Histomorphometric Survey of Placentas of HIV-positive Mothers in Relation to their Clinical Stage in a Teaching Hospital in Uyo, South-South Nigeria

Abstract

Objectives: HIV infection in pregnancy affects the mother, her placenta, and fetus resulting in perinatal/maternal morbidity and mortality. Studies show that HIV-positive mothers have several placental morphological changes. This study aimed to describe the histomorphometric parameters/lesions of placentas of HIV-positive mothers in Uyo, Akwa Ibom State, Nigeria.

Methods: A prospective cross-sectional hospital-based analytical study was conducted at the departments of Obstetrics and Gynecology, and Histopathology, University of Uyo Teaching Hospital, Nigeria from December 2015 to May 2016. We studied 144 pregnant mothers (48 HIV-positive as the test group vs. 96 HIV-negative as controls). Their placentas (fetal membrane, umbilical cord, and placental disk) were collected post-delivery and evaluated (grossly/microscopically) to determine the range of histomorphometric placental parameters/lesions. Relevant obstetric data were obtained from their case notes.

Results: The test group delivered more through cesarean section than the control group (52.1% vs. 31.3%), with mean birth weights of 2.8±0.7 and 3.1±0.6 kg (p = 0.004). The mean placental weights were 57±190.1 and 664.6±167.4 g (p = 0.003), with mean placenta-birth weight ratio of 20.1±4.8 and 20.5±4.57% (p = 0.33). The test groups placental fetal membranes, umbilical cords, and disks mainly displayed acute chorioamnionitis (47.9%), acute umbilical phlebitis (14.6%), and villous vasculopathy (33.3%). The test group had a higher stage/grade of placental inflammation than the control group. In the test group, two stage 4 HIV disease state cases presented with the most severe form of placental inflammatory lesions.

Conclusions: The commonest placental histomorphometric parameters/lesions were acute chorioamnionitis, acute umbilical phlebitis, and acute intervillositis. There was no significant association between HIV/AIDS disease stage with the most severe forms of placental inflammatory lesions.

Keywords: Acquired Immunodeficiency Syndrome; Chorioamnionitis; HIV Infections; Nigeria; Placenta; Pregnancy.

Figure 1

Frequency distribution of fetal outcome in relation to gestational age in both the test and control groups.

Figure 2

Gross morphology of the placentas of (a) a 36-year-old HIV-positive mother showing meconium (greenish brown) staining of the fetal surface; (b) a 30-year-old HIV-negative mother showing massive chorionic plate hematoma of the fetal surface of the placental disk; (c) a 24-year-old HIV-positive mother showing velamentous insertion of the umbilical cord to the fetal membrane instead of the fetal surface of the placental disk; (d) a 37-year-old HIV-positive mother showing massive umbilical cord hematoma as well as maternal surface of the placental disk; (e) a 19-year-old HIV-negative mother showing an area of massive infarction of the cut surface of the placental disk; and (f) a 24-year-old HIV-positive mother showing two false knots of the umbilical cord as well as opaque greenish grey maternal surface of the placental disk.

Figure 3

Photomicrographs of the fetal membrane of (a) a 34-year-old HIV-positive mother showing acute suppurative necrotizing chorioamnionitis (stage 3, grade 2) with acute choriodeciduitis; (b) a 29-year-old HIV-positive mother showing acute choriodeciduitis; (c) a 24-year-old HIV-positive mother showing acute suppurative chorioamnionitis; and (d) a 22-year-old HIV-positive mother showing severe acute suppurative deciduitis with mild acute chorionitis. All images stained with hematoxylin and eosin, magnification = 100 ×.

Figure 4

Photomicrographs of the placental disk of (a) a 32-year-old HIV-positive mother showing acute villitis and acute vasculitis of stem villous; (b) a 32-year-old HIV-positive mother showing infarction and acute intervillositis; (c) a 35-year-old HIV-positive mother showing infarcted villi and massive perivillous fibrin deposition;(d) a 29-year-old HIV-positive mother showing calcification and massive perivillous fibrin deposition; (e) a 30-year-old HIV-positive mother showing acute villitis and fibrin deposition; and (f) a 29-year-old HIV-positive mother showing chronic vasculitis with obliterative features. All images hematoxylin and eosin staining, magnification = 100 ×.

Figure 5

Photomicrographs of the umbilical cord of the placenta from (a) a 32-year-old HIV-positive mother showing acute funisitis (stage 3, grade 2). (b) A 24-year-old HIV-positive mother showing acute phlebitis. Hematoxylin and eosin staining, magnification = 100 ×.

Figure 6

Exploratory relationship between stages of HIV/AIDS and mean placental/birth weight ratio in the test group. Note: F value = 0.46 and p = 0.71. There was a weak association between the stages of HIV/AIDS and the mean placental/birth weight ratios of the test group.