23
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
23-27
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
Hypothyroidism is a thyroid dysfunction in which the thyroid gland is not ready to produce enough hormones, leading
to a number of diseases such as sickness, cretinism and myxedema. Thyroid hormones play an important role in
maternal development for the brain and div of the child, during the first three months of motherhood the child
depends on thyroid hormones delivered through the placenta thyroid hormones until 18-20 weeks of pregnancy.
KEYWORDS
Hypothyroidism, fetoplacental insufficiency in pregnant women, pathomorphology.
Research Article
FEATURES OF FETOPLACENTAL INSUFFICIENCY IN PREGNANT
WOMEN WITH HYPOTHYROIDISM
Submission Date:
February 10, 2022,
Accepted Date:
February 20, 2022,
Published Date:
February 28, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue02-06
Farida Muinovna Khamidova
Associate Professor, Candidate of Medical Sciences, pathological anatomy course Samarkand State
Medical Institute, Uzbekistan
Umarova Farangiz Abdufattoevna
Assistant at the course of anatomical pathology Samarkand State Medical Institute, Uzbekistan
Burkhanov Akbar Shukhratovich
202 group student of international faculty Samarkand State Medical University, Uzbekistan
Kumar Lokesh
301- group MBBS Samarkand State Medical Institute, Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
24
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
23-27
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
INTRODUCTION
Adequate placental function is critical for an
uncomplicated
pregnancy
and
better
fetal
development, as the placenta provides the supply of
nutrients, gas exchange and excretion of metabolic
products as well as estrogens, progesterones and
prostaglandins.
Preterm birth has been associated with low thyroid
function, and high thyroid function has been
associated with preeclampsia in pregnant women and
fetal growth retardation, which can result from
adverse pregnancy outcomes. because of impaired
placentation in early pregnancy, while placental tissue
is alert to TG, the authors hypothesised that early
maternal thyroid function may be a regulator of
placentation.
Despite a growing div of basic evidence suggesting
that TG plays a role in the regulation of placental
development. Furthermore, because thyroid and
placental dysfunction are associated with similar birth
complications, the clinical association of thyroid
function with adverse pregnancy outcomes may be
mediated by changes in placental function or vice
versa.
The presence of specific nuclear receptors and
hormones detected in the cranial medulla at the eighth
week of gestation, the free T4 detected in the whole-
brain and amniotic fluid and the demonstration of
maternal thyroid hormone transfer through the
placenta underline the role of thyroid hormones in
cranial brain development. The complex interactions
between the deiodinases iodoamino acids D2 and D3
throughout pregnancy facilitate the fine-tuning of the
availability of adequate amounts of T3 required for
traditional brain development.
A number of pioneering studies by Man et al Haddow
et al and newer studies by Rovet et al and Pop et al
have proved once and for all that children born to
mothers with hypothyroidism have a significantly
increased risk of impaired ratio, psychobiological and
learning skills. children born to untreated women with
hypothyroidism had an AN ratio that was seven points
below the average of children born to healthy women
who received T supplements. This risk extended to
children born not only to untreated girls but also to
girls with suboptimal complementation. A study by
Rovet et al found that these children had slight defects
in intellectual perception of the world, but visual-
spatial ability, language, fine motor skills and learning
ability were not affected. This study emphasises the
need for adequate monitoring of girls at the start of
treatment.
Suboptimal placental function is associated with
complications of labour as well as pre-eclampsia
(which
in
turn
further
worsens
placental
haemodynamics and worsens cranial blood supply),
fetal growth retardation and preterm birth, which is
one of the leading causes of maternal and perinatal
mortality worldwide. Hypothyroidism is difficult to
diagnose during pregnancy because the signs will
belong to the mother herself. Changes in the thyroid
gland have a serious negative effect on both the
mother and the foetus. To date, there is no consensus
on the causes of inadequate function of the feto-
placental complex in this pathology, which makes this
problem urgent.
OBJECTIVE
To investigate the features of feto-placental
insufficiency in pregnant women with hypothyroidism.
To solve this problem, it is necessary to conduct a
25
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
23-27
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
consistent study of the frequency, cause, mechanism
of
development
and
pathomorphological
manifestations of placental abnormalities in pregnant
women with hypothyroidism.
MATERIALS AND METHODS
Placental
tissue
of
pregnant
women
with
hypothyroidism and charts of sick women with
hypothyroidism of pregnant women were used as the
study material. For histological examination, 5 pieces
of 1 × 1 cm were cut from different parts of the placenta
for light microscopy and then fixed in 10% neutral
formalin. After embedding pieces in paraffin, sections
were prepared on a microtome with subsequent
staining with hematoxylin and eosin.
RESULTS OF THE STUDY
Thyroid pathology progressed throughout gestation. A
comprehensive study of placentas obtained both after
natural childbirth and during cesarean section was
carried out. The clinical symptomatology is
polymorphic, usually non-specific and mainly related to
the timing and severity of the hormone deficiency.
acceptable, early treatment and maintenance of
conventional thyroid hormone levels minimise the
chance of maternal and cerebral complications and
increase the chance that motherhood can be carried to
term without serious complications. Hypothyroidism
during pregnancy is sometimes asymptomatic,
especially in the subclinical period. When pregnant
women with hypothyroidism have been observed,
signs and symptoms indicative of hypothyroidism
include inadequate weight gain, cold intolerance, dry
skin and delayed relaxation of deep connective tissue
reflexes. Various symptoms such as constipation,
fatigue and drowsiness are usually associated with
pregnancy.
Macroscopic examination of placenta of women in
labour with hypothyroidism and healthy women was
carried out. In most patients, a number of changes in
placental tissue were observed, such as increased
mass, change in shape, and increased elastic
consistency. Attachment of the umbilical cord is more
often paracentral or central. The membranes are
slightly thickened, ischaemic. In some placentas, there
is an area occupied by infarcts and caverns. In some
cases, lymphohistiocytic infiltrates of interstitial
substance were found. The analysis of the histological
structure of the villous tree revealed that a variant of
pathological immaturity of the placenta was observed
to a greater extent than in the control group. There
were e a functional zones and thrombi in the
intervillous space. Intermediate-type villi with
moderate vascularization of their stroma and a
reduced number of lateral branches dominated over a
large area. The villi were not densely arranged. The
placental tissue was dominated by intermediate and
terminal villi of small calibre. Microscopic examination
of the placenta of women in labour with
hypothyroidism revealed connective tissue fibre
overgrowth, hyperelastosis, edema, fibrinoid swelling
and hyalinosis in the walls of small vessels, and thrombi
were detected. The number of fibrinoid-altered and
sclerosed villi also increased. The syncytiotrophoblast
was desquamated on a large scale. An insignificant
number of syncytial nodules were observed, the
number of nuclei with karyopycnosis and karyorexis
increased sharply. The stroma was loose. Capillaries
were ischemic. In addition, degenerative and
dystrophic changes in syncytotrophoblasts and
cytotrophoblasts were observed. The dystrophic
changes were proteinaceous in nature. Thus,
untreated maternal hypothyroidism will lead to
premature birth, low birth weight and metabolic
abnormalities in the baby. Over the years, ample
26
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
23-27
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
evidence has accumulated for the role of thyroxine in
traditional fetal development.
Children born to mothers with iodine deficiency felt
even worse, and many of them had attention deficit
disorder. The complications that arise depend on the
severity of hypothyroidism, how timely and early
treatment is initiated, the various medical specialities
and the extra-genital pathologies associated with this
maternity. When maternal endocrine imbalances
overlap, there can be undesirable consequences for
each mother and foetus. It is generally accepted that
hypothyroidism in pregnant women is associated with
an increased risk of abortion, stillbirth, preterm birth,
intrauterine
death,
developmental
delay
and
congenital fetal anomalies, congenital hypothyroidism,
anaemia, postnatal depression and internal organ
dysfunction, resulting in excessive maternal morbidity,
perinatal pathology and mortality.
CONCLUSIONS
Thus, the placenta against the background of maternal
thyroid pathology showed signs of damage,
characterised by alteration, focal sclerosis and fibrinoid
necrosis. Circulatory disturbances in the form of full-
thickness and thrombosis have also been observed.
The combination of obstetric and endocrine pathology
increases the risk of pregnancy and delivery
complications with various types of maternal thyroid
pathology. Pregnancy can be a period of good
physiological stress for both mother and foetus.
However, if maternity is combined with endocrine
disorders, such as hypothyroidism, the chances of
adverse outcomes for the mother and the foetus are
enormous. Since hypothyroidism is fully treatable,
early detection and treatment of the disease can
reduce the burden of adverse outcomes.
REFERENCES
1.
Pavlova T.V., Malyutina E., Petrukhin V.,
Markovskaya V. Hypothyroidism in pregnant
women: clinical and morphological parallels. /
J. Phys. No. 4. 2015. Pp. 47-49.
2.
Pavlova T.V., Malyutina E.S. Influence of
thyroid pathology on the condition of
pregnancy and childbirth. / / Zh. nauchnye
vedomosti. 2011. № 10 (105). Issue 14. pp. 9-14.
3.
Kular N.K., Samsonova L.N., Kasatkina E.P. The
course of perinatal period in pregnant women
with diffuse nontoxic goiter, living in the region
of moderately severe iodine deficiency / J.
Gynecology. 2004. Т. 6 no. 2. pp. 12-16.
4.
Kamalova M. I., Islamov Sh. E., Khaydarov N.K.//
Morphological changes in brain vessels in
ischemic stroke. Journal of Biomedicine and
Practice 2020, vol. 6, issue 5, pp.280-284
5.
Nikonova L.V., Davydchik E.V., Tishkovsky S.V.,
Gadomskaya V. I. Thyroid diseases and
pregnancy. / Journal of Grodno State Medical
University No 1, 2016. Pages 82-87.
6.
DeryabinaE.G., Bashmakova N.V., Zilber N.A.,
Dankova I.V. The significance of active
diagnostic
and
therapeutic
tactics
in
autoimmune
hypothyroidism
and
thrombophilia in early pregnancy / J. Vestnik
RUDN, series Medicine, 2009, No.6 p.142-146.
7.
Abalovich .М., Gutierrez S., Alcaraz G.,
Maccallini G., Garcia A., Levalle O. Overt and
subclinical
hypothyroidism
complicating
pregnancy / Thyroid. 2002. V. 12. P. 63.
8.
Krassas, G.E., Poppe, K. & Glinoer, D. Thyroid
function and human reproductive health. /
Endocr. Ed. 31, 702-755 (2010).
9.
Hershman, J.M. The role of human chorionic
gonadotropin as a thyroid stimulant in normal
pregnancy. / J. Clin. Endocrinol. Metab. 93,
3305-3306 (2008).
27
Volume 04 Issue 02-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
02
Pages:
23-27
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
10.
Lazarus, J. et al. European Thyroid Association
Guidelines for the Treatment of Subclinical
Hypothyroidism in Pregnant Women and
Children, 2014. / Euro. Thyroid J. 3, 76–94
(2014).
