Objective: Pregnant women with systemic sclerosis (SSc; scleroderma) have increased risk of premature delivery and small full-term infants. During placental development, angiogenesis and vascular remodelling are essential for a successful pregnancy outcome. We analysed the pathological changes and expression of angiogenic factors in SSc placentas.
Methods: Placenta biopsies were obtained from 3 SSc patients and 4 healthy uncomplicated pregnancies after delivery at 34-38 weeks of gestation. Sections were stained with Masson's trichrome and PhosphoTungstic-Acid-Haematoxylin and immunostained for CTGF, α-SMA, VEGF, PlGF, VEGFR-1 and VEGFR-2.
Results: Pathological findings were signs of decidual vasculopathy, increased syncytiotrophoblast knotting, placental infarcts and villous hypoplasia. Severe and diffuse perivascular and stromal fibrosis of decidua and chorionic villi, as well as extensive deposition of fibrinoid material around decidual vessels and in intervillous spaces were observed. Strong CTGF expression in vessel wall, decidual cells and fibroblasts, and α-SMA+ myofibroblasts were found. VEGF and VEGFR-2 expression was stronger in SSc than in healthy placentas, while VEGFR-1 expression was similar to controls. PlGF immunopositivity was weaker in SSc.
Conclusion: In SSc placentas, severe fibrosis and abnormal vascular remodelling were detected. This may result in reduced blood flow leading to deep sufferance of maternal placenta and possible premature delivery.