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The “Great Obstetrical Syndromes” are associated with disorders of deep placentation
Open accessAbstract
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.
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“Inadequate placentation is seen in several common obstetrical syn dromes, including fetal growth restriction, spontaneous second trimester miscarriages, placental abruption, preterm birth, and hyper tensive disorders in pregnancy (Brosens et al., 2011).”
From Pregnancy-related maternal physiological adaptations and fetal chemical exposure (2023) · cites this paper as Brosens et al., 2011
In the citing paper
“Failure of trophoblast invasion and arterial remodeling is associated with the 'Great Obstetrical Syndromes', including growth restriction, pre-eclampsia and late spontaneous abortion, due to impaired maternal perfusion (64).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [64]
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“In mothers with pre-eclampsia, more preterm births were also expected for those with PCOS, as both disorders are associated with placental dysfunction and increased androgens (Brosens et al. , 2011; Kelley et al. , 2019).”
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“This gene is implicated in angiogenic process and it is possible that angiogenesis may be involved in the occurrence of typical malperfusion lesions [37,38] and in preterm parturition [39].”
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“Placental-mediated disease, which is an umbrella term for describing different clinical phenotypes, including intra-uterine growth restriction (IUGR), pre-eclampsia (PE) and abruptio placentae, arises from a single pathophysiological event in the first trimester relating to placental maladaptation and lack of vascular…”
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“Decreased trophoblast cell invasion and vascular conversion resulting in poor placental perfusion may lead to the development of preeclampsia (Brosens et al., 2011).”
BackgroundThe impact of risk factors on aspirin's efficacy for the prevention of preterm birth
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Gökdemir, İ. E., Evliyaoğlu, Ö., & Çoşkun, B. (2016) · Journal of Turkish Society of Obstetric and Gynecology · doi:10.4274/tjod.57701 · Cited by 7
Interobserver Agreement in the Study of 2D and 3D Sonographic Criteria for Adenomyosis
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“The additional adverse pregnancy outcomes were chosen as exclusion criteria due to their shared pathophysiological characteristics with HDP, specifically vascular placental dysfunction [36].”
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“Placental dysfunction contributes to pregnancy complications such as pre-eclampsia, fetal growth restriction, and pre-term labour, among others [125,126].”
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“ondary to defective remodelling of the uterine spiral arteries [8], in contrast, the LP is characterized by an”
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“Brosens et al. [9] referred to these as “great obstetric syndromes” and focused on the key role of placentation.”
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“The underlying pathophysiology of preeclampsia has been proposed to be a result of an abnormal trophoblastic invasion during placental implantation, leading to placenta ischemia and insufficiency, with subsequent endothelial injury [7–9].”
Liu, X., Xin, S., Xu, F., Zhou, M., Ying, X., Zeng, Y., Zeng, X., & Zou, Y. (2024) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2024.2361278 · Cited by 5
“Defects in the human placenta during early pregnancy can result in miscarriage and complications in late pregnancy, such as preeclampsia, intrauterine growth restriction, and placenta accreta, which can affect the long-term health of both the fetus and its mother [17,18].”
Pattamathamakul, S., Duangkum, C., Chaiyarach, S., Kongwattanakul, K., Saksiriwuttho, P., Komwilaisak, R., Chantanavilai, S., Pongsamakthai, M., & Sirikarn, P. (2024) · Journal of Pregnancy · doi:10.1155/2024/9968509 · Cited by 5
“Consequently, this reduction in villous volume and surface area results in chronic fetal hypoxia and stress [9, 12 – 14].”
BackgroundEvaluation of optimal trophoblastic models to mimic uterine vessel remodeling in human pregnancy
Li, W., Zhang, S., Ye, S., Fang, X., Yu, X., Wang, X., Ma, Y., & Wang, Y.-L. (2025) · Biology of Reproduction · doi:10.1093/biolre/ioaf108 · Cited by 5
“SAR is a critical placentation event essential for safeguarding maternal and fetal health, as impaired SAR is strongly associated with severe obstetric complications such as early pregnancy loss, preeclampsia, and fetal growth restriction [6].”
Ohtani, T., Ichinose, M., Ariyoshi, Y., Irie, M., Toshimitsu, M., Sayama, S., Seyama, T., Muto, H., Shitara, Y., Ito, A., et al. (2025) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.70075 · Cited by 5
“32,33 Although the overall frequency of HDP did not significantly differ between the groups in this study, six of seven (86”
Large-Scale Proteomics Reveals New Candidate Biomarkers for Late-Onset Preeclampsia
Andresen, I. J., Romero, R. J., Westerberg, A. C., Than, N. G., Gomez‐Lopez, N., Bhatti, G., Ahmodu, O., Gudicha, D. W., Meyyazhagan, A., Awonuga, A. O., et al. (2025) · Hypertension · doi:10.1161/hypertensionaha.125.25189 · Cited by 6
Self-citationThe Etiopathogenesis of Preeclampsia: Where Do We Stand Now?
Laskowska, M., Bednarek, A., & Stworowski, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14227992 · Cited by 5
“This results in the extensive remodeling of the maternal spiral arterioles into low-resistance, high-capacity, high-flow vessels [5,30,32,33].”
Zhu, X., Jiang, Y., Wang, L., Jiang, P., Zhong, Z., Li, H., Zheng, C., Chen, L., Wei, J., Lin, X., et al. (2025) · Physiological Genomics · doi:10.1152/physiolgenomics.00185.2025 · Cited by 5
Park, I. Y., Wie, J. H., Park, J. H., & Kwon, J. Y. (2021) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.14781 · Cited by 5
“The disturbance of this initial process leads to inadequate coordination of vascular and inflammatory processes between mother and fetus, which can cause SGA pregnancy, preterm delivery, and a hypertensive disorder as various other factors are added during pregnancy.(19) This prospective study explored whether first t…”
BackgroundInfluentialGeneration of Knockout Mouse Trophoblast Stem Cells by CRISPR/Cas9
Doria-Borrell, P., Moya-Navamuel, M., Hemberger, M., & Pérez-García, V. (2024) · Methods in molecular biology · doi:10.1007/978-1-0716-3746-3_8 · Cited by 5
Ip, P. N. P., Nguyen‐Hoang, L., Chaemsaithong, P., Guo, J., Wang, X., Sahota, D. S., Chung, J. P. W., & Poon, L. C. (2024) · Taiwanese Journal of Obstetrics and Gynecology · doi:10.1016/j.tjog.2023.09.023 · Cited by 7
Liu, J., Li, W., Wang, J., Bai, L., Xu, J., Chen, X., Wang, S., Li, L., & Xu, X. (2024) · Biology of Reproduction · doi:10.1093/biolre/ioae118 · Cited by 5
“Many studies had showed that shallow EVTs invasion into the decidua accompanied by the insufficient remodeling of uterine spiral artery in patients with preeclampsia, which has been suggested to be major contributing factors of preeclampsia [12, 13].”
Establishment of human trophoblast stem cells from term smooth chorion
Hoshiyama, T., Muto, M., Matsumoto, S., Okamura, E., Jargalsaikhan, B.-E., Murakami, T., Tsuji, S., & Ema, M. (2025) · Placenta · doi:10.1016/j.placenta.2025.07.090 · Cited by 5
Live birth after uterine transplantation remains challenging
Donnez, J. (2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2013.07.1988 · Cited by 5
An efficient and combined placental T1‐ADC acquisition in pregnancies with and without pre‐eclampsia
Hutter, J. M., Ho, A., Jackson, L. H., Slator, P. J., Chappell, L. C., Hajnal, J. V., & Rutherford, M. (2021) · Magnetic Resonance in Medicine · doi:10.1002/mrm.28809 · Cited by 5
“The mean results from the healthy cohort for the combined ADC-T 1 fit (Equation 2), displayed in Figure 5A,B show a downward trend over gestation for both T 1 (slope −11.3, P .”
BackgroundMethodInfluentialNeurologic Sequelae Associated with Hypertensive Disorders of Pregnancy
Scher, M. S. (2021) · Children · doi:10.3390/children8110945 · Cited by 5
Maternal Vascular Malperfusion and Associated Maternal Diseases
Dahlstrom, J. E., Subramaniam, A., & Faye-Petersen, O. M. (2021) · Springer eBooks · doi:10.1007/978-3-030-84725-8_19 · Cited by 6
Gusar, V. A., Timofeeva, A. V., Chagovets, V., Кан, Н. Е., Vysokikh, M. Y., Marey, M. V., Овиковна, К. А., Baev, B. O. R., & Sukhikh, G. T. (2022) · Life · doi:10.3390/life12010101 · Cited by 7
Decidual Natural Killer Cells Are Essential for a Successful Pregnancy (Review)
Elagab, E. A. M., Alshahrani, M. S., Elbadawi, A. A. A., Aedh, A. I., Osman, A. M., & Osman, H. M. (2022) · Advances in Reproductive Sciences · doi:10.4236/arsci.2022.103008 · Cited by 6
Short communication: Is there any benefit of initiating aspirin before the 11th week of gestation?
Ghesquière, L., Vachon‐Marceau, C., Kingdom, J. C., Ferreira, E., Côté, S., Guerby, P., Maheux‐Lacroix, S., & Bujold, E. (2022) · Pregnancy Hypertension · doi:10.1016/j.preghy.2022.10.009 · Cited by 5
Deep-learning based segmentation of the placenta and uterine cavity on prenatal MR images
Huang, J., Do, Q. N., Shahedi, M., Xi, Y., Lewis, M. A., Herrera, C. L., Owen, D. M., Spong, C. Y., Madhuranthakam, A. J., Twickler, D. M., et al. (2023) · SPIE Medical Imaging: Computer-Aided Diagnosis · doi:10.1117/12.2653659 · Cited by 5
“Abnormal placenta growth and development results in adverse pregnancy complications, such as preeclampsia, fetal growth restriction, and stillbirth [3].”
BackgroundComprehensive Review of Hypertensive Disorders Related to Pregnancy
Bangi, E. F., Yousuf, M. H., Upadhyay, S., Jain, P., & Jain, R. (2023) · Southern Medical Journal · doi:10.14423/smj.0000000000001571 · Cited by 5
de Vos, E. S., van der Meeren, L. E., Koning, A. H. J., Nikkels, P. G. J., Steegers, E. A. P., Steegers‐Theunissen, R. P. M., & Mulders, A. G. M. G. J. (2024) · Placenta · doi:10.1016/j.placenta.2024.01.019 · Cited by 6
Hinchliffe, E., & Heazell, A. E. P. (2025) · Journal of Chromatography B · doi:10.1016/j.jchromb.2025.124541 · Cited by 5
Can prenatal screening reduce the adverse obstetric outcomes related to abnormal placentation?
Ghidini, A., & Gratacós, E. (2014) · Prenatal Diagnosis · doi:10.1002/pd.4423 · Cited by 5
PP13, Decidual Zones of Necrosis, and Spiral Artery Remodeling—Preeclampsia Revisited?
Than, N. G. (2012) · Reproductive Sciences · doi:10.1177/1933719111431678 · Cited by 5
Metadata
- Authors
- Brosens, I., Pijnenborg, R., Vercruysse, L., & Romero, R.
- Affiliations
- Leuven Institute for Fertility and Embryology (BE)
- Universitair Ziekenhuis Leuven (BE)
- National Institutes of Health (US)
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 204
- Issue
- 3
- Pages
- 193-201
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC3369813
- OpenAlex
- W2034492080
- Cited by
- 1,568
- References
- 82
- Citations by year
- 2026: 123 · 2025: 126 · 2024: 128 · 2023: 147 · 2022: 153 · 2021: 155 · 2020: 145 · 2019: 121 · 2018: 91 · 2017: 79 · 2016: 61 · 2015: 69 · 2014: 66 · 2013: 49 · 2012: 30
- FWCI
- 4.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institutes of Health
- U.S. Department of Health and Human Services
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- great obstetrical syndromes, preeclampsia, fetal growth restriction, preterm labor, preterm premature rupture of membranes, miscarriage, placental abruption, spiral artery remodeling, placental biopsy
- MeSH terms
- Biopsy, Female, Humans, Placenta, Placenta Diseases, Pregnancy, Pregnancy Complications, Syndrome
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