Maternal circulation in the first-trimester human placenta - Myth or reality?
Maternal circulation in the first-trimester human placenta - Myth or reality?
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DOI：
10.1016/s0002-9378(97)70572-6
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发表时间：
1997-03-01
影响因子：
9.8
通讯作者：
Hustin, J
中科院分区：
文献类型：
--
作者：
Jaffe, R;Jauniaux, E;Hustin, J
子宫胎盘和绒毛间循环发育的经典理论确定，母体血液从妊娠早期就以高压流进入绒毛间隙。这一理论最近受到了挑战，我们提出的假设是，绒毛间循环直到妊娠前三个月结束时才完全建立。对子宫切除标本的离体研究表明，滋养层栓塞在妊娠早期阻碍血液流入绒毛间隙，只有在 12 至 13 周时，这些栓塞才变得松动，允许母体血液持续流入绒毛间隙。这个概念得到了许多其他实验结果的支持。在复杂的早期妊娠中，子宫胎盘循环表现出与正常早期妊娠明显不同的流动特征。在异常妊娠中，彩色多普勒成像显示绒毛间隙内血流增加。我们的假设支持其他研究，这些研究表明胚胎在早期发育过程中喜欢低氧环境，并且在妊娠早期胎盘组织中的氧气水平较低。胎盘循环的经典绘图是基于妊娠中期和晚期的研究，应该重新审视其对妊娠早期的适用性，因为我们将证明新的数据支持早期绒毛间循环的发展是一种渐进现象的假设。
The classic theory of development of the uteroplacental and intervillous circulation determined that maternal blood enters the intervillous space in high-pressure streams from the early first trimester. This theory has recently been challenged and our hypothesis to be presented is that the intervillous circulation is not fully established until the end of the first trimester. Ex vivo studies of hysterectomy specimens have demonstrated that trophoblastic plugs obstruct blood flow into the intervillous space in early pregnancy and only at 12 to 13 weeks do these plugs become loose and allow for continuous maternal blood flow into the intervillous space. This concept is supported by many other experimental findings. In complicated early pregnancies the uteroplacental circulation demonstrates flow characteristics that are strikingly different from those of normal early pregnancies. In abnormal pregnancies increased flow within the intervillous space is demonstrated by color Doppler imaging. Our hypothesis supports other studies that have shown that the embryo favors an environment low in oxygen during early development and that oxygen levels in placental tissue are low in the early first trimester. The classic drawing of placental circulations is based on second- and third-trimester studies, and its applicability to the early first trimester should be revisited because we will show that new data support the hypothesis that the development of the early intervillous circulation is a progressive phenomenon.