The "Great Obstetrical Syndromes" are associated with disorders of deep placentation

Brosens I; Pijnenborg R; Vercruysse L; Romero R

doi:10.1016/j.ajog.2010.08.009

Research Methods · Evidence Synthesis

The "Great Obstetrical Syndromes" are associated with disorders of deep placentation

Brosens I, Pijnenborg R, Vercruysse L, Romero R

Published March 2011 American journal of obstetrics and gynecology, 204(3), 193-201

DOI 10.1016/j.ajog.2010.08.009 PMID 21094932 PMC PMC3369813

RRM Academy Synopsis

Deep placentation defects are linked to preeclampsia and preterm labor

Defective deep placentation is associated with preeclampsia, poor fetal growth and preterm labor. This review gathers biopsy studies of how the uterine spiral arteries remodel in these pregnancies. The authors propose sorting the defect into 3 types. The types rest on how much remodeling is restricted and whether obstructive lesions are present.

Key Findings

The review links defective deep placentation to preeclampsia, poor fetal growth, preterm labor, preterm premature rupture of membranes, abruption and late miscarriage.
A blinded biopsy study found fully transformed spiral arteries in 59% of term deliveries, 29% of preterm premature rupture of membranes cases and 4.3% of preeclampsia cases.
A 1977 study of growth restriction without maternal hypertension found absence of physiological changes in the myometrial segment in 55% of biopsies.
Of 18 women with abruptio placentae, 12 biopsies contained a myometrial spiral artery. Seven of the 12 lacked physiological transformation.
The authors propose 3 types: partial transformation, absence of transformation, and absence of transformation with obstructive lesions.

Interpretation

The authors review placental bed biopsies from cesarean deliveries and hysterectomy specimens. A biopsy samples a small part of the placental bed, the authors note, and neighboring areas may differ. In normal pregnancy, 90% of the junctional zone spiral arteries in the myometrium are fully transformed. The 3-type scheme is the authors' own proposal.

RRM Context

The authors cite a suggestion that the monthly build-up and shedding of the uterine lining prepares the uterus for placentation. They name the lining's preparation as a target for care before pregnancy. Restorative reproductive medicine works on that ground: the ovulatory cycle and the health of the lining before conception.

Our editorial summary of this paper, not the article's abstract.

Abstract

Defective deep placentation has been associated with a spectrum of complications of pregnancy including preeclampsia, intrauterine growth restriction, preterm labor, preterm premature rupture of membranes, late spontaneous abortion, and abruptio placentae. The disease of the placental vascular bed that underpins these complications is commonly investigated with targeted biopsies. In this review, we critically evaluate the biopsy technique to summarize the salient types of defective deep placentation, and propose criteria for the classification of defective deep placentation into 3 types based on the degree of restriction of remodeling and the presence of obstructive lesions in the myometrial segment of the spiral arteries.

Topics

Research Methods › Evidence Synthesis › Systematic Reviews · Clinical Guidelines and Standards › Diagnostic Criteria and Classification › Staging and Classification Systems

Robert Pijnenborg, Lisbeth Vercruysse, Roberto Romero

Bob Pijnenborg, Rob Pijnenborg, Bobby Pijnenborg, R Pijnenborg, L Vercruysse, R Romero

PMID 21094932 21094932 DOI 10.1016/j.ajog.2010.08.009 10.1016/j.ajog.2010.08.009 Brosens et al. 2011, Brosens 2011

The "Great Obstetrical Syndromes" are associated with disorders of deep placentation

Deep placentation defects are linked to preeclampsia and preterm labor

Key Findings

Interpretation

RRM Context

Abstract

Topics

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