The study was performed on the material obtained from 194 pregnant women, in 84 of which was diagnosed the iron deficiency anemia of pregnancy (grade I–II) with placental calcinosis, 80 pregnant women without signs of anemia with placental calcinosis, and 30 with physiological pregnancy without signs of placental calcinosis. In the work were used such research methods as macroscopic, histological, histochemical, immunohistochemical examination, mathematical and statistical data processing.
The dissertation presents a theoretical summarizing and a new solution of a scientific problem concerning the improvement of morphological classification of placental calcinosis in pregnant women in iron deficiency anemia of pregnancy by identification of peculiarities of morphogenesis of pathological placental calcinosis on the background of iron deficiency.
For the first time, the 14 different types of placental calcium deposits were described in iron deficiency anemia of pregnancy, they were divided depending on the internal structure, size and location. In the chorionic tree were distinguished seven types and seven types of deposits were identified in the basal plate of the placenta.
The analysis of the frequency of different variants of calcium deposits in the chorionic tree of the placenta showed that in iron deficiency anemia of pregnancy in the intervillous fibrinoid strongly dominate the deposits of type II and of type IV (over 90% and 80% of placentas, respectively). Deposits in intervillous of fibrinoid of type III were also often found (about 45% of observations). These indicators significantly exceed (p<0.05) the value of frequency of the group of women in which was not mentioned anemia during pregnancy. Other variants of calcium deposits in anemia were much less common, although it should be noted that in anemia, compared with observations of pregnancy without anemia, more common (p<0.05) were met small granular deposits in the syncytiotrophoblast of the chorionic villi of the placenta.
The analysis of the frequency of different variants of calcium deposits in the basal plate of the placenta showed that both in observations of iron deficiency anemia in pregnant women and in observations without anemia, predominate the calcium deposits in fibrinoid of all four types (slightly less of type IV compared to other types). However, it should be noted that in iron deficiency anemia of pregnancy, compared to observations of pregnancy without anemia, the fibrinoid deposits of type II and type IV were detected more often (p<0.05).
According to a histochemical study of iron deficiency anemia of pregnancy in the fibrinoid with calcium deposits of type II and of type IV (small granular deposits) in the chorionic tree and in the basal plate of the placenta, the processes of oxidative modification of proteins and limited proteolysis increase significantly compared to observations without anemia.
The optical density of immunohistochemical staining for placental lactogen and placental alkaline phosphatase in the placental trophoblast in calcinoses is in average lower than in physiological pregnancy. In all placentas there is a vertical heteromorphism of color intensity on placental lactogen and placental alkaline phosphatase in the trophoblast, which manifests in increase of color intensity in the direction from the chorionic plate (zone A) to the basal plate (zone C). Placental calcinosis in iron deficiency anemia of pregnancy compared to observations without anemia is characterized by lower average values of optical density of staining for placental lactogen and placental alkaline phosphatase in the trophoblast in the areas under the basal plate (zone C) and the intermediate zone (zone B) unlike the area under the chorionic plate (zone A).
In placental calcinoses, in comparison with physiological pregnancy, the optical density of immunohistochemical staining for the proapoptotic protein Bax is in average higher, and for the antiapoptotic protein Bcl-2 – lower. In the placenta there is a vertical heteromorphism of color intensity on the proapoptotic protein Bax and anti-apoptotic protein Bcl-2 in the trophoblast, which manifests by increasing of the color intensity in the direction from the chorionic plate (zone A) to the basal plate (zone C) for protein Bax, but by decreasing of intensity of staining in the direction from the chorionic plate (zone A) to the basal plate (zone C) for the protein Bcl-2. Placental calcinosis in iron deficiency anemia of pregnancy in comparison with observations without anemia is characterized by higher average values of optical color density on protein Bax and by lower average values of optical color density on antiapoptotic protein Bcl-2 in trophoblast of all areas of placenta (A, B, C).
