Abstract
Arteriolar injuries in clinical obstetric and gynecologic syndromes
Highlights
In 1937, Drs Alan Moritz and Mary Oldt described narrowing of arterioles associated with hyperplasia of the tunica media and intima in kidney, spleen, pancreas and adrenals in a series of 100 hypertensive, post-mortem subjects (Figure 1) [1]
Professor Brosens and Romero have broadened the description of these narrowed arterioles to include many other important, clinical obstetric syndromes including intrauterine growth retardation, placental abruption, preterm labor, preterm PROM and midtrimester loss [8,9,10]
In the UK, uterotubal neurovascular injuries frequently occur during “difficult” first labors and straining during defecation leading to “partial” injuries to nerve bundles that permit a pathway for regenerating injured nerves and subsequent painful, clinical syndromes of chronic pelvic pain, painful periods, painful sex, vulval pain, irritative bladder and bowel syndromes
Summary
In 1937, Drs Alan Moritz and Mary Oldt described narrowing of arterioles associated with hyperplasia of the tunica media and intima in kidney, spleen, pancreas and adrenals in a series of 100 hypertensive, post-mortem subjects (Figure 1) [1]. Working independently on gynecologic tissue samples, our group described a perivascular “halo of injured nerves” in women with different forms of chronic pelvic pain with, or without, “endometriosis”, dysmenorrhea, vulval pain, irritative bladder and bowel syndromes (Figure 2b) [11,12]. Our group has drawn attention to the similarity of the histologic appearances in gynecologic syndromes in chronic pelvic pain, “endometriosis”, vulval and vaginal pain, irritative bladder and bowel syndromes [21,22,23,24,25,26,27,28,29,30] In all these syndromes the histologic appearances include perivascular nerve fiber proliferation (PVNFP) where there are one, or more, layers of injured, regenerating nerves around narrowed arterioles (Figure 1b-1d) [21]. The laparoscopic phenotypes of parous women with chronic pelvic pain often demonstrate asymmetric, A
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