Rogers B B, Bloom S L, Leveno K J
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, USA.
Obstet Gynecol Surv. 1999 Mar;54(3):189-95. doi: 10.1097/00006254-199903000-00023.
There are two distinct histological manifestations of impaired placental implantation in humans--incomplete trophoblastic vascular invasion and atherosis. Both have been described to occur in pregnancies affected by a variety of disorders such as preeclampsia, fetal growth restriction, systemic lupus erythematosus, and diabetes. Our purpose was to integrate recent developments in the understanding of implantation site disorders into a pathophysiological scenario that interrelates these placentation disorders and associated pregnancy complications. Sources were identified from a MEDLINE search of English-language articles published from 1966 to 1997. Additional sources were identified from references cited in relevant reports. We selected articles relating to the following topics: atherosis, implantation site disorders, trophoblastic invasion, preeclampsia, fetal growth restriction, implantation site development, atherosclerosis, and endothelial activation-damage. A contemporary version of normal placentation, including vascular adaptation, was reviewed with comments on normal trophoblastic differentiation and vascular invasion. Specific abnormalities of the implantation site, including atherosis and incomplete trophoblastic invasion, were discussed in the context of placental site hypoperfusion and the association with pregnancy complications. It was concluded that atherosis and incomplete trophoblastic invasion may be both a consequence and a cause of placental site hypoperfusion resulting in the development of preeclampsia and a variety of other pregnancy disorders.
人类胎盘植入受损有两种不同的组织学表现——滋养层血管侵入不全和动脉粥样硬化。这两种情况都被描述为发生在受多种疾病影响的妊娠中，如先兆子痫、胎儿生长受限、系统性红斑狼疮和糖尿病。我们的目的是将对植入部位疾病的最新认识进展整合到一个病理生理场景中，该场景将这些胎盘形成疾病与相关的妊娠并发症联系起来。通过对1966年至1997年发表的英文文章进行MEDLINE检索来确定资料来源。从相关报告中引用的参考文献中确定了其他资料来源。我们选择了与以下主题相关的文章：动脉粥样硬化、植入部位疾病、滋养层侵入、先兆子痫、胎儿生长受限、植入部位发育、动脉粥样硬化和内皮激活损伤。回顾了正常胎盘形成的当代版本，包括血管适应，并对正常滋养层分化和血管侵入进行了评论。在胎盘部位灌注不足以及与妊娠并发症的关联背景下，讨论了植入部位的特定异常情况，包括动脉粥样硬化和滋养层侵入不全。得出的结论是，动脉粥样硬化和滋养层侵入不全可能既是胎盘部位灌注不足的结果，也是其原因，导致先兆子痫和各种其他妊娠疾病的发生。
