title: The severity of clinical manifestations in preeclampsia correlates with the amount of placental infarction.
abstract: OBJECTIVE
  To correlate placental histopathology, in particular ischemic changes, with the clinical severity of preeclampsia.
  
  
  METHODS
  A blinded retrospective study.
  
  
  METHODS
  One Swedish hospital.
  
  
  METHODS
  One hundred and fifty-seven women with severe (n= 116) or mild (n= 41) preeclampsia and 157 normotensive women matched according to gestational-age.
  
  
  METHODS
  One senior pathologist, blinded to clinical data and group, examined all histological slides. In the statistical analyses, adjustment for gestational week was done when appropriate.
  
  
  METHODS
  Placental histopathological findings.
  
  
  RESULTS
  Amount of infarction increased with the severity of preeclampsia (p < 0.001). Infarction involving ≥5% of the placental tissue was seen in 39.7% of severe preeclampsia, 17.1% of mild preeclampsia and 5.1% of non-preeclampsia. When comparing placentas in severe preeclampsia, mild preeclampsia and non-preeclampsia, there was an increase in the presence of any infarction (80.2%, 61.0%, vs. 20.4%). Also, there was a difference in the presence of decidual arteriopathy (35.3%, 22.0%, vs. 3.8%) and accelerated villous maturation (71.6%, 53.3%, vs. 12.6%). We found no difference in intervillous thrombosis, abruption placenta or placental weight in relation to gestational week.
  
  
  CONCLUSIONS
  In pregnancies with mild or severe preeclampsia, a large proportion of the placentas had histological signs of pathology, in particular signs of ischemia. The pathology was similar, but more pronounced in severe compared to mild preeclampsia, suggesting mild and severe preeclampsia to have similar underlying etiology.
authors.affiliation: Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden. marie-therese.vinnars@ki.se
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Vinnars
authors.forename: Josefine
authors.initials: J
authors.lastname: Nasiell
authors.forename: Sam
authors.initials: S
authors.lastname: Ghazi
authors.forename: Magnus
authors.initials: M
authors.lastname: Westgren
authors.forename: Nikos
authors.initials: N
authors.lastname: Papadogiannakis
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007238:Infarction / Q000150:complications / Q000473:pathology*; D010920:Placenta / Q000098:blood supply* / Q000473:pathology*; D011225:Pre-Eclampsia / Q000209:etiology / Q000473:pathology*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index