Placental bed disorders in preterm labor, preterm PROM, spontaneous abortion and abruptio placentae

Abstract

Failure of physiologic transformation of the spiral arteries has been studied using placental bed biopsies in several obstetrical syndromes. Contrary to what was originally believed, this lesion is not restricted to preeclampsia and/or intrauterine growth restriction. A review of published evidence indicates that failure of physiologic transformation can be observed in women with spontaneous second trimester abortions, preterm labor with intact membranes, prelabor rupture of membranes and abruptio placentae. Therefore, disorders of deep placentation are present in a wide range of complications of pregnancy, emphasizing the importance of understanding the physiology and pathology of transformation of the spiral arteries. We propose that changes in the population and function of immunocytes at the maternal-fetal interface can be part of the mechanism of disease of obstetrical disorders, and this requires further investigation.

Porphyromonas gingivalisand adverse pregnancy outcome

“…Studies of DDP are challenging because adequate specimens can only be obtained by invasive biopsy, hysterectomy, or from cadavers [75]. Despite this limitation, it has become clear that DDP underpins a spectrum of obstetric complications ranging from first-and second-trimester spontaneous abortion, preterm premature rupture of membranes (PPROM), and spontaneous preterm birth to intrauterine growth restriction (IUGR) and abruption placentae [75,76]. These complications are often referred to as the great obstetrical syndromes (GOS) [75].…”

“…These complications are often referred to as the great obstetrical syndromes (GOS) [75]. Remarkably, each of these obstetric disorders has different clinicopathologic features within the placenta and/or fetal membranes that set them apart from each other [75,76]. The diversity of the GOS underscores the significance of DDP as a central pathologic mechanism that begins during the earliest weeks of pregnancy before any complications manifest.…”

Notch1 controls development of the extravillous trophoblast lineage in the human placenta

“…The latter deeply migrate into uterine tissue and the maternal spiral arteries, provoking vessel remodelling and adaptation of adequate blood flow to the placenta (5,6). Failures in placentation and artery remodelling have been associated with a variety of pregnancy diseases, such as miscarriage, preeclampsia, fetal growth restriction, and preterm labor (7)(8)(9)(10). Besides unfavorable immunological interactions of EVTs with uterine natural killer (uNK) cells (11), abnormal placental development and trophoblast differentiation are thought to contribute to the pathogenesis of gestational disorders.…”

Chromosomal abnormalities of embryos as a major factor recurrent spontaneous abortion after artificial and natural fertilization

“…Unbalanced chromosomal constitution may influence the development of the placenta and cause abortion [8,17].…”