Severe pre-eclampsia complicated by HELLP syndrome alterations in the structure of the umbilical cord (morphometric and immunohistochemical study)

Figures & data

Table 1. Obstetric characteristics of the HELLP syndrome and control group.

Characteristics	HELLP group	Control group	p
Maternal age (years)	27.4 ± 6.7	28.4± 4.6	0.512
Number of living children	1.4± 2.14	2.14± 1.52	0.058
Gestational age (week)	32.8± 3.34	33.6± 4.1	0.187
Systolic blood pressure (mmHg)	162.3± 19	119.8± 6.6	<0.001
Diastolic blood pressure (mmHg)	105.7± 15	73.4± 5.7	<0.001

Data are presented as mean± standard deviation

Table 2. Hematological and biochemical parameters in both groups.

	HELLP group	Control group	p
HGB	10.3± 1.6	11.8± 1.18	0.161
WBC	15148± 4178	10810± 2892	<0.001
PLT	93.2± 48.8	252± 64.4	<0.001
ALT	232± 186	17± 7	<0.001
AST	207± 125	23± 9	<0.001
LDH	902± 355	283± 119	<0.001

Data are presented as mean± standard deviation, HGB:Hemoglobin (gram/deciliter), WBC: White blood cell (cells/microliter), PLT: Platelet (cells/microliter), AST: Aspartate aminotransferaseU/L, ALT: Alanine aminotransferaseU/L, LDH: Lactate dehydrogenase (international unit/liter)

Table 3. Morphometric parameters in both groups.

	HELLPn = 20	Controln = 20	p
Group	Mean (SD)Median (SEM)Range		Mann–Whitney U Test
Arterial wall thickness	95.3 (8.06) 96.9 (2.54) 82.7–105	71.1 (7.73) 70.4 (2.44) 56.3–81.3	<0.001
Vein wall thickness	78.6 (8.84) 80.9 (2.79) 63.8–88.9	63.0 (10.7) 68.9 (3.39) 45.3–73.3	0.007
Basement membrane thickness	9.07 (2.41) 8.70 (0.76) 6.06-14.9	4.63 (0.76) 4.73 (0.24) 3.57–5.73	<0.001
Amnion cell nucleus length	8.34 (2.06) 8.51 (0.65) 4.25–11.7	4.54 (1.34) 4.38 (0.42) 3.04–7.39	0.001
Endothelial cell nucleus length	7.27 (1.38) 7.67 (0.43) 4.70–8.80	6.16 (1.54) 6.22 (0.48) 3.40–8.57	0.096
Fibroblast cell nucleus length	10.0 (0.77) 9.91 (0.24) 9.02–11.4	6.27 (1.06) 6.34 (0.33) 4.15–7.81	<0.001
Smooth muscle cell nucleus length	12.3 (2.12) 12.6 (0.67) 9.51–15.6	8.62 (1.47) 8.33 (0.46) 6.70–10.7	0.002

Table 4. Morphometric graphics.

Note: A – arterial wall thickness, B –vein wall thickness, C – basal membrane thickness, D – amnion epithelial length, E – endothel cell nucleus length, F – fibroblast nucleus length, G – smooth muscle nucleus length.

Figure 1. A: Control group, appearance normally of umbilical cord, H–E stain Bar 50 µm. B and C: HELLP group; degeneration of endothelial cell in the vessel wall (arrows), thickness in basal membrane, edema in the intermediate connective tissue between muscle layers (arrows), H–E stain Bar 100 µm, increase in collagen fibres between smooth muscle layers (arrow), Tichrom-Masson stain Bar 100 µm. D and E: Strong expression of MMP9 in basal membrane of vessel wall and amniotic epithelium (arrows). Also positive expression in Wharton's jelly. MMP9 immunohistochemistry staining Bar 100 µm. F and G: Positive expression in endothelial cells, basal membrane and fibroblast cells in HELLP group, CD44 immunohistochemistry staining Bar 50 µm. H and I: Positive reaction of actin protein in Wharton's jelly spindle-like fibroblast cells and smooth muscle layers. α-smooth muscle actin immunohistochemistry staining Bar 100 µm.