|Year : 2021 | Volume
| Issue : 4 | Page : 449-451
Hydropic placenta in a case of malaria
Department of Pathology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, Karnataka, India
|Date of Submission||10-Nov-2021|
|Date of Acceptance||25-Nov-2021|
|Date of Web Publication||22-Dec-2021|
Dr. Prema Saldanha
Department of Pathology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, Karnataka.
Source of Support: None, Conflict of Interest: None
Malarial infection can be life-threatening to both the mother and the developing fetus. The placenta can show various histological changes, and the presence of mature parasites or malarial pigment in the placenta is necessary to define placental malaria. This is a case of a 28-year-old multigravida who presented with malaria and was found to have a hydropic fetus on ultrasonography. Hydropic change has not been reported so far in placental malaria.
Keywords: Hydropic change, malaria, placenta
|How to cite this article:|
Saldanha P. Hydropic placenta in a case of malaria. MGM J Med Sci 2021;8:449-51
| Introduction|| |
Malarial infection is endemic in many tropical countries including India and can be dangerous to both the mother and the developing fetus. Malaria can result in complications such as abortion, stillbirth, intrauterine growth retardation, and low birth weight. The placenta can show various histological changes. This case highlights a rare finding in the placenta in the case of malaria.
| Case report|| |
A 28-year-old patient, multigravida, presented with fever and vomiting at 18 weeks of gestation. The patient also gave a history of fever 1 month back and had tested positive for malarial parasites (Plasmodium vivax and falciparum).
Ultrasonography suggested hydrops fetalis with ascites and pleural effusion. The patient was advised termination of the pregnancy. The fetus was found to be macerated and the placenta was edematous. The placenta was sent for histopathological examination.
Grossly the specimen of the placenta weighed 480 g and measured 16 × 12×4.5 cm. The umbilical cord was attached centrally and the cross-section showed three blood vessels. The placenta appeared black and was edematous and heavy and showed multiple cysts ranging in size from 0.5 to 1.5 cm [Figure 1]. No infarcts were seen. Membranes were unremarkable. On microscopic examination, all the villi were enlarged, edematous, and showed the formation of cisternae [Figure 2]. The villi were also avascular. Increased intervillous fibrin was noted. Many of the lining cytotrophoblasts and Hofbauer cells showed black pigment [Figure 3], which was negative for Prussian blue reaction excluding hemosiderin pigment. No parasites were found in the erythrocytes. No trophoblastic proliferation was noted.
|Figure 1: Gross appearance of the placenta showing multiple cystic structures|
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|Figure 2: Histology showing edematous villi. The cytotrophoblast shows blackish pigment (hematoxylin & eosin ×10)|
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|Figure 3: Black pigment seen within the cytotrophoblastic cells (hematoxylin & eosin ×40)|
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| Discussion|| |
Malaria in pregnancy poses a great health risk to the mother and her fetus. In malaria-endemic areas, it is estimated that at least 25% of pregnant women are infected with malaria. Malaria is transmitted transplacentally and results in complications, such as abortion, stillbirth, intrauterine growth retardation, and low birth weight.
It has been observed that woman who is pregnant for the first time is more susceptible to malarial infection than a woman who is multigravidae. This resistance to the malarial infection in multigravidae is due to the development of placental parasite-specific immunity in subsequent pregnancies., However, in our case, the patient was multigravida.
Histological evidence of Plasmodium in the placenta is indicative of placental malaria, a condition associated with severe outcomes for mother and child. Evidence of mature parasites or parasite products (hemozoin pigment) in the placenta is considered a defining feature of placental malaria., The heavy infiltration of Plasmodium falciparum-infected RBCs in the intervillous spaces of the placenta seems to be responsible for all the complications observed. The placenta turns black due to the deposition of the malarial pigment. The accumulation of parasites occurs in the intervillous space, a region in the placenta where the maternal blood bathes the syncytiotrophoblast (the site of maternal fetal transfer).
Histological lesions found in placentas from Plasmodium-exposed women include syncytial knotting, thickening of the placental barrier, necrosis of villous tissue, and intervillositis. These histological changes have been associated with P. falciparum infections, but little is known about the contribution of Plasmodium vivax to such changes.
Hydropic change in the placenta has been reported in some infections such as syphilis, parvovirus B19, herpes simplex virus, cytomegalovirus, and HIV, but not reported in malarial infection to date. It is possible that the hydropic change could be secondary to severe anemia induced by the malarial parasites or the thickening of the trophoblastic basement membrane and could be responsible for causing a mechanical blockage of oxygen and nutrients transport across the placenta.,,
Hydropic villi and cystic change are also seen in hydatidiform mole and placental mesenchymal dysplasia (PMD). Hydatidiform mole, complete or partial, represents an abnormal placenta characterized by enlargement of chorionic villi caused by central edema of the stroma. Variable hyperplasia of the villous trophoblastic cells is present, and this hyperplasia may be marked. Trophoblastic proliferation was not seen in our case.
PMD is a rare condition, characterized by vascular and villous stromal placenta malformation. Most are seen in association with intrauterine growth restriction or fetal demise. It is characterized by placentomegaly and grape-like vesicles resembling hydatidiform mole by ultrasonography. The classic gross finding is the presence of macroscopic cysts. Microscopically, the villi are enlarged with increased stromal connective tissue and cyst formation. The stem villous vessels are characteristically thick-walled and can show thrombosis or dilation. Other than hydropic change, the histological findings characteristic of this lesion were not seen in our case.
| Conclusion|| |
This case represents a rare finding in placental malaria. Histologically, the presence of malarial pigment, and the absence of other features characteristic of molar pregnancy and PMD, suggests that this change was secondary to malarial infection.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]