Defective implantation and placentation: laying the blueprint for pregnancy complications.
Defective implantation and placentation: laying the blueprint for pregnancy complications.
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DOI：
10.1016/s1472-6483(10)61464-2
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发表时间：
2007-01-01
影响因子：
4
通讯作者：
Norwitz, Errol R
中科院分区：
文献类型：
--
作者：
Norwitz, Errol R
正常的着床和胎盘是妊娠成功的关键。妊娠后期出现的许多妊娠相关并发症（如先兆子痫和早产）似乎起源于妊娠早期植入和胎盘发育异常。胚胎着床的特点是滋养细胞侵入母体子宫组织，滋养细胞侵入这些组织的程度似乎是妊娠结局的主要决定因素。过度侵入可导致胎盘异常牢固附着于子宫肌层（胎盘增生），增加产妇和围产期发病率。侵袭不足，特别是血管内侵袭受限，与先兆子痫（妊娠期蛋白尿高血压）、早产、胎膜早破、早产和宫内生长受限等疾病的病理生理学有关。负责植入的分子和细胞机制仍然是个谜。这篇综述将包括植入的概述，然后讨论一些与植入和胎盘缺陷有关的分子机制，包括蜕膜前列腺素和出血在调节滋养细胞侵袭中的作用。对异常着床和胎盘发生的分子机制的进一步了解将有可能提高临床医生治疗这一连续体中发生的疾病的能力，包括不孕症、复发性妊娠丢失、先兆子痫和早产。
Normal implantation and placentation is critical for pregnancy success. Many pregnancy-related complications that present late in gestation (such as pre-eclampsia and preterm labour) appear to have their origins early in pregnancy with abnormalities in implantation and placental development. Implantation is characterized by invasion of the maternal tissues of the uterus by fetal trophoblast, and the degree to which trophoblast invades these tissues appears to be a major determinant of pregnancy outcome. Excessive invasion can lead to abnormally firm attachment of the placenta to the myometrium (placenta accreta) with increased maternal and perinatal morbidity. Inadequate invasion, specifically restricted endovascular invasion, has been implicated in the pathophysiology of such conditions as pre-eclampsia (gestational proteinuric hypertension), preterm premature rupture of membranes, preterm labour, and intrauterine growth restriction. The molecular and cellular mechanisms responsible for implantation remain enigmatic. This review will include an overview of implantation followed by a discussion of a number of molecular mechanisms implicated in defective implantation and placentation including the role of decidual prostaglandins and haemorrhage in regulating trophoblast invasion. An improved understanding of the molecular mechanisms responsible for abnormal implantation and placentation will likely improve clinicians' abilities to treat disorders that occur along this continuum, including infertility, recurrent pregnancy loss, pre-eclampsia, and preterm birth.