Abstract
Decidual vasculopathy at late gestation was shown to be associated with spiral artery remodeling at implantation. Dramatic decidual vascular transformation from early to late stage pregnancy suggests a dynamic spatiotemporal relationship between the various vascular components in spiral artery remodeling and decidual vasculopathy. The central and peripheral portions of 105 placentas with decidual vasculopathy at term were examined with or without preeclampsia to see if temporal vascular regeneration was present. Central and peripheral vasculopathy and central and peripheral regeneration were compared. The peripheral portion showed more decidual vasculopathy (88 of total 105, 83.8%) than central portion (72 of total 105, 68.6%, p < 0.0001). However, central portion showed more vascular regeneration (51 of total 105, 48.6%) than the peripheral portion (23 of total 105, 21.9%, p < 0.0001). There was no difference in vasculopathy or regeneration with or without preeclampsia. Spiral artery remodeling is non-synchronous during placental growth and vascular regeneration. This spatiotemporal sequence may help interpretation of morphologic changes of decidual vasculopathy.
Highlights
Placental growth is continuous throughout the pregnancy to reach maturity at term [1,2]
The questions remain if the spiral artery in the central portion of the placenta and those in the peripheral portion show synchronous morphologic changes of remodeling, and how this difference of spiral artery remodeling in the time between the central and peripheral portions of placenta affects the development of decidual vasculopathy at late gestation, and how this spatiotemporal spiral artery remodeling affects the interpretation of morphologic changes of placenta in normal pregnancy and complications
The study is exempt from Institutional Review Board (IRB) approval according to section 46.101(b) of 45CFR 46 which states that research involving the study of existing pathological and diagnostic specimens in such a manner that subjects cannot be identified is exempt from the Department of Health and Human Services Protection of Human Research Subjects
Summary
Placental growth is continuous throughout the pregnancy to reach maturity at term [1,2]. The central portion of the placental bed is emphasized for placental bed biopsy in order to achieve the expected results [15] Under these circumstances, the spatiotemporal sequence of maternal vascular changes makes a difference in interpretation of the material obtained for the procedure [15]. The theory of “failure to invade” has been proposed as the key pathogenic mechanism of preeclampsia and hypertensive disorders of pregnancy, and the cardinal vascular change of “failure to invade” theory is the lack of trophoblastic invasion of vascular wall in the superficial myometrium In this setting, an attempt was made to delineate the difference of morphologic features of the maternal vessels within the center and the peripheral areas of maternal surface in regards to the presence and absence of decidual vasculopathy and vascular regeneration/restoration. A slight modification of standard placental examination protocol for a period of this study was made in order to answer this question
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