PLACENTA CRETA AND PLACENTA PREVIA CRETA
PLACENTA CRETA AND PLACENTA PREVIA CRETA
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DOI：
10.1016/0143-4004(87)90067-1
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发表时间：
1987-07-01
期刊：
影响因子：
3.8
通讯作者：
ROBERTSON, WB
中科院分区：
文献类型：
--
作者：
KHONG, TY;ROBERTSON, WB
从妊娠或产后即刻子宫切除标本中研究了胎盘植入和前置胎盘的胎盘床。在所有病例中，胎盘绒毛都与子宫肌层直接接触，这是胎盘植入的必要条件，但在某些病例中是局灶性的。没有明显减少的壁蜕膜，或在局灶性accreta的情况下，相邻的基底。在所有的情况下，绒毛外滋养细胞主要是单核或双核的，相反，胎盘床合胞体巨细胞中看到的晚期正常胎盘。在胎盘与子宫肌层交界处有明显的间质滋养细胞增生，但在子宫肌层深处间质滋养细胞的密度低于正常胎盘。观察到一种不寻常的子宫胎盘血管系统，其中子宫肌层深处的放射状/弓状系统的大动脉存在生理变化，而更浅表的螺旋动脉也没有生理变化。这些结果表明，在胎盘植入中，母体组织（特别是蜕膜）与胎盘形成早期的迁移性滋养层之间的相互作用存在缺陷，导致胎盘过度粘附或渗透到子宫内，并伴有异常子宫胎盘循环的发展。
The placental bed in placenta creta and placenta praevia creta was studied from pregnancy or immediate postpartum hysterectomy specimens. In all cases placental villi were seen in direct contact with myometrium, the sine qua non of placenta creta, but was focal in some cases. There was no apparent diminution of decidua parietalis, or in cases of focal accreta, of adjacent basalis. In all cases the extravillous trophoblast was mainly uninuclear or binuclear, in contrast to the placental bed syncytial giant cells seen in late normal placentation. There was an apparent proliferation of interstitial trophoblast at the junction of placenta with myometrium, but the density of interstitial trophoblast deeper in the myometrium was lower than it is in normal placentation. An unusual uteroplacental vasculature was seen in which physiological changes were present in large arteries of the radial/arcuate system deep in the myometrium, while there were also spiral arteries more superficially without physiological changes. These findings suggest that in placenta creta there is defective interaction between maternal tissues, particularly decidua, and migratory trophoblast in the early stages of placentation resulting in undue adherence of the placenta or penetration into the uterus coupled with the development of an abnormal uteroplacental circulation.