IMMUNOHISTOCHEMICAL EXPRESSION OF VASCULAR ENDOTHELIAL GROWTH FACTOR VEGF-A, VEGFR-2 AND TOPOGRAPHICAL FEATURES OF SCANNING ELECTRON MICROSCOPY OF PLACENTAS IN GESTATIONAL DIABETES AT DELIVERY

Abstract

The aim of this study was to notice different histopathological changes in light and SEM of
diabetic placentas and Immunohistochemical expression of vascular endothelial growth factor
VEGF-A, VEGFR-2. Gestational diabetes mellitus result in the metabolic and hormonal
alteration in the fetus. fetal hyperglycaemia will result in fetal hyperinsulinemia and stimulation
of fetal metabolism. Lower fetal oxygen content associated by higher lactate concentrations
reflect better fetal metabolism as a result of hyperglycaemia and hyperinsulinemia. So, the
growth of fetal oxygen stresses will worsen the chronic fetal hypoxia. The hyperglycemia of
GDM an effect on placental angiogenesis and microvascular remodeling. VEGF/VEGFR-2,
which was designated as descriptive factors related to the placental blood barrier and
angiogenesis in this study, is important in indorsing vascular endothelial cell growth and in
increasing the number of vessels and capillaries, the suitable supply of nutrients to the fetus.
Pregnant women were screened for diabetes. They were subsequently divided into
normoglycemic (40 cases), GDM (40 cases). Placentas collected were subjected to
histopathological examination. VEGF expressions were studied by immunohistochemistry
expression. Placental villi in a case of fetal death associate to complications of pregnancy as
preeclampsia severe, megaloblastic macrocitic anemia, infection by Zika virus and marginal
insertion of umbilical cord were showed in woman pregnancy of 26 years old at 22 weeks of
pregnancy causing severe degenerative changes. Is our objective to explore the cell surface of the
trophoblast identifying the changes observed with scanning electron microscopy. Samples of
normal trophoblast were compared with samples of the case with the four complications. This
case was correlated besides with the features found with light microscopy according with a
preliminary study previously published. Groups of villi were seen not following their normal
morphological pattern. Immature globular terminal villi rush out of mesenchymal villi in
irregular aspect. This experimental study revealed the reduced expressions of VEGFA and
VEGFR2 in the placental tissues obtained from women with GDM. It should be noticed for both
clinicians and GDM women that the reduced VEGF/ VEGFR2 may affect the placental blood
barrier and angiogenesis, and resulting placental function, in the pregnancy with GDM.
Histological finding of GDM group showed increased thickening of Placental barrier, massive
fibrinoid necrosis and chorangiosis . Histopathological changes in SEM of diabetic placentas
found bad development of villi with curvilinear with reduced cylindrical microvilli in the
surface of terminal villi.