Barinova I V, Kondrikov N I, Voloshchuk I N, Chechneva M A, Shchukina N A, Petrukhin V A
Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia.
Arkh Patol. 2018;80(2):18-23. doi: 10.17116/patol201880218-23.
to investigate the structural and pathogenetic features of pathological placental attachment in the scar after cesarean section.
The investigators explored 12 uteri; 11 of which were removed with placentas at 9 to 38 weeks' gestation (one in the first trimester, three at 18-22 weeks, two at 32-35 weeks, and five at 37-38 weeks); one uterus was removed after an artificial abortion at 12 weeks' gestation in the scar, as well as the scars excised in the first trimester in non-developing (n=4) and progressive (n=2) pregnancies. For histological examination, fragments of the full-thickness uterine wall were taken from the placental bed in different areas. The sections were stained for fibrin with hematoxylin and eosin, van Gieson stain, and the Martius scarlet/blue (MSB) technique. Decidual tissue, trophoblast, vascular component, and smooth muscle tissue were identified by an immunohistochemical assay using antibodies to vimentin, pan-cytokeratin, vascular endothelium (СD31), and smooth muscle actin.
In most cases, placental localization in the scar after cesarean section was accompanied by abnormal placental attachment: almost always placenta accreta, less frequently in combination with its ingrowth (placenta accreta/increta). The morphological substrate of placenta increta was a change in the content and ratio of normal histological components in the uterine wall, such as the mucosa, smooth muscle tissue, and vessels (the absence or thinning of decidual tissue and the myometrium, as well as its cicatricial changes). The structural criterion for placenta increta was necrosis of the walls of the large veins in the myometrium due to the replacement of their intermediate trophoblast and fibrin and to the destruction of vessel walls, leading to prolapse of the chorionic villi into the veins.
In most cases, placental localization in the scar after cesarean section is accompanied by abnormal placental attachment: placenta accreta, less frequently in combination with its ingrowth (placenta accreta/increta).
研究剖宫产术后瘢痕处病理性胎盘附着的结构及发病机制特点。
研究人员对12例子宫进行了探查；其中11例在妊娠9至38周时连同胎盘一并切除（1例在孕早期，3例在18 - 22周，2例在32 - 35周，5例在37 - 38周）；1例在瘢痕处妊娠12周人工流产后切除子宫，以及在孕早期非发育性（n = 4）和进行性（n = 2）妊娠中切除的瘢痕。为进行组织学检查，从胎盘床不同区域取全层子宫壁碎片。切片用苏木精和伊红、范吉森染色以及马休黄猩红/蓝（MSB）技术进行纤维蛋白染色。通过使用波形蛋白、泛细胞角蛋白、血管内皮（СD31）和平滑肌肌动蛋白抗体的免疫组织化学分析来鉴定蜕膜组织、滋养层、血管成分和平滑肌组织。
在大多数情况下，剖宫产术后瘢痕处的胎盘定位伴有异常胎盘附着：几乎总是胎盘植入，较少情况下伴有胎盘侵入（胎盘植入/穿透性胎盘植入）。穿透性胎盘植入的形态学基础是子宫壁中正常组织学成分的含量和比例发生变化，如黏膜、平滑肌组织和血管（蜕膜组织和肌层缺失或变薄以及其瘢痕性改变）。穿透性胎盘植入的结构标准是肌层中大静脉壁坏死，这是由于中间滋养层和纤维蛋白替代以及血管壁破坏，导致绒毛膜绒毛脱垂至静脉内。
在大多数情况下，剖宫产术后瘢痕处的胎盘定位伴有异常胎盘附着：胎盘植入，较少情况下伴有胎盘侵入（胎盘植入/穿透性胎盘植入）。
