Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
Med Sci Monit. 2023 Apr 15;29:e939125. doi: 10.12659/MSM.939125.
BACKGROUND Placenta accreta spectrum (PAS) is a complex obstetric complication that poses a major risk for life-threatening hemorrhage. The pathogenesis of PAS is known to be related to placentogenesis, trophoblastic cells invasion, and previous obstetrical procedures that cause uterine wall defects. However, the precise mechanism of this disease has not been fully explained. This study aimed to evaluate the differences in maximum depth of invasion and distribution pattern of implantation site intermediate trophoblasts between PAS and non-accreta cases. MATERIAL AND METHODS This was an observational, analytic, cross-sectional study that utilized paraffin block specimen of peripartum hysterectomy performed in Hasan Sadikin General Hospital Bandung from 2018 to 2020. Sixty-four samples were obtained, then classified as PAS and non-accreta (normal placenta). Implantation site-intermediate trophoblasts were identified using CD-146 staining. Maximum invasion depth of intermediate trophoblasts was measured in micrometers, while the distribution pattern was assessed and classified into 2 groups: confluent and scattered. RESULTS We found that the maximum invasion depth of the intermediate trophoblasts was significantly higher in the PAS group compared to that of the non-accreta group (2453.52±1172.122 µm vs 1613.59±822.588 µm, P=0.009). The confluent distribution pattern was significantly more common in the PAS group compared to that of the non-accreta group (87.2% vs 17.6%, P=0.0001). CONCLUSIONS The findings of our study suggested that implantation site intermediate trophoblasts play a role in the pathophysiology of placenta accreta. Further studies are needed to determine factors that affect trophoblast invasion leading to placenta accreta spectrum.
胎盘部位滋养细胞肿瘤谱（PAS）是一种复杂的产科并发症，对危及生命的出血有重大风险。PAS 的发病机制已知与胎盘发生、滋养细胞浸润以及导致子宫壁缺陷的先前产科手术有关。然而，这种疾病的确切机制尚未完全解释清楚。本研究旨在评估 PAS 与非粘连病例之间胎盘植入部位中间滋养细胞的最大浸润深度和分布模式的差异。
这是一项观察性、分析性、横断面研究，使用了 2018 年至 2020 年在万隆哈桑萨迪金综合医院进行的围产期子宫切除术的石蜡块标本。获得了 64 个样本，然后分为 PAS 和非粘连（正常胎盘）组。使用 CD-146 染色鉴定胎盘植入部位中间滋养细胞。中间滋养细胞的最大浸润深度以微米为单位进行测量，而分布模式则进行评估并分为 2 组：融合和分散。
我们发现，中间滋养细胞的最大浸润深度在 PAS 组明显高于非粘连组（2453.52±1172.122 µm 与 1613.59±822.588 µm，P=0.009）。融合分布模式在 PAS 组明显比非粘连组更为常见（87.2% 比 17.6%，P=0.0001）。
我们的研究结果表明，胎盘植入部位中间滋养细胞在胎盘部位滋养细胞肿瘤谱的病理生理学中起作用。需要进一步研究以确定影响滋养细胞浸润导致胎盘部位滋养细胞肿瘤谱的因素。
