Introduction: the placental bed

The placental bed underlies the fetal placenta and includes the decidua basalis and the underlying myometrium containing the uterine spiral arteries. In order to establish human hemochorial placentation and to provide a progressive increase in blood supply to the growing fetus, the placental bed spiral arteries must undergo considerable alterations. These physiological modifications are thought to be brought about by the interaction of invasive cytotrophoblast with the spiral artery vessel wall. Failure of spiral artery transformation is thought to play an important role in the sequence of events which gives rise to pre-eclampsia. The mechanisms that control human trophoblast invasion in normal, let alone abnormal pregnancy, are still poorly understood. This is partly due to difficulties in obtaining “true” placental bed biopsies.

Much of the information on the early physiological changes within the placental bed comes from unique studies on intact hysterectomy specimens (Pijnenborg et al., 1981) Details of trophoblast invasion during late pregnancy and in pregnancies complicated by pre-eclampsia and fetal growth restriction is principally derived from the study of placental bed biopsies taken at the time of Cesarean section. Placental bed biopsies may not be representative of the whole placental bed. To help circumvent this problem, multiple biopsies combined with large numbers of cases should help to provide a more representative picture. The entire blood vessel will not be present in a single biopsy, thus limiting our interpretation of what is happening along its full length.

Pre-eclampsia complicates 2–3% of primigravid pregnancies and 5–7% of nulliparous women. It is one of the leading causes of death and disability of mothers and babies. Over four million women will develop the disorder worldwide every year. This book, written by scientists and clinicians who are internationally recognized as experts in their respective fields, focuses on both the scientific basis of pre-eclampsia along with management.

The basic science section contains up-to-date reviews and theories focused on the most exciting research developments in pre-eclampsia. The clinical chapters provide a comprehensive review of the pertinent literature highlighting recent data and work that suggest new ideas or changes in current management. There is a section in each chapter (when appropriate) that deals with management on a practical level so that the clinician (residents/registrars/consultants) will be able to take away a formulated treatment plan that they can implement directly.

The book will be of interest to scientists and students interested in reproductive sciences as well as medical students, obstetricians and physicians with an interest in pre-eclampsia.