Comparing features of placental morphology between Preeclamptic and Normotensive mothers delivering at Kawempe National Referral Hospital

Abstract

Introduction: Preeclampsia is a complication of hypertensive disorder of pregnancy that affects 5 – 10% of all pregnancies and is responsible for majority of maternal and perinatal mortalities. The placenta is vital for growth and survival of the foetus but its morphology and function are altered by maternal diseases such as preeclampsia leading to fetal complications. Despite the high burden of pre-eclampsia in Africa, very few studies have investigated the relationship between placental morphology, pre-eclampsia and perinatal outcomes.The objective of this study was to compare features of placental morphology between preeclamptic and normotensive mothers who delivered at Kawempe National Referral Hospital in Uganda. Methodology: A comparative cross sectional study was conducted among preeclamptic and normotensive mothers recruited at the emergency obstetric ward of Kawempe National Referral Hospital. The study included consented women who had singleton pregnancies and were at 28 weeks of gestation or more. The normotensives were consecutively recruited and each would then be matched to a preeclamptic mother using a purposive sampling approach based on the gestational age. Results: The study recruited 194 preeclamptics and 194 normotensives. There was no observed noteworthy difference from the mean gestational age of the mothers with pre-eclampsia vs the normotensive mothers (35.7 vs 35.6 weeks; p-value=0.76). 127(68.3%) of the pre-eclamptic mothers had a personal history of gestational hyperstension in the previous pregnancies compared to 7(3.6%) normotensives with a p-value <0.001. 114(60.3%) placentae for pre-eclamptic mothers were round, 41(21.7%) were oval and 34(18%) were irregular and these results had a substantial difference from those of normotensive mothers (P-value<0.001). The fetal to placental weight ratio of pre-eclamptic mothers was slightly lower than that of the normotensives (5.485 vs 5.736; p-value= 0.053). Conclusion: The shape of placentae of pre-eclamptic mothers, number of cotyledons contained therein, the site of cord insertion were significantly different from those of the normotensive mothers. Therefore enhanced anterpartal surveillance including doppler ultrasonography and characterisation of placental features to suitably plan for delivery and postnatal care would improve perinatal outcome for babies with low fetal to placental weight ratio.