Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 13 , ISSUE 5 ( September-October, 2021 ) > List of Articles


Endometrial Histopathological Evaluation in Antepartum Hemorrhage for Placental Etiology

Sarbeswar Mandal, Chaitali Karmakar, Masihon Murmu, Nurejjaman, Mahua Mondal, Shermin Siria Begum

Keywords : APH, Decreased fibrin deposition, Endomyometrial biopsy, Hemorrhage, Less physiological changes, Trophoblast invasion

Citation Information : Mandal S, Karmakar C, Murmu M, N, Mondal M, Begum SS. Endometrial Histopathological Evaluation in Antepartum Hemorrhage for Placental Etiology. J South Asian Feder Obs Gynae 2021; 13 (5):319-324.

DOI: 10.5005/jp-journals-10006-1954

License: CC BY-NC 4.0

Published Online: 22-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aims and objectives: The aims of the study were to investigate and identify the structural changes in endomyometrium in association with placental causes of antepartum hemorrhage (APH). Background: The microscopic comparative evaluation of endomyometrium in upper and lower segments including placental bed in APH and non-APH. Type of study: This is a clinical, interventional, prospective, randomized controlled trial (RCT). Place, duration, and sample size: The study was conducted in the Department of Gynaecology and Obstetrics, IPGMER-SSKM Hospital, Kolkata, West Bengal, India, prior to more than a year. Methods and materials: After getting ethical approval, sixty-four (64 cases) APH and non-APH patients were selected, randomized, and allowed into two groups for management point of view by cesarean delivery like Gr-A (N = 32) = cases (APH); Gr-B (N = 32) = controls (non-APH). Four samples from each patient during cesarean delivery of randomly selected cases and controls each from upper lower, anterior, and posterior with one must from placental bed were taken and studied microscopically. The results of microscopic features revealed that there were hemorrhage, an unusual, abnormal vascular structure, absent deciduas changes, direct contact between placenta and myometrium with higher trophoblast infiltration into deciduas, myometrium, and vessels with decreased villous fibrin deposition. Conclusion: The decidua has a major role to play in negotiating “the treaty of compromise” ultimately signed between fetal and maternal tissues if such a treaty is not signed or broken, defective placentation (imperfect fibrinoid—Nitabuch layer) and its consequence must follow.

PDF Share
  1. Penny G, Kernaghan D, Adamson L. Scottis confidential audit service maternal morbidity. Second Annual Report; 2005.
  2. Department of Reproductive Health and Research, WHO maternal morbidity in 2000 estimates, developed by WHO, UNICEF, UNFPA. Geneva. WHIO; 2004.
  3. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. BMJ 2001;322(7294): 1089–1093; discussion 1093–1094. DOI: 10.1136/bmj.322.7294.1089.
  4. Heidari Z, Mahmoudzadeh-Sagheb H, Zakeri Z, et al. Stereological changes of human placenta in systemic lupus erythematosus compared with healthy controls. ZJRMS 2013;15(7):50–54. Available from:
  5. Zhang L, Wang Y, Liao AH. Quantitative abnormalities of fetal trophoblast cells in maternal circulation in preeclampsia. Prenat Diagn 2008;28(12):1160–1166. DOI: 10.1002/pd.2135.
  6. Mc Shane PM, Heyl PS, Epstein MF. Maternal and peri-natal morbidity resulting from placenta previa. Obstet Gynecol 1985;65(2):176–182. PMID: 4038547.
  7. Naeye RL. Placenta previa, predisposing factors and effect on the fetus and surviving infants. Obstet Gynecol 1978;52(5):521–525. PMID: 724168.
  8. Cunningham FG, Leveno KJ, Bloom SL, Spong YC, Dashe SJ, Hoffmann LB, KCasey MB, Sheffield SJ, Editors. Obstetrical hemorrhage. Text book of Williams obstetrics, 25TH Edition. New York: McGrow-Hill; 2018. p.755–802(Sec-11 & Chap-41).
  9. Nyango DD, Mutihir JT, Kigbu JH. Risk factors for placenta praevia in Jos, north central Nigeria. Niger J Med 2010;19(1):46–49. DOI: 10.4314/njm.v19i1.52479.
  10. Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985;66(1):89–92. PMID: 4011075.
  11. Naeye RL. Abruptio placentae and placenta previa: frequency, perinatal mortality and cigarette smoking. Obstet Gynecol 1980;55(6):701–704. PMID: 7383456.
  12. Salihu HM, Li Q, Rouse DJ, et al. Placenta previa: neonatal death after live births in the United States. Am J Obstet Gynecol 2003;188(5): 1305–1309. DOI: 10.1067/mob.2003.303.
  13. Druzin ML. Packing of lower uterine segment for control of postcesarean bleeding in instances of placenta previa. Surg Gynecol Obstet 1989;169(6):543–545. PMID: 2814771.
  14. Wath CA, Ananth CV, Smulian JC, et al. The Histological evidence of inflammation and risk of placental abruption. Am J Obstet Gynecol 2007;197(3):319. Available from:
  15. Dommisse J, Tiltmam AJ. Placental bed biopsies in placental bed. BJOG 1992;99(8):651–654. Available from:
  16. Fox H. Placenta accrete, 1945–1969. Obstet Gynecol Surv 1972; 27(7): 475–490. Available from:
  17. Hardardottir H, Borgida AF, Sanders MM. Histological myometrial fibers adherent to placenta: Impact of method of placenta removal. Am J Obstet Gynecol 1996;174:358.
  18. Brosen I, Robertson WB, Dixon HG. The physiological response of the vessels of the placental bed to normal pregnancy. J Pathol Bacteriol 1967;93:253–266. DOI: 10.1002/path.1700930218. PMID: 6054057.Available from:
  19. Bieniarz J. The patho-mechanism of late pregnancy toxemia and obstetrical haemorrhage 1. Contradiction in the clinical picture of eclampsia and placenta previa depending upon the placental site. Am J Obstet Gynecol 1958;75(2):444–453. DOI: 10.1016/0002-9378(58)90411-3.
  20. Biswas R, Sawhaey H, Dass R, et al. Histological study of placental bed biopsy in placenta praevia. Acta Obstet Gynecol Scand 1999;78(3):173–179. PMID: 10078576.
  21. Zhang J, Savitz DA. Maternal age and placenta previa. A population based, case control study. Am J Obstet Gynecol 1993;168(2):641–645. DOI: 10.1016/0002-9378(93)90511-g.
  22. McFadyen IR, Price AB, Geirsson RT. The relation of birth weight to histological appearance in vessels of placental bed. Br J Obstet Gynaecol 1986;93(5):476–481. PMID: 3707878.
  23. Gerretsen G, Huisje HJ, Elema JD. Morphological changes of spiral arteries in the placental bed in relation to preeclampsia and fetal growth retardation. Br J Obstet Gynaecol 1981;88(9):876–881. DOI: 10.1111/j.1471-0528.1981.tb02222.x.
  24. Meekins JW, Pijnenborg R, Hanseens M, et al. A study of placental bed spiral arteriols and tro-phoblastic invasion in normal and severe preeclamptic pregnancies. Br J Obstet Gynaecol 1994;101(8):669–675. DOI: 10.1111/j.1471-0528.1994.tb13182.x.
  25. Khong TY, Robertson WB. Placenta accreta and placenta previa accreta. Placenta 1987;8(4):399–409. DOI: 10.1016/0143-4004(87)90067-1.
  26. Leibermann JR, Fraser D, Kasis A, et al. Reduced frequency of hypertensive disorder in placenta previa. Obstet Gynecol 1991;77(1):83–86. PMID: 1984232.
  27. Ananth CV, Bowes Jr WA, Sautz DA, et al. Relationship between pregnancy induced hypertension and placenta previa. A population based study. Am J Obstet Gynecol 1997;177(5):997–1002. DOI: 10.1016/s0002-9378(97)70003-6.
  28. Lin S, Shimizu I, Suehara N, et al. Uterine artery Doppler velocimetry in relation to trophoblastic migration into the myometrium of the placental bed. Obstet Gynecol 1995;85:760–765. DOI: 10.1016/0029-7844(95)00020-r.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.