Morfološka svojstva posteljica iz trudnoća nastalih izvantjelesnom oplodnjom i prijenosom embrija

Objectives: the purpose of this study was to identify the most common features and morphological characteristics of placentas from assisted reproduction technology (IVF + ET) pregnancies. We hypothesize that low placental weight, together with fetal and maternal inflammatory response, would be one of the most common characteristic of placentas from assisted reproductive technology. Furthermore, we expected an increased number of preterm deliveries and reduced birth weight. Materials and methods: This retrospective observational cohort study was conducted at the pathology department of the University Hospital Center of Split. The data were collected from the period of January 1st 2016 until December 31st 2020. The study included placentas from IVF+ET pregnancies that were delivered at the Department of Gynecology and Obstetrics at University Hospital center of Split, and pathohistological analysis was done at the Pathology department of the same hospital. From the database of Gynecology department, the following was noted: maternal age, gestational week, newborn gender and birth weight. From the Pathology department database, morphological characteristics of studied placentas were noted. Inclusion criteria were all of the placentas from IVF+ET pregnancies in the above-mentioned time period. Exclusion criteria were placentas from pregnancies that weren’t IVF+ET and with insufficient data. Results: From the 54 placentas from IVF+ET pregnancies that were analyzed, 36 appeared to be of the dichorionic diamniotic kind. The average age of the mother at the time of delivery was 34 years and most of the placentas were from preterm delivery with a median of 36 gestational weeks. Furthermore, a predominance of male gender was noted (77.8% male newborns). On gross examination median placental weight was 406 grams with a diameter of 16,7 cm, while average placental thickness was 2,5 cm. The most common site of umbilical cord insertion was eccentric (79.6%), followed by central and velamentous insertion. An interesting finding of our study was the reduced average length of the umbilical cord. In addition, the results show that there was not a significant finding when looking at the isolated maternal or fetal vascular malperfusion. On the other hand, with further results investigation, it is possible to assert that whenever combined with multiple lesions, MVM was noted in 31.5% of the samples (17 placentas). The most common type of MVM was abnormal villous maturation (78.9%), followed by retroplacental hematoma (10.5%), placental infarction and intervillous thrombosis (5.3%). Conclusion: According to the pathohistological analysis, the most important and relevant finding in the IVF+ET placentas was the presence of multiple lesions. The most prominent were combined umbilical cord abnormalities and maternal vascular malperfusion. Additionally, results suggest that the most common type of MVM observed was abnormal villous maturation. Another noteworthy finding was a reduced umbilical cord length average and low placental weight. Further research is required to reveal the exact reasons for morphological abnormalities in the IVF+ET placentas, in order to reduce their potential harm on the mother and the baby.Ciljevi: odrediti najčešće morfološke karakteristike posteljica iz trudnoća potpomognute oplodnje (IVF+ET). Očekujemo da će niska masa posteljice, majčin i fetalni upalni odgovor, kao i niska porođajna masa djeteta i prijevremeno dovršenje poroda biti najučestaliji nalaz. Materijali i metode: retrospektivna opservacijska kohortna studija provedena je na Odjelu patologije KBC Split i Klinici za ženske bolesti i porode iste bolnice. Istraživanje je obuhvatilo sve posteljice IVF+ET trudnoća u razdoblju od 1. siječnja 2016. do 31. prosinca 2020. godine, s dostupnim patohistološkim nalazom. Iz baze podataka Klinike za ženske bolesti i porode zabilježeni su: dob majke, gestacijski tjedan, spol novorođenčeta i porođajna masa djeteta. Iz baze podataka Odjela za patologiju zabilježene su morfološke karakteristike proučavanih posteljica. Kriteriji uključenja u studiju su bili sve posteljice iz IVF+ET trudnoća u gore navedenom vremenskom razdoblju. Kriteriji isključenja iz studije su bili posteljice iz trudnoća koje nisu bile IVF+ET i/ili nisu imale sve potrebne podatke. Rezultati: Od 54 IVF+ET analizirane posteljice, 36 su blizanačke, i to biamnijalne bikorijalne. Prosječna dob majke u vrijeme poroda bila je 34 godine, a većina posteljica bila je iz prijevremenog poroda s medijanom od 36 gestacijskih tjedana. 77.8% novorođenčadi je bilo muškog spola. Medijan mase posteljice je bio 406 grama s promjerom od 16.7 cm, dok je prosječna debljina posteljice bila 2,5 cm. Najčešće mjesto insercije pupkovine bilo je ekscentrično (79.6%), a zatim središnje i velamentozno. Zanimljiv nalaz našeg istraživanja bila je smanjena prosječna duljina pupkovine. Najčešći patohistološki nalaz IVF+ET posteljica su bile višestruke lezije, i to kombinacija maternalne vaskularne malperfuzije (MVM) i fetalne vaskularne malperfuzije (FVM) s upalnim lezijama posteljice i lezijama pupčane vrpce. Zaključak: Prema patohistološkoj analizi, najučestaliji nalaz IVF+ET posteljica su višestruke lezije, smanjena prosječna duljina pupkovine i mala masa posteljice. Potrebna su daljnja istraživanja morfoloških karakteristika IVF+ET posteljica, te njihova usporedba s posteljicama normalnih trudnoća. Bolje razumijevanje istih može doprinjeti boljem razumijevnju IVF+ET trudnoća