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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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“The two disorders have some shared placental histopathological abnormalities [42], with a highly significant overlap between the transcripts dysregulated in PE and FGR [43].”
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“Due to these abnormalities, endometriosis has been associated with defective deep placentation and several obstetrics adverse outcomes [6].”
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“Accordingly, deranged early utero-placental vascular development is one of the main causes of the major disorders of pregnancy, also known as placenta-related complications (Brosens et al., 2011).”
BackgroundIFPA award in placentology lecture: Phylogenomic origins and evolution of the mammalian placenta
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“Therefore, future, prospective studies of RPL patients would need to investigate whether placental biomarkers also have predictive power for RPL before pregnancies fail.”
BackgroundHong, J. G. S., Crawford, K., Cavanagh, E., Clifton, V. L., & Kumar, S. (2024) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14831 · Cited by 11
“The development of defective deep placentation characterized by nontransformation of myometrial spiral arteries 10,11 leads to placental ischemia 9,12 and perturbations in levels of circulating angiogenic factors.”
BackgroundChen, Y., Ye, X., Zhong, Y., Kang, X., Tang, Y., Zhu, H., Pang, C., Ning, S., Liang, S., Zhang, F., et al. (2024) · Developmental Cell · doi:10.1016/j.devcel.2024.03.025 · Cited by 11
de Vos, E. S., Mulders, A. G. M. G. J., Koning, A. H. J., Willemsen, S. P., Rousian, M., van Rijn, B. B., Steegers, E. A. P., & Steegers‐Theunissen, R. P. M. (2024) · Human Reproduction · doi:10.1093/humrep/deae056 · Cited by 11
“Histopathological research has shown that morphologic variations of the placental vasculature, including vessel caliber and number of remodeled spiral arteries in the placental bed, are associated with prenatal growth (Brosens et al. , 2011).”
Trophoblast Organoids: Capturing the Complexity of Early Placental Development In Vitro
Wessel, B. M., Castro, J. N., & Roberts, V. H. J. (2024) · Organoids · doi:10.3390/organoids3030012 · Cited by 11
“Dys-regulation of these events is suspected to contribute to, or outright cause, obstetric syndromes such as pre-eclampsia, fetal growth restriction, preterm labor, and placental abruption [1].”
Zambella, E., Peruffo, B., Guarano, A., Inversetti, A., & Simone, N. D. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms251810099 · Cited by 12
“Consequently, this results in inadequate blood flow to the placenta and ischemia, triggering the release of anti-angiogenic factors such as sFlt-1 and PlGF [61,62] but also of immune mediators and ROS [47,63].”
BackgroundQin, C., Wu, J., Wei, X., Liu, X., & Lin, Y. (2024) · PeerJ · doi:10.7717/peerj.18227 · Cited by 11
“Placental dysfunction associated with impaired trophoblast function might lead to miscarriage, fetal growth restriction, preeclampsia, and stillbirth ( Brosens et al., 2011 ; Turco et al., 2018 ).”
BackgroundDaggett, E. E., & Ananth, C. V. (2024) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000914 · Cited by 12
Development, Function, and Pathology of the Placenta
Maltepe, E., & Penn, A. A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-40139-5.00005-x · Cited by 11
Fetal renal artery impedance in pregnancies affected by preeclampsia
Ma’ayeh, M., Krishnan, V., Gee, S. E., Russo, J. R., Shellhaas, C., & Rood, K. M. (2020) · Journal of Perinatal Medicine · doi:10.1515/jpm-2020-0024 · Cited by 11
Tavarna, T., Phillips, P. L., Wu, X., & Reyes, L. (2020) · Scientific Reports · doi:10.1038/s41598-020-71762-9 · Cited by 11
Catechol-O-methyltransferase and Pregnancy Outcome: an Appraisal in Rat
Iqbal, K., Dhakal, P., Pierce, S. H., & Soares, M. J. (2020) · Reproductive Sciences · doi:10.1007/s43032-020-00348-7 · Cited by 11
Ritter, A., Safdar, B. K., Jasmer, B., Kreis, N., Friemel, A., Roth, S., Solbach, C., Louwen, F., & Yuan, J. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21218393 · Cited by 11
Syncytiotrophoblast Derived Extracellular Vesicles in Relation to Preeclampsia
Cooke, W. R., Jones, G. D., Redman, C. W. G., & Vatish, M. (2021) · Maternal-Fetal Medicine · doi:10.1097/fm9.0000000000000093 · Cited by 11
“Indeed, other obstetric syndromes may be part of the same spectrum, including intrauterine growth restriction, placental abruption, stillbirth, gestational diabetes, and preterm birth.(3) Redman first proposed the “two stage model” of earlyonset preeclampsia (EOPE), shown in Figure 1.”
BackgroundBurton, G. J. (2021) · Springer eBooks · doi:10.1007/978-3-030-84725-8_4 · Cited by 13
Anthoulakis, C., & Mamopoulos, A. M. (2021) · Annals of Medicine · doi:10.1080/07853890.2021.2014553 · Cited by 11
Pregnancy complications and risk of uterine rupture among women with singleton pregnancies in China
Tao, J., Mu, Y., Chen, P., Xie, Y., Liang, J., & Zhu, J. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04465-w · Cited by 13
Sehgal, A., Dassios, T. G., Nold, M. F., Nold‐Petry, C. A., & Greenough, A. (2022) · Paediatric Respiratory Reviews · doi:10.1016/j.prrv.2022.09.002 · Cited by 11
An update on maternal cardiac hemodynamics in fetal growth restriction and pre‐eclampsia
Dall’Asta, A., Minopoli, M., Zegarra, R. R., di Pasquo, E., & Ghi, T. (2022) · Journal of Clinical Ultrasound · doi:10.1002/jcu.23392 · Cited by 11
“related to the shallow trophoblastic invasion of the uterine wall leading to primary placental disfunction.(1) Pre-eclampsia is characterized by de novo hypertension after 20 weeks of gestation associated with maternal organ dysfunction.”
BackgroundA Bioengineered Model for Studying Vascular-Pericyte Interactions of the Placenta
Cherubini, M., & Haase, K. (2023) · Methods in molecular biology · doi:10.1007/978-1-0716-2887-4_23 · Cited by 11
Development of a Fluid Dynamic Model for Quantitative Contrast-Enhanced Ultrasound Imaging
de Senneville, B. D., Novell, A., Arthuis, C., Mendes, V., Dujardin, P., Patat, F., Bouakaz, A., Escoffre, J., & Perrotin, F. (2017) · IEEE Transactions on Medical Imaging · doi:10.1109/tmi.2017.2743099 · Cited by 11
“iatrogenic preterm birth and maternal morbidity [13], [14].”
BackgroundMethodMillischer, A., Marcellin, L., Santulli, P., Maignien, C., Bourdon, M., Borghese, B., Goffinet, F., & Chapron, C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0223330 · Cited by 11
Hanchard, T. J., de Vries, B. S., Quinton, A. E., Sinosich, M. J., & Hyett, J. A. (2020) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.21962 · Cited by 11
Dai, Y., Zhang, J., Liu, R., Xu, N., Yan, S., Chen, Y., & Li, T. (2020) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-020-01750-5 · Cited by 11
“It has been reported that endothelial dysfunction can affect placental development and participate in the occurrence of FGR [13, 14].”
BackgroundCellular immune responses in amniotic fluid of women with a sonographic short cervix
Galaz, J., Romero, R. J., Xu, Y., Miller, D., Levenson, D., Para, R., Varrey, A., Hsu, R. C., Tong, A., Hassan, S. S., et al. (2020) · Journal of Perinatal Medicine · doi:10.1515/jpm-2020-0037 · Cited by 11
Self-citationGiants in Obstetrics and Gynecology Series: a profile of Ivo Brosens, MD, PhD, FRCOG (ae)
Romero, R. J. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.09.008 · Cited by 11
Self-citationSerrand, C., Mura, T., Fabbro-Péray, P., Seni, G., Mousty, E., Boudemaghe, T., & Gris, J. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.14486 · Cited by 12
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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