibers was more common in recrudescent reproductive failures (56%) than in physiological reproductive status (8%) (p<0.001), despite the fact that aNPS was detected only in recrudescent reproductive failures, and in physiological reproductive status was not detected (p<0.00001). Conclusions: We determined the histochemical pattern of the extracellular matrix of the endometrium by the type of «reticulin-collagen», associated in our study with recrudescent clinical/biochemical pregnancy losses, with improved predictability compared to ultrasonography and standard histological examination. We propose to use the method of histochemical evaluation of the «reticulin-collagen» pattern in order to stratify a group of women of fertile age with a risk of reproductive failures.