[Contribution on functional morphology of the human placenta]

Re-view and view on maturation disorders in the placenta

Until delivery, the placenta plays an important mediator role between mother and fetus. This unit is affected by peristatic conditions, such as acute or chronic maternal diseases, malnutrition, drugs, and others. But also genetic factors and fetal malformations due to embryonic developmental disorders may contribute to macroscopically visible changes and functional disorders of the placenta. In a constantly ongoing progress of maturation, the placenta records and saves changes due to fetal distress partly as maturation disorders. Understanding of maturation disorders might, therefore, be an important contribution to a better understanding of influences on villous differentiation and might improve follow up and fetal outcome to reduce recurrence risk. However, an internationally unified classification system of maturation disorders does not exist. In this review, terminology, trials, and classifications of villous maturation disorders are summed up and compared, to pinpoint the need of agreement on an international unified and reproducible classification of maturation disorders.

Working Towards a Reproducible Method for Quantifying Placental Syncytial Knots

Prominent syncytial knots (SK) in placentas signal advanced gestation or placental malperfusion, reflecting exposures that adversely affect placental development and pregnancy outcomes. Molecular-level interrogations of syncytiotrophoblast have altered perceptions of and raised questions about the function and disposition of SK. Quantifying SK and achieving acceptable levels of interrater reliability have been challenging. Our objective was to develop a simple, reproducible protocol for counting SK and demonstrate interrater reliability overall and within 3 parameters, ie, preterm vs term delivery, presence vs absence of diffuse prominent SK (DPSK), and SK relationship with a lesion, all of which could influence measurement reproducibility and interpretation. Criteria for defining SK and a grid system drawn on glass slides were developed for counting percentage of villi with SK. One disc section each from 151 placentas, sampled from 8 groups defined by the 3 parameters, was assessed by 2 pretrained pathologists. The resulting weighted kappa statistic for overall interrater agreement was 0.60 (very good) and Spearman correlation coefficient for ranking quartiles was >0.70. Agreement was best for preterm placentas, kappa  =  0.61, and those only showing DPSK associated with a lesion, kappa  =  0.67. Agreement was low in the absence of DPSK, kappa  =  0.22, or when DPSK was present in a placenta not associated with a lesion, kappa  =  0.32. The proposed method offers a potentially reliable approach for categorizing SK counts as normal vs abnormal or providing continuous measure counts. More extensive pretraining, focused on placentas with few SK and those without an associated lesion, is recommended to improve agreement.

Syncytial nuclear aggregates in normal placenta show increased nuclear condensation, but apoptosis and cytoskeletal redistribution are uncommon

Introduction

Syncytial nuclear aggregates (SNAs) are increased in pregnancy complications; however, little is known about their origin or function. This study aimed to characterise SNAs in more detail than has been reported previously.

Methods

Immunohistochemistry and morphological examination at the light and ultrastructural level were used to determine the nature and structure of SNAs.

Results

SNAs comprising bridges and syncytial knots had similar frequency with 974 per mm³ of villous tissue (IQR 717–1193) and 833 per mm³ (IQR 766–1190), respectively while there were approximately four times as many sectioning artefacts than knots and bridges combined. SNAs had increased proportions of condensed nuclei compared to the remaining syncytiotrophoblast (33.3% vs. 8.9%) and decreased proportions of euchromatic nuclei (0.0% vs. 16.2%), as assessed by examination of an electron micrograph archive. SNAs showed little evidence of apoptosis, with weak positivity for the apoptosis markers M30-neoepitope at 16.6% and TUNEL at 10.0%; strong staining was rarely seen for either marker. Immunofluorescence demonstrated rare association of actin (α, β or γ) with SNAs, whereas tubulin was in close proximity to SNAs and cytokeratin was seen within and surrounding SNAs.

Discussion

M30-positive SNAs traced through serial sections were significantly more likely to be syncytial knots or sectioning artefacts than bridges. Nuclei within SNAs showed signs consistent with degeneration; however, this is unlikely to be an apoptotic process. There are few changes in configuration of cytoskeletal proteins around SNAs.

Conclusions

These data suggest that the biogenesis and functional significance of SNAs still require resolution.

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.

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.

Interpretation of syncytial sprouts and bridges in the human placenta

Human placental villi from normal and pathological material from the eighth to the 40th week of gestation were examined by light, scanning and transmission electron microscopy. Trophoblastic specializations--such as syncytial sprouts of early and late pregnancy, syncytial knots and syncytial bridges--were classified into proliferative and degenerative processes or artefacts caused by tangential sectioning. In early pregnancy and in diabetes mellitus most syncytial sprouts represent the initial phases in the development of villi. In late pregnancy, in particular in pre-eclampsia, most syncytial knots, sprouts and bridges are histological artefacts, caused by tangential sectioning of the trophoblastic surface. The chance of producing such artefacts is increased with increasing section thickness and with increasing branching and tortuosity of the villi. However, a small proportion of the syncytial knots, sprouts and bridges in the last-trimester placenta, those containing coarse pyknotic nuclei, are trophoblastic specializations of a probably degenerative character.

Intercellular junctions in the full term human placenta. I. Syncytiotrophoblastic layer

Inter- and intrasyncytiotrophoblastic junctions within the human full term placenta were electronmicroscopically investigated using thin sections and freeze-fracturing. Narrow clefts were occasionally situated between surface areas where adjacent chorionic villi exhibited close contact. Within these clefts, extensive zonulae and maculae occludentes and numerous maculae adherentes were found. The zonulae occludentes showed a continuous and irregular course on the membrane surface, and the maculae occludentes were irregularly distributed over extended membrane areas. Besides these areas, maculae occludentes and maculae adherentes were observed on infoldings and invaginations of the synctiotrophoblastic surface membrane. Investigations of the inner surface of the syncytiotrophoblastic layer, that is, the layer facing the villous stroma, also revealed invaginations joined by maculae adherentes. The functional significance of the inter- and intrasyncytiotrophoblastic junctions is discussed with respect to the differentiation of the trophoblast.

[A mathematical model for the description of oxygen-diffusion in the intervillous space of the human placenta (author's transl)]

The oxygen consumption has a central place in the complicated interaction between diminished oxygen supply and degenerative trophoblastic tissue change. In the present investigation, that serves as a mathematical model, the problem of the diffusion equation for the constant state is discussed and solved. It is shown that the diminishing of length of the radius of the maternal blood compartment has the same meaning as the decrease in the flow velocity. The influence of the mass transfer coefficient h on the oxygen partial pressure and on the oxygen transfer is investigated. The influence of parameter variations on the placental alterations during toxemia is discussed and their clinical importance is obvious. Our theoretical model elusidates the value of an early therapeutical approach in the case of toxemia.