Morphological changes in the bloodstream and chorionic villi in partial premature detachment of normally located placenta in women with exacerbation of herpesvirus and cytomegalovirus infection

Aim. To assess the morphological changes in the bloodstream and chorionic villi with partial premature detachment of a normally located placenta in women with exacerbation of herpesvirus (HSV type 1) and cytomegalovirus infection (CMVI).
Materials and methods. An X-ray phlebographic and histological examination of 87 placentas was carried out in uncomplicated pregnancy and partial premature detachment of a normally located placenta, developed after reactivation of HSV type 1 and CMVI in patients in the second trimester of gestation. The first group included 32 placentas from women with CMV-seronegative uncomplicated pregnancy, the second group included 21 placentas from patients with exacerbation of HSV type 1, the third – 18 placentas from women with CMVI reactivation, in the fourth – 16 placentas from patients with combined exacerbation of HSV type 1 and CMVI. In all cases, a dosed injection of red lead on drying oil (1:3) was carried out through the umbilical cord vein into the placental blood vessels. In the same areas of the intact placenta and with partial premature detachment of the normally located placenta, the morphological structure of the biopsy specimens was analyzed before and after the introduction of contrast into the bloodstream. When isolating DNA in the tissues of the organ, PCR was used.
Results. In the second group, in comparison with the first one, placental hypoplasia was diagnosed in 14.3% (0%), hematomas on its fetal part in 19% (3.1%, p>0.05), hemorrhages in the maternal part in 38% (6.2%, p<0.01), foci of sclerosis in 9.5% (9.3%, p>0.05), tortuosity of the veins of the first order in 14.3% (6.2%, p>0.05), the phenomenon of “amputation” of veins in 19% (9.3%, p>0.05). Cotyledons with weakly contrasted vessels occurred in 4 cases (in the first group 3, p>0.05), and with non-visualized bloodstream – in 3 cases (in the first group 2, p>0.05). A clear-cut structure of veins of the 2nd order was found in 3 cases, and extravasation in the tissues of the organ – in 2 cases. CMV DNA was isolated in 14.3% of biopsies. In the second group, unlike the first one, terminal villi with partial desquamation of syncytiotrophoblast were visualized in 23.8% (9.3%, p>0.05), with necrosis and calcification of syncytial kidneys in 23.8% (6.25%, p>0.05), with clots in the veins in 9.5% (6.25%, p>0.05), with moderate plethora in 76.1% (65.6%, p>0.05) and with pronounced plethora in 28.5% (12.5%, p>0.05). More often, villi with edema, an increase in collagen fibers, fibrinoid and vascular inflammation, as well as avascular terminal villi were found. The third group, unlike the first one, was characterized by an increase in the number of hematomas on the fetal to 27.8% (p<0.05) and on the maternal parts of the placenta up to 55.6% (p<0.001), as well as blind-ended vessels up to 38.9% (p<0.05). In 5.6% of cases, CMV DNA was determined, as well as pronounced sclerotic changes (50%, p<0.05), inflammation of the walls of blood vessels and stroma of the villi. In the fourth group, HSV DNA was identified in 31.3%, and CMV DNA – in 37.5% of cases (p<0.05), in comparison with the third group, partial desquamation of syncytiotrophoblast was a frequent morphological finding (75%, p<0,05), necrosis and calcification of syncytial nodules (87.5%, p<0.05), calcium deposit in clots of the veins of the stem villi of the I and II order (56.2%, p<0.05) and a pronounced plethora of capillaries of the terminal villi (81 .2%, p<0.01) against the background of a decrease in the number of villi with moderate blood filling (18.7%, p<0.01), which contributed to ischemia, premature stimulation of endothelial activity and contraction of the smooth muscle elements of the blood vessels of the placenta and uterus.
Conclusion. With partial premature detachment of a normally located placenta caused by reactivation of combined HSV type 1 and CMVI, compared with that initiated by mono-HSV type 1 or mono-CMVI, the frequency of morphological markers of damage to the venous bed increases in cotyledons, as a result of the cyto- and angiodestructive influence of pathogens infections. 

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