The "Great Obstetrical Syndromes" Are Associated with Disorders of Deep Placentation

Overview

Journal Am J Obstet Gynecol

Publisher Elsevier

Specialty Gynecology & Obstetrics

Date 2010 Nov 25

PMID 21094932

Citations 532

Authors

Ivo Brosens

Robert Pijnenborg

Lisbeth Vercruysse

Roberto Romero

Affiliations

Soon will be listed here.

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.

Citing Articles

Association of maternal calprotectin plasma levels with abruption placenta.

Kahraman N, Obut M, Arat O, Gucel F, Caglar A, Ustun Y BMC Pregnancy Childbirth. 2025; 25(1):249.

PMID: 40055628 PMC: 11887217. DOI: 10.1186/s12884-025-07356-y.

Impact of maternal smoking and secondhand smoke exposure during singleton pregnancy on placental abruption: analysis of a prospective cohort study (the Japan Environment and Children's Study).

Karumai-Mori H, Hamada H, Iwama N, Tomita H, Tagami K, Kumagai N BMJ Open. 2025; 15(3):e089499.

PMID: 40044195 PMC: 11881201. DOI: 10.1136/bmjopen-2024-089499.

Universal First-Trimester Screening Biomarkers for Diagnosis of Preeclampsia and Placenta Accreta Spectrum.

Timofeeva A, Fedorov I, Tarasova A, Sukhova Y, Kolodko V, Ivanets T Biomolecules. 2025; 15(2).

PMID: 40001531 PMC: 11852485. DOI: 10.3390/biom15020228.

Multi-System Dysregulation in Placental Malaria Contributes to Adverse Perinatal Outcomes in Mice.

Ekregbesi P, Seibert B, Parish M, Flores-Garcia Y, Creisher P, Hoffmann J bioRxiv. 2025; .

PMID: 39868257 PMC: 11761038. DOI: 10.1101/2025.01.15.633265.

Household Air Pollution Exposures Over Pregnancy and Maternal Blood Pressure Trajectories through 8 Years Postpartum: Evidence from the Ghana Randomized Air Pollution and Health Study (GRAPHS).

Kaali S, Li M, Mujtaba M, Colicino E, Awuni S, Wylie B medRxiv. 2025; .

PMID: 39867416 PMC: 11759240. DOI: 10.1101/2025.01.17.25320752.

References

Brosens I, Dixon H, Robertson W . Fetal growth retardation and the arteries of the placental bed. Br J Obstet Gynaecol. 1977; 84(9):656-63. DOI: 10.1111/j.1471-0528.1977.tb12676.x. View

Chaiworapongsa T, Romero R, Kusanovic J, Mittal P, Kim S, Gotsch F . Plasma soluble endoglin concentration in pre-eclampsia is associated with an increased impedance to flow in the maternal and fetal circulations. Ultrasound Obstet Gynecol. 2010; 35(2):155-62. PMC: 2944768. DOI: 10.1002/uog.7491. View

Chaiworapongsa T, Romero R, Tarca A, Kusanovic J, Gotsch F, Mittal P . A decrease in maternal plasma concentrations of sVEGFR-2 precedes the clinical diagnosis of preeclampsia. Am J Obstet Gynecol. 2010; 202(6):550.e1-10. PMC: 3437767. DOI: 10.1016/j.ajog.2010.04.002. View

Chaiworapongsa T, Espinoza J, Gotsch F, Kim Y, Kim G, Goncalves L . The maternal plasma soluble vascular endothelial growth factor receptor-1 concentration is elevated in SGA and the magnitude of the increase relates to Doppler abnormalities in the maternal and fetal circulation. J Matern Fetal Neonatal Med. 2008; 21(1):25-40. PMC: 7062304. DOI: 10.1080/14767050701832833. View

Chaiworapongsa T, Romero R, Kim Y, Kim G, Kim M, Espinoza J . Plasma soluble vascular endothelial growth factor receptor-1 concentration is elevated prior to the clinical diagnosis of pre-eclampsia. J Matern Fetal Neonatal Med. 2005; 17(1):3-18. DOI: 10.1080/14767050400028816. View

Matijevic R, Meekins J, Walkinshaw S, Neilson J, McFadyen I . Spiral artery blood flow in the central and peripheral areas of the placental bed in the second trimester. Obstet Gynecol. 1995; 86(2):289-92. DOI: 10.1016/0029-7844(95)00129-f. View

Brosens I, Dixon H . The anatomy of the maternal side of the placenta. J Obstet Gynaecol Br Commonw. 1966; 73(3):357-63. DOI: 10.1111/j.1471-0528.1966.tb05175.x. View

Dixon H, Robertson W . A study of the vessels of the placental bed in normotensive and hypertensive women. J Obstet Gynaecol Br Emp. 1958; 65(5):803-9. DOI: 10.1111/j.1471-0528.1958.tb08876.x. View

Romero R . Prenatal medicine: the child is the father of the man. 1996. J Matern Fetal Neonatal Med. 2009; 22(8):636-9. DOI: 10.1080/14767050902784171. View

10.

Smith S, Dunk C, Aplin J, Harris L, Jones R . Evidence for immune cell involvement in decidual spiral arteriole remodeling in early human pregnancy. Am J Pathol. 2009; 174(5):1959-71. PMC: 2671283. DOI: 10.2353/ajpath.2009.080995. View

11.

Romero R, Chaiworapongsa T, Erez O, Tarca A, Gervasi M, Kusanovic J . An imbalance between angiogenic and anti-angiogenic factors precedes fetal death in a subset of patients: results of a longitudinal study. J Matern Fetal Neonatal Med. 2010; 23(12):1384-99. PMC: 3023956. DOI: 10.3109/14767051003681121. View

12.

Brosens J, Pijnenborg R, Brosens I . The myometrial junctional zone spiral arteries in normal and abnormal pregnancies: a review of the literature. Am J Obstet Gynecol. 2002; 187(5):1416-23. DOI: 10.1067/mob.2002.127305. View

13.

Levine R, Maynard S, Qian C, Lim K, England L, Yu K . Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004; 350(7):672-83. DOI: 10.1056/NEJMoa031884. View

14.

Khong T, LIDDELL H, Robertson W . Defective haemochorial placentation as a cause of miscarriage: a preliminary study. Br J Obstet Gynaecol. 1987; 94(7):649-55. DOI: 10.1111/j.1471-0528.1987.tb03169.x. View

15.

Aardema M, Saro M, Lander M, De Wolf B, Oosterhof H, Aarnoudse J . Second trimester Doppler ultrasound screening of the uterine arteries differentiates between subsequent normal and poor outcomes of hypertensive pregnancy: two different pathophysiological entities?. Clin Sci (Lond). 2003; 106(4):377-82. DOI: 10.1042/CS20030385. View

16.

Meekins J, Pijnenborg R, Hanssens M, McFadyen I, van Asshe A . A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre-eclamptic pregnancies. Br J Obstet Gynaecol. 1994; 101(8):669-74. DOI: 10.1111/j.1471-0528.1994.tb13182.x. View

17.

Kam E, Gardner L, Loke Y, King A . The role of trophoblast in the physiological change in decidual spiral arteries. Hum Reprod. 1999; 14(8):2131-8. DOI: 10.1093/humrep/14.8.2131. View

18.

Roberts J, Hubel C . The two stage model of preeclampsia: variations on the theme. Placenta. 2008; 30 Suppl A:S32-7. PMC: 2680383. DOI: 10.1016/j.placenta.2008.11.009. View

19.

Fraser A, Brockert J, Ward R . Association of young maternal age with adverse reproductive outcomes. N Engl J Med. 1995; 332(17):1113-7. DOI: 10.1056/NEJM199504273321701. View

20.

Robertson W, Khong T, Brosens I, de Wolf F, Sheppard B, Bonnar J . The placental bed biopsy: review from three European centers. Am J Obstet Gynecol. 1986; 155(2):401-12. DOI: 10.1016/0002-9378(86)90843-4. View