Syncytial Knots: A Reflection of Placental Injury in Diabetics and Hypertensive, in Comparison to Normal Placental Maturity

Abstract

The placenta’s essential role in pregnancy is to support fetal development and maternal-fetal exchange. Despite medical advancements, abnormalities in placentas of diabetic and hypertensive women still remains a concern. The placenta manages vital functions like respiration, nutrition, and hormone production, but increased fetal monitoring and caesarean deliveries have not significantly improved outcomes, raising obstetric risks. The early appearance of syncytial knots may indicate abnormal placental function, impacting fetal health This study aimed to assess placental changes in diabetic and hypertensive pregnancies through a cross-sectional comparative design. Conducted at IBMS and DDRRL/DUHS, it involved 150 placental samples categorized into Control (A), Diabetic (B), and Hypertensive (C) groups, each with 50 samples. Placentas were preserved within 40 minutes post-delivery to avoid structural alterations. Tissue samples were taken from central and marginal regions for microscopic evaluation. Average syncytial knots were found to be significantly different in all the study groups. A stark difference was noticed in the diabetic & hypertensive group of about 10.76 and 13.86 respectively in comparison to the control group. This study identified a significant link between syncytial knot formation and pregnancy complications in diabetic and hypertensive groups. The mean syncytial knot count was 17.26 in diabetic placentas and 20.36 in hypertensive placentas, compared to 6.50 in normal pregnancies. Preeclampsia cases showed cytotrophoblast proliferation and excessive syncytial knots. Hypoxic changes and acute arthrosis were common in third-trimester placentas affected by eclampsia and preeclampsia. Previous research supported a relationship between the duration of hypertension and increased syncytial knots, and clinical hypertension classifications were found insufficient to fully capture placental morphology variations. The increased knots in hypertensive pregnancies demonstrate the trophoblast's hypoxia-driven adaptive response, characterized by abnormal cytotrophoblast proliferation and structural changes.