Placental Angiodysplasia: A New Sign for Prediction of Fetal Outcome?

Andrea Marzullo; Emmanuela Vitelli; Gerardo Cazzato; Margherita Fanelli; Giuseppe Ingravallo; Antonella Vimercati; Roberta Rossi; Leonardo Resta

doi:10.3390/jcm12113835

Placental Angiodysplasia: A New Sign for Prediction of Fetal Outcome?

J Clin Med. 2023 Jun 3;12(11):3835. doi: 10.3390/jcm12113835.

Authors

Andrea Marzullo¹, Emmanuela Vitelli¹, Gerardo Cazzato¹, Margherita Fanelli¹, Giuseppe Ingravallo¹, Antonella Vimercati², Roberta Rossi¹, Leonardo Resta¹

Affiliations

¹ Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy.
² Section of Gynaecology and Obstetrics, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy.

Abstract

The study of the placenta is of great importance, not only in the attempt to understand the etiopathogenesis of various maternal-fetal pathologies, but also in the attempt to understand whether it is possible to find the cause of pathological neonatal outcomes. On the other hand, abnormalities of blood vessel formation, such as angiodysplasias, have been poorly characterised in the literature, and there is a need for more studies investigating the potential impact on the fetus. In this paper, we retrospectively analysed 2063 placentas received at the Department of Pathology of the University of Bari 'Aldo Moro', among which we identified 70 placentas affected by angiodysplasia. On these placentas, we carried out histochemical staining with Masson's Trichrome, orcein-alcian blue, and, subsequently, immunostaining with anti-CD31, CD34, and desmin and actin muscle smoothness antibodies. Finally, we performed a morphometric analysis on the allantochorionic and truncal vessels and correlated the results with neonatal outcomes. We studied the characteristics of the angiodysplasias in detail, dividing the patients into two classes (A and B) according to the morphology and histochemical characteristics of the affected vessels; statistical analysis reported a statistically significant association (p < 0.05) between the ratio of maximum thickness to maximum diameter (Tmax/Dmax) and neonatal outcome, with only 30% physiological outcome in the cohort of the placentas affected by angiodysplasia. These results shed light on a rather neglected aspect in the 2015 Amsterdam Classification, as well as in the literature, and provided strong evidence that placental angiodysplasia is predictive of an increased likelihood of the pathological fetal outcome, while other factors remain in the field. Studies with larger case series and guidelines with more attention to these aspects are mandated to further investigate the predictive potential of this pathology.

Keywords: angiodysplasia; gynaecology; malformation; neonatal; obstetrics; outcome; placenta.

Grants and funding

This research received no external funding.