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  1. Home
  2. Books
  3. Placental Bed Disorders
  • Cited by 21
  • Edited by Robert Pijnenborg, University Hospital Gasthuisberg, Leuven, Ivo Brosens, Leuven Institute for Fertility and Embryology, Roberto Romero, National Institute of Child Health and Human Development, Detroit
Publisher:
Cambridge University Press
Online publication date:
July 2010
Print publication year:
2010
Online ISBN:
9780511750847
DOI:
https://doi.org/10.1017/CBO9780511750847
Subjects:
Obstetrics and Gynecology, Reproductive Medicine, Medicine, Cardiovascular Medicine
Information

Book description

It is now recognized that defective placentation in the human is a cause of many pregnancy complications, such as spontaneous abortion, preterm labor and delivery, pre-eclampsia, intrauterine growth restriction, fetal death and abruptio placenta. These clinical disorders can often have long-term consequences into adulthood, causing cardiovascular disease, obesity and diabetes for the newborn as well as an increased risk of premature death in the mother. This is the first book to be entirely focused on the placental bed, bringing together the results of basic and clinical research in cell biology, immunology, endocrinology, pathology, genetics and imaging to consolidate in a single, informative source for investigators and clinicians. Its core aim is to explore new approaches and improve current clinical practice. This is essential reading for clinicians in obstetric, cardiovascular and reproductive medicine.

Reviews

'… a really excellent and timely volume (especially given Robert’s retirement), scholarly, comprehensive, well presented, critical, stimulating in the presentation of new ideas and with an authoritative panel of contributors.'

Professor John Aplin - Maternal and Fetal Health Research Group, University of Manchester

'The distinctly individual writing style of the contributors keeps the reader engaged and their interpretation of published literature provides a unique insight into placental bed research and exposes the controversies that still exist … I thoroughly recommend this book to every obstetrician and basic science researcher who is interested in the field of maternal-fetal and perinatal medicine.'

Source: Acta Obstetricia et Gynecologia Scandinavica

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Contents

Page 2 of 2

Contents
  • Chapter 18 - Imprinting
    pp 183-194
  • View abstract

    Summary

    This chapter reviews the roles and distribution of O2 inside the early human gestational sac and its impact on our understanding of the physiology of O2 metabolism by the fetus during the first and early second trimesters of pregnancy. The mammalian fetus is exposed to major fluctuations in O2 concentration from conception to delivery. The first trimester gestational sac has additional barriers to materno-fetal exchange compared to the definitive placenta of the second and third trimesters of pregnancy. Ample dilation of the uteroplacental circulation together with rapid villous angiogenesis are the key factors necessary to adequate placental development and function and subsequent fetal growth. Overall the data have confirmed that the human placenta is not truly hemochorial until the end of the first trimester. Rather it is deciduochorial, being supported by tissue fluids and endometrial secretions.
  • Chapter 19 - The epidemiology of preeclampsia with focus on family data
    pp 195-206
  • View abstract

    Summary

    This chapter deals with the deeper zonal anatomy of the uterus and particularly with the role these areas have in controlling uterine movements. The morphology of the junctional zone (JZ) suggests a distinct compartment of myometrium, tightly packed with muscle cells with an increased vascularity, designed as it were for a specific purpose. The JZ is responsive to changes in sex steroid levels, and undergoes a cycle of change which parallels the changes in endometrial thickness. Rapidly developing technology allows better images and the introduction of ever more complex classification of JZ contractions (JZC). The frequent use of ultrasound during assisted conception cycles provides most of the information we have about JZC, with most data coming from the study of long protocol stimulation in vitro fertilization (IVF) cycles. Excessive JZC have been shown to reduce implantation rates in both spontaneous and stimulated cycles.
  • Chapter 21 - Angiogenic factors and preeclampsia
    pp 229-242
  • View abstract

    Summary

    This chapter reviews the role of endometrial and subendometrial blood flow determined by Doppler ultrasound in the prediction of pregnancy during in vitro fertilization (IVF) treatment. Uterine Doppler study may not reflect the actual blood flow to the endometrium as the major compartment of the uterus is the myometrium and there is collateral circulation between uterine and ovarian vessels. Absent endometrial and subendometrial blood flow has been shown to be associated with no pregnancy or a significantly lower pregnancy rate. In combination with a 3D ultrasound, power Doppler provides a unique tool with which to measure the blood flow towards the whole endometrium and the subendometrial region. There was a significant elevation in the middle to late follicular phase, followed by a substantial fall and a secondary slow luteal phase rise that was maintained until the onset of menstruation. Doppler flow study of spiral arteries is not predictive of pregnancy.
  • Chapter 22 - Periconceptual and early pregnancy approach
    pp 243-255
  • View abstract

    Summary

    At the time of the discovery of the physiological changes of spiral arteries in the pregnant uterus, Brosens and colleagues suggested that these changes result from the destructive action of the invading trophoblasts on the vascular smooth muscle and the elastic membrane. This chapter reiterates the main findings regarding the successive spiral artery remodeling steps. It seems appropriate to relate the time-course of the vascular remodeling process to the new insights in uteroplacental flow changes during this pregnancy period. In preeclampsia, trophoblast-associated remodeling is restricted to decidual spiral arteries throughout the placental bed. Spiral artery conversion is obviously important for safeguarding an adequate maternal blood supply to the placenta. Deep trophoblast invasion and spiral artery remodeling of the inner 'junctional zone' myometrium is a feature of normal human pregnancy, while in preeclampsia and maybe in other pregnancy complications this process may be seriously impaired.
  • Chapter 23 - New concepts and recommendations on clinical management and research
    pp 256-270
  • View abstract

    Summary

    Comparative studies of placentation across mammals have been greatly facilitated by the availability of phylogenetic trees for the entire range of placental mammals based on molecular data. The three basic placenta types defined by Grosser on grounds of increasing invasiveness epitheliochorial, endotheliochorial, and hemochorial have routinely served as a basis for comparative discussions. Primates differ starkly from all other placental mammal orders because the two extreme kinds of placentation are represented, while the moderately invasive is not. Reliable inference of the primitive condition is an essential starting-point for successful reconstruction of the evolution of placentation in placental mammals. Having considered the general background to evolution of the placenta in primates, it is now possible to focus specifically on catarrhines Old World monkeys, apes, and humans. The architecture of the placenta is notably different in New World monkeys (platyrrhines), which diverged from catarrhines at least 40 mya.

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