THE SPECIFIC FEATURES OF THE PLACENTAL STRUCTURE IN WOMEN OPERATED ON FOR CONGENITAL MALFORMATIONS OF THE HEART AND VESSELS AT 33-36 WEEKS' GESTATION

Objective. To reveal the structure of placentas from pregnant women operated on for congenital malformations of the heart and vessels during preterm labor at 33-36 weeks’ gestation. Subject and methods. Forty-three placentas from pregnancies resulting in live birth in patients operated on for congenital malformations of the heart and vessels at 33-36 weeks’ gestation were examined. These included 16 (37.2%) placentas from women operated on for acyanotic heart disease, 18 from puerperants for cyanotic heart disease, and 9 (20.9%) from patients for heart defects with an obstacle to blood flow. ere examined. A study group consisted of 56 women operated on for CMHV. A control group comprised 20 patients without congenital heart disease who were matched for parity, age, and social class. The study group patients were divided into three subgroups: 1) 22 (39.3%) pregnant women operated on for acyanotic heart disease; 2) 18 (32.1 %) women operated on for cyanotic heart disease; 3) 16 (28.6%) patients with operated heart defects with an obstacle to blood flow. Results. The findings were compared with those described in the literature on placentas of the same period during physiological pregnancy. The macro- and microscopic features of the structure of placentas from women operated on for congenital malformations of the heart and vessels were revealed. Major changes were noted in the villous chorion and intervillous lacuna. The development of the villous tree was marked by the preponderance of chorionic villus angiogenesis that was inadequate to the period of pregnancy, as well as accelerated collagenization of the stroma of villi that led to the narrowing of intervillous lacunas. In turn, the impairment of maternal blood rheological properties in the intervillous lacuna, which was accompanied by vascular stases, infarction, thrombosis, and excessive intervillous fibrinoid deposition in the presence of maternal hemodynamic disorders, resulted in hemodynamic impairments at the level of the structures of the placental barrier. Conclusion. The found structures suggest that chronic placental insufficiency in the patients operated on for congenital malformations of the heart and vessels results from inadequate inflow of maternal blood with the predominance of two variants: impaired and normal maturity of the villous tree.

pregnancy, congenital heart diseases, placentas