Department of Gynecology and Reproductive Medicine, Kashihara, Japan.
Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan.
J Obstet Gynaecol Res. 2024 Jun;50(6):929-940. doi: 10.1111/jog.15936. Epub 2024 Mar 27.
The refinement of assisted reproductive technology, including the development of cryopreservation techniques (vitrification) and ovarian stimulation protocols, makes frozen embryo transfer (FET) an alternative to fresh ET and has contributed to the success of assisted reproductive technology. Compared with fresh ET cycles, FET cycles were associated with better in vitro fertilization outcomes; however, the occurrence of pregnancy-induced hypertension, preeclampsia, and placenta accreta spectrum (PAS) was higher in FET cycles. PAS has been increasing steadily in incidence as a life-threatening condition along with cesarean rates worldwide. In this review, we summarize the current understanding of the pathogenesis of PAS and discuss future research directions.
A literature search was performed in the PubMed and Google Scholar databases.
Risk factors associated with PAS incidence include a primary defect of the decidua basalis or scar dehiscence, aberrant vascular remodeling, and abnormally invasive trophoblasts, or a combination thereof. Freezing, thawing, and hormone replacement manipulations have been shown to affect multiple cellular pathways, including cell proliferation, invasion, epithelial-to-mesenchymal transition (EMT), and mitochondrial function. Molecules involved in abnormal migration and EMT of extravillous trophoblast cells are beginning to be identified in PAS placentas. Many of these molecules were also found to be involved in mitochondrial biogenesis and dynamics.
The etiology of PAS may be a multifactorial genesis with intrinsic predisposition (e.g., placental abnormalities) and certain environmental factors (e.g., defective decidua) as triggers for its development. A distinctive feature of this review is its focus on the potential factors linking mitochondrial function to PAS development.
辅助生殖技术的不断完善，包括冷冻保存技术（玻璃化）和卵巢刺激方案的发展，使冷冻胚胎移植（FET）成为新鲜胚胎移植的替代方案，并有助于辅助生殖技术的成功。与新鲜胚胎移植周期相比，FET 周期与更好的体外受精结局相关；然而，FET 周期中妊娠高血压、子痫前期和胎盘部位疾病谱（PAS）的发生率更高。随着全球剖宫产率的上升，PAS 作为一种危及生命的疾病，其发病率一直在稳步上升。在这篇综述中，我们总结了目前对 PAS 发病机制的理解，并讨论了未来的研究方向。
在 PubMed 和 Google Scholar 数据库中进行了文献检索。
与 PAS 发生率相关的风险因素包括底蜕膜原发性缺陷或瘢痕裂开、血管异常重塑和异常侵袭性滋养细胞，或其组合。冷冻、解冻和激素替代操作已被证明会影响多种细胞途径，包括细胞增殖、侵袭、上皮间质转化（EMT）和线粒体功能。在 PAS 胎盘组织中，开始鉴定与绒毛外滋养细胞异常迁移和 EMT 相关的分子。许多这些分子也被发现参与线粒体生物发生和动力学。
PAS 的病因可能是一种多因素的起源，具有内在的易感性（例如胎盘异常）和某些环境因素（例如，有缺陷的蜕膜）作为其发展的触发因素。本综述的一个特点是重点关注将线粒体功能与 PAS 发展联系起来的潜在因素。
