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2 - Development of the utero-placental circulation: purported mechanisms for cytotrophoblast invasion in normal pregnancy and pre-eclampsia

from Part I - Basic science

Published online by Cambridge University Press:  03 September 2009

By
Fiona Lyall
Edited by
Fiona Lyall  and
Michael Belfort
Fiona Lyall
Affiliation:
University of Glasgow
Michael Belfort
Affiliation:
University of Utah
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Summary

Introduction: the placental bed

The placental bed underlies the fetal placenta and includes the decidua basalis and the underlying myometrium containing the uterine spiral arteries. In order to establish human hemochorial placentation and to provide a progressive increase in blood supply to the growing fetus, the placental bed spiral arteries must undergo considerable alterations. These physiological modifications are thought to be brought about by the interaction of invasive cytotrophoblast with the spiral artery vessel wall. Failure of spiral artery transformation is thought to play an important role in the sequence of events which gives rise to pre-eclampsia. The mechanisms that control human trophoblast invasion in normal, let alone abnormal pregnancy, are still poorly understood. This is partly due to difficulties in obtaining “true” placental bed biopsies.

Much of the information on the early physiological changes within the placental bed comes from unique studies on intact hysterectomy specimens (Pijnenborg et al., 1981) Details of trophoblast invasion during late pregnancy and in pregnancies complicated by pre-eclampsia and fetal growth restriction is principally derived from the study of placental bed biopsies taken at the time of Cesarean section. Placental bed biopsies may not be representative of the whole placental bed. To help circumvent this problem, multiple biopsies combined with large numbers of cases should help to provide a more representative picture. The entire blood vessel will not be present in a single biopsy, thus limiting our interpretation of what is happening along its full length.

Type
Chapter
Information
Pre-eclampsia
Etiology and Clinical Practice
 , pp. 20 - 36
Publisher: Cambridge University Press
Print publication year: 2007

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