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Placental pathologic changes in malaria. A histologic and ultrastructural study.

P R Walter, Y Garin, P Blot

    The American Journal of Pathology
    |December 1, 1982
    PubMed
    Summary
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    Maternal Plasmodium infection causes placenta malarial changes (PMCs) in 33% of placentas, with reduced placental weight and increased prevalence in primiparas. Macrophages appear to clear parasites, suggesting an immunopathologic process in malaria-affected placentas.

    Area of Science:

    • Pathology
    • Immunology
    • Obstetrics

    Background:

    • Maternal Plasmodium infection is a significant global health concern, particularly in endemic areas.
    • Placental changes associated with malaria can impact pregnancy outcomes.
    • Understanding these changes is crucial for managing malaria in pregnancy.

    Purpose of the Study:

    • To investigate the prevalence and morphologic characteristics of placenta malarial changes (PMCs) in a high-endemicity area.
    • To explore the relationship between PMCs, maternal parasitemia, and demographic factors like parity.
    • To elucidate the role of macrophages and immunopathologic processes in PMCs.

    Main Methods:

    • Analysis of 741 placentas from an unselected population in Gabon.
    • Microscopic examination for PMCs and Plasmodium parasites.

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  • Correlation of PMCs with maternal blood film results, parity, and placental weight.
  • Histologic and ultrastructural assessment of placental tissues.

    • Main Results:

    • PMCs were present in 33% of placentas, with Plasmodium falciparum being the most common.
    • PMCs were more frequent and severe in primiparas.
    • Placentas with PMCs had significantly lower mean weight (46g less).
    • Morphologic changes included parasites, macrophages, pigment, fibrinoid deposits, syncytiotrophoblastic damage, and basal lamina thickening.
    • Macrophages containing parasites and pigment suggest a role in parasite clearance.

    Conclusions:

    • Placenta malarial changes are common in high-endemicity areas and are associated with reduced placental weight.
    • Primiparity is a risk factor for more severe PMCs.
    • The observed placental alterations suggest an immunopathologic mechanism in response to Plasmodium infection.