Estudo da morfologia vascular do leito placentário na hipertensão arterial crônica / Morphology of the vascular placental bed in chronic arterial hypertension

RESUMO

OBJETIVO: Analisar os padrões histopatológicos das artérias do leito placentário em gestações complicadas por hipertensão arterial crônica (HAC) comparando-os com o de grávidas normais. MÉTODOS: Biópsias de leito placentário, segundo técnica de Robertson et al.1, foram realizadas em pacientes com idade gestacional igual ou superior a 28 semanas, submetidas a cesárea, após a dequitação. O grupo controle (GC) foi composto por 25 pacientes normais e o grupo de estudo composto por 13 pacientes com HAC leve (HL), 11 pacientes com HAC moderada (HM) e 11 pacientes com HAC grave (HG). As classes de hipertensão foram consideradas leve (PAD 90 - 100 mmHg), moderada (PAD 100 - 110 mmHg) e grave (PAD3 > 110mmHg). Os padrões histológicos das artérias espiraladas foram classificados em padrão inalterado, modificações fisiológicas, desorganização da camada média, alterações hiperplásicas, necrose e aterose aguda. RESULTADOS: 1) Os achados anormais foram predominantes no grupo de hipertensas, sendo mais freqüente nos grupos HM e HG. 2) O achado anormal mais prevalente foi a desorganização da camada média, com distribuição semelhante nos grupos HM e HG. 3) Os padrões normais ocorreram nos grupos GC e HL, com distribuição semelhante entre si.

ABSTRACT

OBJECTIVES: To analyze histopathological patterns of placental bed arteries in pregnancies complicated by chronic arterial hypertension. Alterations were considered according to clinical classification of the hypertensive disorders as mild (MG); moderate (MoG) and severe (SG) for comparison with uncomplicated pregnancies, control group (CG). METHODS: Placental bed biopsy was performed in 60 pregnant women; the study group was comprised of pregnant women with hypertension, subdivided in 13 with severe chronic hypertension (CH), 11 with moderate CH and 11 with mild CH, and results were compared to 25 placental bed biopsies from uncomplicated pregnancies. All the pregnant women had a gestational age of at least 28 weeks of gestation with a live fetus and were submitted to cesarean section. Hypertension was considered mild with diastolic blood pressure (DBP) 90 I? 100 mmHg, moderate DBP 100 I? 110 mmHg and severe DBP = 110 mmHg. Placental bed variables selected for histological analysis were unaltered patterns, physiological changes, medial layer disorganization, medial and intimal hyperplasic changes, acute necrosis and atherosis. RESULTS: In cases with SG and MoG there was predominance of abnormal histophysiological findings: medial layer disorganization and hyperplasic changes, with a statistically significant difference when compared to MG and CG. Alteration in the medial layer was observed in these cases. The normal pattern, unaltered patterns and physiologic changes were more frequent in CG and MG. Physiological changes were the most usual finding, further, there was no acute necrosis or atherosis. CONCLUSION: 1. Abnormal histophysiological findings were predominant in hypertensive pregnant women compared to the normotensive ones; 2. These patterns were more frequent, according to the severity of the hypertensive disorders Severe, Moderate and Mild; 3. More significant abnormal findings were a change in the medial layer, mainly in...