On the role of erythropoietin and ghrelin in placenta previa and placenta accrete

   Summary. Abnormal placental insertion is a cause of massive obstetric hemorrhage, maternal and perinatal morbidity, and mortality.

   The pathogenesis of placenta accreta is currently unknown, and there are no definitive instrumental or serum tests for the precise diagnosis of placenta accreta spectrum (PAS), which underpins the relevance of this study.

   The purpose of the study. To study placental expression of erythropoietin and ghrelin in pathological placental attachment.

   Materials and methods. A morphological study of the placenta of women who gave birth in the inpatient department of the Clinic of the Federal State Budgetary Educational Institution of Higher Education South Ural State Medical University of the Ministry of Health of the Russian Federation in Chelyabinsk was conducted (53 specimens): group 1 — 21 specimens of normally located placentas, group 2 — 17 specimens of placenta previa without signs of placenta accreta, group 3 — 15 specimens of placenta previa (7 cases of placenta accreta, 5 — placenta increta, 3 — placenta percreta, invasion degree 3a). The expression of erythropoietin (EPO) and ghrelin in the placenta was studied using immunohistochemistry.

   Results and discussion. In placenta accreta, EPO expression in placental villous-stromal macrophages was statistically significantly higher than in the control group. Furthermore, in placenta accreta, a clear trend toward an increase in the number of syncytiotrophoblast cells positively expressing EPO was recorded. In abnormal placental attachment (especially in placenta accreta), ghrelin expression in symplastotrophoblast cells was statistically significantly higher than that in the control group. The number of villous-stromal macrophages expressing ghrelin in PAS significantly exceeded that in placenta previa and its normal location. Placental expression of ghrelin and erythropoietin in the amniotic epithelium and decidual cells did not differ between the groups.

   Conclusions. In placenta accreta, erythropoietin and ghrelin expression in villous-stromal macrophages was statistically significantly higher than in normal placentation. In placenta accreta, a clear trend toward increased erythropoietin and ghrelin expression in the symplastotrophoblast was recorded. We propose the use of serum erythropoietin and ghrelin levels as promising serum biomarkers for placenta accreta.

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