Spiral Arteries in Second Trimester of Pregnancy: When Is It Possible to Define Expected Physiological Remodeling as Abnormal?

Contreras, Mercedes Olaya; Garrido, Marta; Franco, Jorge A.; Rodríguez, Jorge L.; Vargas, Magda Jimena; Aula-Olivar, Ana; Quintero, Laura; Cajal, Santiago Ramón y

doi:10.1007/s43032-020-00403-3

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…As in the case of the physiological process, its presence is discontinuous in the same vessel and is not constant between neighboring vessels 14 (Figure 2).…”

Section: Discussionmentioning

confidence: 77%

“…In addition to those listed, we also observed persistent parietal trophoblast lining, which is recognized as part of the remodeling process in the second trimester 11–14 ; however, because we considered its presence to be disturbing at the end of gestation (Figures 2 and 3), we began to collect pertinent data. In the analysis of 720 consecutive cases in our hospital, parietal trophoblast lining maternal arteries at the end of gestation were associated with HDP ( P 0.014; OR 2.18 (IC 1.20–3.97)).…”

Section: Resultsmentioning

confidence: 99%

“…There are also recent publications on comparative histological illustration of the sequential process. 14 We highlight the endovascular extravillous trophoblast subtype, which is the one that replaces or accompanies the arterial endothelium during the remodeling of the spiral arteries, and that, at the end of pregnancy, persists abnormally among the endothelial cells of the arterial wall.…”

Section: Discussionmentioning

confidence: 99%

“…28 Some authors think complete remodeling is expected for the 20th week, 13 or around that time. 14 As pregnancy progresses, the process leads to thin-walled, vein-like arteries. The endovascular extravillous trophoblast normally disappears giving way once again to a flattened endothelium.…”

Section: Discussionmentioning

confidence: 99%

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Contreras

Zuluaga

2022

Int J Surg Pathol

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Introduction: Hypertensive disorders of pregnancy continue to pose the most important risks for adverse maternal and neonatal outcome. Among histological findings, decidual artery disease is one of the most common, one that has both good reproducibility among observers and whose abnormal vascular remodeling is the sole aspect of preeclampsia pathophysiology on which experts agree. Nevertheless, some aspects of arterial remodeling alterations are still under investigation. Methods: We selected 720 routine and consecutive placenta case studies, concordant with the Amsterdam consensus. From these studies, we collected maternal and neonatal clinical data and specific placental findings on spiral artery abnormalities. We took into account all criteria for decidual arteriopathy. Two hundred and fifteen (215) cases out of this population presented hypertensive disorders of pregnancy. Additional to expected arterial findings, we noted frequent persistent parietal trophoblast lining. Results: A large proportion of our population developed hypertensive disorders of pregnancy (30%). Among the histologic findings reported for preeclampsia, we paid particular attention to spiral artery abnormalities, and this interpretive analysis revealed high frequency of arterial remodeling abnormalities. We examined two additional aspects in our routine analysis: first, the novel one of parietal trophoblast persistence, and second, the established problem of associated acute inflammation, as a possible pitfall. Conclusion: In order to better understood, spiral maternal artery remodeling merits further study. The abnormalities in this process provide an objective tool in the study and diagnosis of important pregnancy complications; furthermore, abnormal remodeling is an expression of early pregnancy alteration, and subsequently related to preeclampsia etiology.

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“…As in the case of the physiological process, its presence is discontinuous in the same vessel and is not constant between neighboring vessels 14 (Figure 2).…”

Section: Discussionmentioning

confidence: 77%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Contreras

Zuluaga

2022

Int J Surg Pathol

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“…A recent study isolated SA from 12 to 23 weeks of gestation and found that the vascular remodeling was not complete until 23 weeks of gestation ( 117 ). Previous studies have mainly focused on pregnant women with GDM with few studies focusing on pregnant women with T1DM or T2DM.…”

Section: Limitation and Future Directionmentioning

confidence: 99%

Hyperglycemia disturbs trophoblast functions and subsequently leads to failure of uterine spiral artery remodeling

Zhu

Liu

et al. 2023

Front. Endocrinol.

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Uterine spiral artery remodeling is necessary for fetal growth and development as well as pregnancy outcomes. During remodeling, trophoblasts invade the arteries, replace the endothelium and disrupt the vascular smooth muscle, and are strictly regulated by the local microenvironment. Elevated glucose levels at the fetal-maternal interface are associated with disorganized placental villi and poor placental blood flow. Hyperglycemia disturbs trophoblast proliferation and invasion via inhibiting the epithelial-mesenchymal transition, altering the protein expression of related proteases (MMP9, MMP2, and uPA) and angiogenic factors (VEGF, PIGF). Besides, hyperglycemia influences the cellular crosstalk between immune cells, trophoblast, and vascular cells, leading to the failure of spiral artery remodeling. This review provides insight into molecular mechanisms and signaling pathways of hyperglycemia that influence trophoblast functions and uterine spiral artery remodeling.

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The Role of Ultrasound in Monitoring Maternal Uterine Artery, Fetal Umbilical Artery and Middle Cerebral Artery in Low Birth Weight Infants

易

2023

ACM

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Spiral Arteries in Second Trimester of Pregnancy: When Is It Possible to Define Expected Physiological Remodeling as Abnormal?

Cited by 3 publications

References 29 publications

More Tools for Evaluating Decidual Artery Disease

More Tools for Evaluating Decidual Artery Disease

Hyperglycemia disturbs trophoblast functions and subsequently leads to failure of uterine spiral artery remodeling

The Role of Ultrasound in Monitoring Maternal Uterine Artery, Fetal Umbilical Artery and Middle Cerebral Artery in Low Birth Weight Infants

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