Placental bed research: I. The placental bed: from spiral arteries remodeling to the great obstetrical syndromes
Placental bed research: I. The placental bed: from spiral arteries remodeling to the great obstetrical syndromes
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DOI：
10.1016/j.ajog.2019.05.044
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发表时间：
2019-11-01
影响因子：
9.8
通讯作者：
Benagiano, Giuseppe
中科院分区：
文献类型：
--
作者：
Brosens, Ivo;Puttemans, Patrick;Benagiano, Giuseppe
术语胎盘床被创造出来描述母胎界面（即胎盘附着在子宫上的区域）。该区域的适当血管化对胎儿的发育至关重要;这就是为什么现在已经对该区域进行了系统的研究。最初的挑战是识别和分类该区域子宫动脉的各种连续分支。这些血管具有独特的重要性，因为其生理转化的失败被认为是先兆子痫、胎儿生长受限、早产、早产胎膜早破、胎盘早破和胎儿死亡妇女绒毛间隙灌注减少的解剖学基础。为了深入研究胎盘床的病理生理学，大约60年前，对早期和晚期血压正常和高血压妊娠的大量胎盘床活检以及带胎盘原位的剖宫产子宫切除标本进行了仔细的解剖和分析。由于存在一系列特定的生理变化，其特征在于动脉内膜被滋养层侵入和取代，这种材料允许在正常妊娠的胎盘床中识别主要血管，即子宫胎盘动脉。随后发现，先兆子痫与子宫胎盘动脉的子宫肌层段的转化缺陷或缺失有关。此外，在严重的高血压病，动脉粥样硬化病变也发现在有缺陷的子宫肌层段。最后，在基底蜕膜中，还发现了一种独特的血管病变，称为急性动脉粥样硬化。这种深层胎盘形成障碍，称为深层胎盘形成缺陷，与重大产科综合征有关，包括先兆子痫、宫内生长受限、早产、早产胎膜早破、晚期自然流产和胎盘早剥。最近，还引入了简化的组织取样技术：蜕膜抽吸允许获得大量的蜕膜动脉，尽管它们在胎盘床中的起源无法确定。平行于基板表面的活检更有趣，可以识别胎盘床中血管的起源区域（中央，旁中央或外周），并为免疫组化研究提供蜕膜材料。最后，组织化学和电子显微镜的调查，现在已经澄清了病理和发病机制的生理血管变化的损害。
The term placental bed was coined to describe the maternal-fetal interface (ie, the area in which the placenta attaches itself to the uterus). Appropriate vascularization of this area is of vital importance for the development of the fetus; this is why systematic investigations of this area have now been carried out. Initially, the challenge was the identification and classification of the various successive branching of uterine arteries in this area. These vessels have a unique importance because failure of their physiological transformation is considered to be the anatomical basis for reduced perfusion to the intervillous space in women with preeclampsia, fetal growth restriction, preterm labor, preterm premature rupture of membranes, abruptio placentae, and fetal death. To investigate in depth the pathophysiology of the placental bed, some 60 years ago, a large number of placental bed biopsies, as well as of cesarean hysterectomy specimens with placenta in situ, from both early and late normotensive and hypertensive pregnancies, were carefully dissected and analyzed. Thanks to the presence of a series of specific physiological changes, characterized by the invasion and substitution of the arterial intima by trophoblast, this material allowed the identification in the placental bed of normal pregnancies of the main vessels, the uteroplacental arteries. It was then discovered that preeclampsia is associated with defective or absent transformation of the myometrial segment of the uteroplacental arteries. In addition, in severe hypertensive disease, atherosclerotic lesions were also found in the defective myometrial segment. Finally, in the basal decidua, a unique vascular lesion, coined acute atherosis, was also identified This disorder of deep placentation, coined defective deep placentation, has been associated with the great obstetrical syndromes, grouping together preeclampsia, intrauterine growth restriction, preterm labor, preterm premature rupture of membranes, late spontaneous abortion, and abruptio placentae. More recently, simplified techniques of tissue sampling have been also introduced: decidual suction allows to obtain a large number of decidual arteries, although their origin in the placental bed cannot be determined. Biopsies parallel to the surface of the basal plate have been more interesting, making possible to identify the vessels' region (central, paracentral, or peripheral) of origin in the placental bed and providing decidual material for immunohistochemical studies. Finally, histochemical and electron microscopy investigations have now clarified the pathology and pathogenetic mechanisms underlying the impairment of the physiological vascular changes.