The “Great Obstetrical Syndromes” are associated with disorders of deep placentation

Brosens, Ivo; Pijnenborg, Robert; Vercruysse, Lisbeth; Romero, Roberto

doi:10.1016/j.ajog.2010.08.009

Cited by 1,271 publications

(1,075 citation statements)

References 76 publications

(68 reference statements)

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“…This would be in line with previous histological studies, which indicate an increasing degree of compromised vascular remodeling and obstructive occlusions in the spiral arteries in pregnancies with normotensive IUGR, PE without IUGR, and PE with IUGR25. In addition, in studies that used in‐vivo scintigraphy, reduced placental perfusion compared with normal pregnancy was seen both in pregnancies with IUGR and in those with PE21, 26.…”

Section: Discussionsupporting

confidence: 90%

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Sohlberg

Mulic‐Lutvica

Olovsson

et al. 2015

Ultrasound in Obstet & Gyne

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ObjectiveTo evaluate in‐vivo placental perfusion fraction, estimated by magnetic resonance imaging (MRI), as a marker of placental function.MethodsA study population of 35 pregnant women, of whom 13 had pre‐eclampsia (PE), were examined at 22–40 weeks' gestation. Within a 24‐h period, each woman underwent an MRI diffusion‐weighted sequence (from which we calculated the placental perfusion fraction), venous blood sampling and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. The perfusion fractions in pregnancies with and without fetal growth restriction were compared and correlations between the perfusion fraction and ultrasound estimates and plasma markers were estimated using linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of PE (P < 0.05) and therefore we included an interaction term between PE and covariates in the models.ResultsThe median placental perfusion fractions in pregnancies with and without fetal growth restriction were 21% and 32%, respectively (P = 0.005). The correlations between placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (P = 0.002 and P = 0.0001, respectively). The highest coefficient of determination (R 2 = 0.56) for placental perfusion fraction was found for a model that included pulsatility index in the ductus venosus, plasma level of soluble fms‐like tyrosine kinase‐1, estimated fetal weight and presence of PE.ConclusionThe placental perfusion fraction has the potential to contribute to the clinical assessment of cases with placental insufficiency. © 2015 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionsupporting

confidence: 90%

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Sohlberg

Mulic‐Lutvica

Olovsson

et al. 2015

Ultrasound in Obstet & Gyne

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“…Deficient remodelling of the spiral arteries has been associated with the 'great obstetrical syndromes' [46]. The mechanistic link is strongest in the case of pre-eclampsia, when the resultant malperfusion of the placenta is thought to cause oxidative stress [47].…”

Section: Establishing the Maternal -Placental Circulationmentioning

confidence: 99%

The placenta: a multifaceted, transient organ

Burton

Fowden

2015

Phil. Trans. R. Soc. B

538

380

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The placenta is arguably the most important organ of the body, but paradoxically the most poorly understood. During its transient existence, it performs actions that are later taken on by diverse separate organs, including the lungs, liver, gut, kidneys and endocrine glands. Its principal function is to supply the fetus, and in particular, the fetal brain, with oxygen and nutrients. The placenta is structurally adapted to achieve this, possessing a large surface area for exchange and a thin interhaemal membrane separating the maternal and fetal circulations. In addition, it adopts other strategies that are key to facilitating transfer, including remodelling of the maternal uterine arteries that supply the placenta to ensure optimal perfusion. Furthermore, placental hormones have profound effects on maternal metabolism, initially building up her energy reserves and then releasing these to support fetal growth in later pregnancy and lactation post-natally. Bipedalism has posed unique haemodynamic challenges to the placental circulation, as pressure applied to the vena cava by the pregnant uterus may compromise venous return to the heart. These challenges, along with the immune interactions involved in maternal arterial remodelling, may explain complications of pregnancy that are almost unique to the human, including pre-eclampsia. Such complications may represent a trade-off against the provision for a large fetal brain.

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“…It has been shown that insufficient invasion of trophoblast cells into the uterine decidua and inadequate remodeling of the uterine vasculature is associated with preeclampsia, which is a dangerous medical condition characterized by high blood pressure and high levels of protein in the urine of pregnant women (1)(2)(3). Thus, a better understanding of the molecular mechanisms that regulate trophoblast invasion will help to delineate the processes involved in the establishment of pregnancy under normal and pathological conditions.…”

mentioning

confidence: 99%

Transforming Growth Factor-β1 Inhibits Trophoblast Cell Invasion by Inducing Snail-mediated Down-regulation of Vascular Endothelial-cadherin Protein

Cheng

Chang

2013

Journal of Biological Chemistry

104

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Background: Transforming growth factor (TGF)-␤1 treatment decreases human trophoblast invasion. Results: Smad-dependent up-regulation of Snail mediates TGF-␤1-induced down-regulation of VE-cadherin. Conclusion: TGF-␤1 decreases human trophoblast invasion by down-regulating VE-cadherin. Significance: Our results provide important insights into the molecular mechanisms mediating TGF-␤1-induced down-regulation of VE-cadherin and decreased cell invasion in human trophoblast cells.

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The “Great Obstetrical Syndromes” are associated with disorders of deep placentation

Cited by 1,271 publications

References 76 publications

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

Magnetic resonance imaging‐estimated placental perfusion in fetal growth assessment

The placenta: a multifaceted, transient organ

Transforming Growth Factor-β1 Inhibits Trophoblast Cell Invasion by Inducing Snail-mediated Down-regulation of Vascular Endothelial-cadherin Protein

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