Research Information System
Thesis Type: Doctorate
Institution Of The Thesis: Gazi University, Sağlık Bilimleri Enstitüsü, Turkey
Approval Date: 2010
Thesis Language: Turkish
Student: SÜLEYMAN AKARSU
Supervisor: SUNA ÖMEROĞLU
Abstract:Clarification of possible factors that build effects of diabetes mellitus on fetus is aimed in this study and immünohistochemical comparison of placentas of Type 1 DM, GDM and control group pregnancies was held for this purpose. Placentas of single term pregnancies in Obstetrics and Gynecology Department in Keçiören Research and Training Hospital is used in this study. All placentas were taken during cesarian section of which; 6 Type 1 DM, 6 GDM and 6 control group pregnancies. Specimens were taken from healthy cotyledons of maternal site. Specimens were evaluated in comparison under light microscope and electronmicroscope both; after staining with caspase–9 antibodies to show placental apoptosis and VEGF antibodies to show vascular changes. Free villi, root villi and stroma of villi were observed accompanied with increased syncytial knots and prominent perivillous congestion in Type 1 DM group placentas. Placentas of GDM patients revealed increase in syncytial knots, endovillous hypercapillarisation and congestion in intervillous space. Half–fine specimens of Type 1 DM group showed that vascularity was increased in free and root villi and there were perivillous congestive areas. Electron microscopic examination of same group revealed that chromatin distribution was homogeneous in microvilli over free villi and syncytiotrophoblasts. In fine specimens, villi stroma contained a large number of vascular formations which was obviously increased when compared with contol group. Fine specimens of GDM group showed that, vascularisation was increased in free and root villi compared with control and DM groups. Electron microcopic evaluation of same group revealed, multiple vacuolar formations in syncytiotrophoblast level, thinning of collagen fibres in villi stroma and vascular formations which were overspread the villi. VEGF immünoreactivity scores were statistically different among groups(p=0,002). But difference between DM and control groups’ immünohistochemical VEGF scores was statistically unsignificant (p=0,026). GDM group VEGF immünohistochemical scores were significantly higher than control group (p=0,002). There was not statistically significant difference in VEGF scores between DM and GDM groups (p=0,132). İmmünoreactive caspase–9 scores were statistically different among groups (p=0,008). İmmünoreactive caspase–9 scores were statistically higher than control gruop, in both DM (p=0,009) and GDM (p=0,009) groups but there was not a significant difference in between two gruops(p=0,699). Placental hypoxia– ischemia in both Type 1 DM and GDM were shown to result with hypercapillarisation and increase in VEGF immünoreactivity immünohistochemically. Another finding of placental hypoxia– ischemia which is increase in syncitial knots was also detected in both DM and GDM group placentas. Placental hypoxia–ischemia is one of the factors that cause apoptosis. Increase in apoptotic factors and passage to maternal circulation, inhibit fetal growth by systemic endothelial toxicity. This may be one of the causative factors that result with IUGR and fetal complications in diabetic pregnancies.