HISTOPATHOLOGICAL ANALYSIS OF PATIENTS WITH ABRUPTIO PLACENTA IN A TERTIARY HEALTH CARE CENTRE Dissertation submitted in Partial fulfillment of the regulations required for the award of M.D. Degree in PATHOLOGY - BRANCH III THE TAMILNADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI MAY 2019 DECLARATION I hereby declare that the dissertation entitled “HISTOPATHOLOGICAL ANALYSIS OF PATIENTS WITH ABRUPTIO PLACENTA IN A TERTIARY HEALTH CARE CENTRE” is a bonafide research work done by me in the Department of Pathology, Coimbatore Medical College during the period from JANUARY 2017 TO JUNE 2018 under the guidance and supervision of Dr.G.S.THIRIVENI BALAJJI, M.D, Associate Professor, Department of Pathology, Coimbatore Medical College. This dissertation is submitted to The Tamilnadu Dr.MGR Medical University, Chennai towards the partial fulfillment of the requirement for the award of M.D., Degree (Branch III) in Pathology. I have not submitted this dissertation on any previous occasion to any University for the award of any Degree. Place : Coimbatore Dr. A. PETER SAMIDOSS Date : CERTIFICATE This is to certify that dissertation entitled “HISTOPATHOLOGICAL ANALYSIS OF PATIENTS WITH ABRUPTIO PLACENTA IN A TERTIARY HEALTH CARE CENTRE” is a bonafide work done by Dr. A. PETER SAMIDOSS, a postgraduate student in the Department of Pathology, Coimbatore Medical College, Coimbatore under guidance and supervision of Dr.G.S.THIRIVENI BALAJJI, M.D, Associate Professor, Department of Pathology, Coimbatore Medical College, Coimbatore in partial fulfillment of the regulations of the Tamil Nadu Dr. M. G. R. Medical University, Chennai towards the award of M.D. Degree (Branch III) in Pathology. Guide Head of the Department Dr.G.S.THIRIVENI BALAJJI, M.D, Prof. Dr. C. LALITHA, M.D., Associate Professor, Professor and Head, Department of Pathology, Department of Pathology, Coimbatore Medical College, Coimbatore Medical College, Coimbatore -14. Coimbatore -14. Prof. Dr. B.ASOKAN, M.S, M.Ch., Dean, Coimbatore Medical College, Coimbatore -14. ACKNOWLEDGEMENT To begin with, I thank the almighty God for bestowing his blessing on me in this dissertation to be a successful one. I wish to thank our beloved Dean Prof. Dr.B.ASOKAN,M.S.,M.Ch, Coimbatore Medical College and Hospital, Coimbatore for permitting me to conduct this study. I thank Prof. Dr. C.LALITHA, M.D., Professor and Head of the Department, Department of Pathology, Coimbatore Medical College, Coimbatore for her guidance and support. I wish to express my gratitude and sincere thanks to my guide Dr.G.S.THIRIVENI BALAJJI, M.D, Associate Professor, Department of Pathology, Coimbatore Medical College, Coimbatore. This dissertation bears her valuable suggestions and highly professional advice. My heartful thanks to Dr.S.YOGALAKSHMI, M.D, Assistant Professor, Department of Pathology, Coimbatore Medical College, Coimbatore for her timely advice and suggestion through the course of my work. I thank all my Associate Professors and Assistant Professors of Department of Pathology, Coimbatore Medical College, Coimbatore for their opinion and encouragement. I thank Department of Obstetrics &Gynecology, Coimbatore Medical College, Coimbatore, for providing clinical cases, valuable support and guidance which made this dissertation possible. I thank all my patients for their co-operation and support. My deepest and most heart whelming thanks goes to my parents, my father Mr.P.S.AYYAPILLAI and my mother Mrs.A.PADMAVATHY who have showered me with lots and lots of love. My special thanks to my wife Mrs. ANGELIN TISHA B.Tech, whose love, support and constant patience have taught me so much about sacrifice, discipline and compromise. At this juncture, I have a special mention about my elder brother Dr.A.ARUL KAMALRAJ, Ph.D., and my younger brother Mr.A.ANANDHA SELVA REUBEN, MBA., without them, I couldn’t have travelled this far. My heartful thanks to Lab Technicians, Mr. M. SUBRAMANIAN, Mrs. S.J. MUTHUSELVI, Mrs. K. ARULMANI, Mrs. S. SHARMILA DEVI, Mrs.SUNDARAMBAL and typist Mrs.SASIKALA for their help in technical aspects. I thank my junior Dr. D.JENIFER for her help in grossing the specimens. I thank all my non-teaching staffs working in Department of Pathology, Coimbatore Medical College, Coimbatore. I would like to dedicate this book to my family’s little princess A.BRINDHA. I also thank my batch mates and my juniors for their love and support Dr. A. PETER SAMIDOSS CERTIFICATE – II This is to certify that this dissertation work titled “HISTOPATHOLOGICAL ANALYSIS OF PATIENTS WITH ABRUPTIO PLACENTA IN A TERTIARY HEALTH CARE CENTRE” of the candidate Dr. A. PETER SAMIDOSS with registration number 201613255 for the award of M.D Degree in the branch of PATHOLOGY. I personally verified the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 7% percentage of plagiarism in the dissertation. Guide and Supervisor CONTENTS S.NO PARTICULARS PAGE NO. 1. INTRODUCTION 1-4 2. AIM OF THE STUDY 5 3. OBJECTIVES OF THE STUDY 6 4. REVIEW OF LITERATURE 7-37 5. MATERIALS AND METHODS 38-45 6. OBSERVATION AND RESULTS 46-68 7. DISCUSSION 69-84 8. SUMMARY 85-92 9. CONCLUSION 93-98 10. BIBLIOGRAPHY 99-108 11. ANNEXURES I: Proforma and Consent Form 109-110 II: Master Chart 111-112 LIST OF TABLES S. PAGE TITLE NO. NO. 1. Age Distribution among cases and controls 46 2. Mean age of the study 47 3. Correlation of clinical features among cases and control 48 4. Histopathological features of Acute abruption in the study 49 5. Histopathological features of chronic abruption in the study 50 6. Expression of Histopathological features of acute abruption 51 in acute abruption cases and in acute abruption with chronic features cases 7. Statistics - Histopathological features of acute abruption 52 8. Expression of Histopathological features of chronic 53 abruption in acute abruption cases and in cases of Acute abruption with chronic features 9. Statistics - Histopathological features of chronic abruption 55 10. Association of paternal smoking with cases of acute 58 abruption and acute abruption with chronic features 11. Gender distribution of children in Placental Abruption 59 12. Status of children in Placental Abruption 60 13. Correlation between chorioamnionitis and preterm 61 deliveries among Placental Abruption 14. Pregnancy Induced Hypertension 62 15. Analysis of gravida between cases and control 63 16. Histopathological features of acute abruption in Primi 64 gravida and Multi gravida 17. Histopathological features of chronic abruption in Primi 67 gravida and Multi gravida LIST OF CHARTS S. PAGE TITLE NO NO. 1. Age Distribution among Cases and Controls 46 2. Mean age of the study 47 3. Correlation of Clinical features among cases and control 48 4. Histopathological features of Acute abruption in the study 49 5. Histopathological features of chronic abruption in the study 50 6. Expression of Histopathological features of acute abruption 51 in acute abruption cases and in Acute abruption with chronic features cases 7. Statistics - Histopathological features of acute abruption 52 8. Expression of Histopathological features of chronic 54 abruption in acute abruption cases and in cases of Acute abruption with chronic features 9. Statistics - Histopathological features of chronic abruption 56 10. Association of Paternal Smoking with cases of acute 58 abruption and acute abruption with chronic features 11. Gender distribution of children in Placental Abruption 59 12. Status of children in Placental Abruption 60 13. Correlation between chorioamnionitis and preterm 61 deliveries among placental abruption 14. Pregnancy Induced Hypertension 62 15. Analysis of gravida between cases and control 63 16. Histopathological features of acute abruption in Primi 65 gravida and Multi gravida 17. Histopathological Features of Chronic Abruption In Primi 67 gravida and Multi gravida LIST OF COLOUR PLATES S.NO TITLE 1 Gross; Placental Abruption Dilated tortuous vessels over the membranes 2 Gross; Placental Abruption Maternal surface- indentation and hemorrhagic areas 3 Gross- Placental Abruption Placental infarction with congestion 4 Gross – Placental Abruption Retroplacental blood clot with vessel thrombus 5 Gross- Placental Abruption Retroplacental hemorrhage 6 Microscopy - Placental Abruption - funisitis 7 Microscopy - Placental Abruption Squamous mataplasia with moderate chorioamnionitis 8 Microscopy - Placental Abruption Squamous mataplasia with moderate chorioamnionitis 9 Microscopy - Placental Abruption Mild chorioamnionitis 10 Microscopy - Placental Abruption Moderate chorioamnionitis 11 Microscopy - Placental Abruption Severe chorioamnionitis 12 Microscopy - Placental Abruption moderate chorioamnionitis with haemorrhage 13 Microscopy - Placental Abruption Acute deciduitis with fibrinoid necrosis 14 Microscopy - Placental Abruption Intervillous haemorrhage 15 Microscopy - Placental Abruption Intervillous and intravillous haemorrhage 16 Microscopy - Placental Abruption Intervillous haemorrhage and adjacent area of acute deciduitis with haemorrhage 17 Microscopy - Placental Abruption Intervillous haemorrhage and acute deciduitis 18 Microscopy - Placental Abruption Intervillous haemorrhage 19 Microscopy - Placental Abruption Villous haemorrhage with large area of haemorrhage 20 Microscopy - Placental Abruption Moderate chorioamnionitis with adjacent area of hemorrhage 21 Microscopy - Placental Abruption Increased syncytiotrophoblastic knotting 22 Microscopy - Placental