Placenta
Nonneoplastic placental conditions and abnormalities
Placental findings in specific conditions
Toxemia of pregnancy (preeclampsia and eclampsia)


Topic Completed: 1 November 2011

Minor changes: 19 February 2021

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PubMed Search: Toxemia of pregnancy preeclampsia eclampsia[title]

Mandolin S. Ziadie, M.D.
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Cite this page: Ziadie MS. Toxemia of pregnancy (preeclampsia and eclampsia). PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/placentatoxemia.html. Accessed May 15th, 2021.
Definition / general
  • Preeclampsia is a pregnancy specific hypertensive disorder diagnosed by the presence of three main signs: hypertension, proteinuria and edema diagnosed after 20 weeks gestational age (usually begins at 32 weeks but may present earlier in patients with preexisting kidney disease or hypertension or hydatidiform moles)
  • Diagnosed in 6% of pregnant women, usually primigravidas, in last trimester
  • Eclampsia is preeclampsia complicated by convulsions, disseminated intravascular coagulation (DIC) affecting liver, kidney, brain, heart and placenta due to thrombosis of arterioles and capillaries
Etiology
  • Early onset disease is attributed to abnormal superficial implantation resulting in diminished blood supply to the placenta
  • Late onset disease is attributed to excessive or ischemic trophoblasts in maternal circulation
  • Maternal hypertension due to endothelial release of vasoactive substances that lead to endothelial damage
Treatment
  • Deliver baby
Gross description
  • Most placentas are smaller than expected although a subset are larger than expected
  • Infarcts and retroplacental hematomas are more common
Microscopic (histologic) description
  • Placenta: villous ischemia (increased syncytial knots, thickening of trophoblastic basement membrane, villous hypovascularity, villous agglutination and infarction), fibrinoid necrosis of uterine vessels and acute atherosis; more tortuous or densely distributed spiral and basal arteries than normal (Hum Pathol 1997;28:353), inappropriate trophoblastic immaturity (Hum Pathol 1995;26:594)
  • Brain: gross or microscopic hemorrhage; small vessel thrombi
  • Kidneys: enlarged, swollen and bloodless glomeruli with capillary lumina obliterated by swollen endothelial cells; no / mild hypercellularity; may have herniation of capillary tuft into proximal tubule (tufting); rare crescent formation in severe cases; normal afferent arterioles; severe disease may cause bilateral renal cortical necrosis
  • Liver: hemorrhage, fibrin thrombi
Microscopic (histologic) images

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Glomeruli

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Glomerular endotheliosis

Immunofluorescence description
  • Fibrinogen deposits, occasionally IgM
Electron microscopy description
  • Lysosomal-like, single membrane lined vacuoles within cytoplasm of endothelium and mesangial cells
  • Some vacuoles contain bland lipids or have myelin-like figures
  • Fibrinogen derived amorphous dense deposits on endothelial side of glomerular basement membrane
Electron microscopy images

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Marked endothelial
cell swelling and
vacuolization

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Swollen endothelial cell with epithelial
foot processes intact (A), swollen
endothelial and mesangial cells showing
prominent vacuolization on capillary lumina

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