Placental villous changes among hypertensive and normotensive pregnant women at Kenyatta National Hospital

Document Type



Pathology (East Africa)


Background: Hypertensive pregnancy disease is a major cause of maternal morbidity and mortality in Africa and is one of the major causes of maternal deaths in Kenyan public health facilities. Previous studies have not demonstrated chorionic villous histological changes specifically observed in chronic hypertension in pregnancy and gestational hypertension. No studies have been done in Kenya to demonstrate variations in chorionic villous histomorphology in normotensive and hypertensive pregnant women. Determining the difference between villous histomorphological findings among the hypertensive pregnancy disease clinical groups (pre-eclampsia eclampsia, chronic hypertensive disease and gestational hypertension) may provide insight onto whether the different groups have a common pathological end point; an altered villous histomorphology. Established associations between placental villous histopathology and clinical variables such as maternal blood pressure status will also help sensitize clinicians on the need for histology examination of placentae.

Objective: To determine placental villous changes among hypertensive and normotensive pregnant women who delivered at Kenyatta National Hospital.

Design: Laboratory based retrospective cross-sectional analytical study.

Methods: The study was carried out at the University of Nairobi (UoN) Histopathology Laboratory. Archived placental tissue blocks (n=143) obtained from hypertensive pregnant women and their normotensive counterparts who delivered at Kenyatta National Hospital between July and December 2015 were processed and analyzed.

Results: Placentae from women with hypertensive pregnancy disease at Kenyatta National Hospital had significantly higher rates of accelerated villous maturity, distal villous hypoplasia, stromal fibrosis, decidual arteriopathy, villous infarction and an increased area (>25%) of intervillous fibrin deposition (p<0.01). The pre-eclampsia-eclampsia clinical group had placentae characterized by lesions associated with placental ischemia supporting evidence that placental hypoperfusion could be characteristic of pre-eclampsia-eclampsia rather than gestational hypertension.

Recommendation: Sensitization of clinicians in Kenyatta National Hospital on clinical utility and need for placental histopathological examination in hypertensive pregnancy disease and related clinical scenarios.

Publication (Name of Journal)

East African Journal of Pathology