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Abnormal spiral artery remodelling in the decidual segment during pregnancy: from histology to clinical correlation
  1. Laura Avagliano1,2,
  2. Gaetano Pietro Bulfamante1,3,
  3. Alberto Morabito4,
  4. Anna Maria Marconi2
  1. 1Unit of Human Pathology, Department of Medicine, Surgery and Dentistry, San Paolo Hospital Medical School, University of Milano, Milano, Italy
  2. 2Unit of Obstetrics and Gynecology, Department of Medicine, Surgery and Dentistry, San Paolo Hospital Medical School, University of Milano, Milano, Italy
  3. 3Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, University of Milano, Milano, Italy
  4. 4Unit of Statistics, Department of Medicine, Surgery and Dentistry, San Paolo Hospital Medical School, University of Milano, Milano, Italy
  1. Correspondence to Dr Anna Maria Marconi, Unit of Obstetrics and Gynecology, DMSD—San Paolo Hospital Medical School, University of Milano, Via A. di Rudinì 8, 20142 Milano, Italy; annamaria.marconi{at}unimi.it

Abstract

Introduction Modification of the spiral arteries with loss of the muscular vascular wall, invaded by the trophoblasts, represents the goal of the physiological vascular adaptation during human implantation. When physiological vascular changes do not occur, an unfavourable evolution of gestation may develop as suggested by uterine biopsies studies.

Aims To evaluate the prevalence of the abnormal spiral arteries modification (ASAM) through the routine examination of placentas, to identify maternal predisposing factors and to examine the correlations between the histological lesion and pregnancy outcome.

Methods 1534 consecutive singleton pregnancies were retrospectively analysed. An extensive histological and clinical investigation was performed.

Results ASAM was present in 5.8% pregnancies. When compared with cases without ASAM, cases with ASAM exhibited a higher prevalence of pre-eclampsia (10% vs 2%), placental abruption (5.5% vs 0.3%), preterm premature rupture of membranes (7% vs 1.3%) and intrauterine fetal death (18% vs 2.2%). Multivariate analysis showed that the maternal body mass index represents the major maternal pregestational factor that can influence the prevalence of ASAM (OR=1.8, 95% CI 1.1 to 3 in cases with BMI>30 kg/m2).

Conclusion The abnormal modification of the decidual segment of the spiral arteries is identifiable at the time of the conventional histopathological placental evaluation and is associated with adverse pregnancy outcome. The identification of the cause of the unfavourable evolution of pregnancy is fundamental for parents, both for counselling and for prevention; the identification of ASAM in such pregnancies might provide additional valuable information.

  • Placenta
  • spiral artery
  • pregnancy
  • outcome
  • maternal-fetal
  • colorectal cancer
  • gall bladder
  • oncogenes
  • pancreas
  • histopathology

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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