ReviewObstetricsThe “Great Obstetrical Syndromes” are associated with disorders of deep placentation
Section snippets
The study of the placental bed: the beginning
The study of the placental bed began in the late 1950s by 2 independent groups of investigators who used different biopsy techniques. Dixon and Robertson,9 working in Jamaica, obtained biopsy samples at the time of cesarean delivery with the use of biopsy forceps. At the time of hysterotomy, biopsy samples were obtained under direct visualization from the implantation site after delivery of the placenta. Using curved scissors, the investigators obtained a disk that was approximately 1 cm in
Spiral artery remodeling
After the physiological changes of the spiral arteries in the placental bed were identified, it was postulated that they resulted from the destructive action of trophoblast on the vascular musculature and the elastic membrane. However, it was soon observed that changes associated with trophoblast invasion were preceded by edema of the wall, disintegration of the elastic elements, and changes in smooth muscle cells, such as rounding of the nucleus, the loss of myofibrils and dense bodies, and
Obstetrical syndromes associated with defective deep placentation
More than 50 years after the original observations, it has become clear that disorders of deep placentation occur in a broader range of clinical complications of pregnancy than initially thought. This underscores the importance of this disorder because it is present in virtually every major obstetrical syndrome.
Comment
Defective deep placentation is associated with a spectrum of obstetrical syndromes that include preeclampsia, IUGR, preterm labor with intact membranes, preterm PROM, abruptio placentae, and spontaneous mid-trimester abortion. We propose that disorders of deep placentation are characterized by (1) the degree of restriction of physiologic transformation of the spiral arteries and (2) the presence of arterial lesions in the JZ myometrium of the placental bed.
The degree and extent of physiologic
Acknowledgments
We thank Giuseppe Benagiano and Jan J. Brosens for useful comments.
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Supported, in part, by the Division of Intramural Research of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health/Department of Health and Human Services.
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