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The number of multinucleated trophoblastic giant cells in the basal decidua is decreased in retained placenta
  1. H J van Beekhuizen1,
  2. I Joosten2,
  3. A N J A de Groot1,
  4. F K Lotgering1,
  5. J van der Laak3,
  6. J Bulten3
  1. 1
    Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
  2. 2
    Department of Blood Transfusion and Transplantation Immunology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3
    Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to Heleen J van Beekhuizen, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands; h.vanbeekhuizen{at}


Aims: Retained placenta (RP) is a major cause of obstetric haemorrhage. The aim of the study was to obtain a better understanding of the mechanisms that cause some placentas to become retained, while most are not.

Methods: 23 RPs clinically diagnosed as placenta adhesiva and 10 control placentas (CPs) were examined for differences in trophoblast fusion into multinucleated trophoblastic giant cells (MTGCs), defects in the basal decidua, and decidual attachment of myometrial fibres.

Results: The number of MTGCs in the basal decidua was significantly smaller in RPs (0.23 MTGC/standard length) than in CPs (1.11 MTGC/standard length) (p<0.001). Defects in the decidua were observed in 4% of the RPs and in 0% of the CPs. Myometrial fibres were attached to the decidua in 78% of the RPs and in 0% of the CPs (p<0.001).

Conclusions: In placenta adhesiva compared with CPs, significantly less MTGCs were present in the basal decidua, the basal decidua was intact, and myometrial fibres were more frequently attached to the basal decidua. It is speculated that these findings may indicate that defective fusion of trophoblastic cells into MTGCs plays a causative role in placenta adhesiva.

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  • Competing interests None.

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

  • Ethics approval Ethics approval was obtained from the Radboud University Medical Ethics Committee.