Effects of local decidua on trophoblast invasion and spiral artery remodeling in focal placenta creta – An immunohistochemical study

• Published in: Placenta (Eastbourne) Vol. 33; no. 12; pp. 998 - 1004
• Main Authors: Hannon, T, Innes, B.A, Lash, G.E, Bulmer, J.N, Robson, S.C
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-12-2012; Elsevier
• Subjects: Adult; Arteries - metabolism; Arteries - pathology; Biological and medical sciences; Biomarkers - metabolism; Cell Movement; Decidua - blood supply; Decidua - metabolism; Decidua - pathology; Embryology: invertebrates and vertebrates. Teratology; Female; Fundamental and applied biological sciences. Psychology; Giant Cells - metabolism; Giant Cells - pathology; Humans; Hyperplasia; Immunohistochemistry; Internal Medicine; MTGC; multinucleate trophoblast giant cells; Myometrium - blood supply; Myometrium - metabolism; Myometrium - pathology; Obstetrics and Gynecology; Placenta accreta; Placenta Accreta - metabolism; Placenta Accreta - pathology; Placental Circulation; Placentation; Pregnancy; Pregnancy Proteins - metabolism; SpA; spiral arteries; Spiral artery remodeling; Trophoblast; Trophoblasts - metabolism; Trophoblasts - pathology; Placenta accreta; multinucleate trophoblast giant cells; spiral arteries; SpA; MTGC; Trophoblast; Spiral artery remodeling; Pregnancy; Immunohistochemistry; Trophoblaste; Vertebrata; Mammalia; Placenta; Uterus; Fetal membrane; Female genital system; Decidua; Local effect; Invasion
• ISSN: 0143-4004; 1532-3102
• DOI: 10.1016/j.placenta.2012.09.004

Abstract Objectives Placenta creta is an increasingly prevalent cause of maternal morbidity/mortality. Decidua is at least focally defective and extravillous trophoblast (EVT) may be abnormal. The study aims to compare differences in migratory trophoblast and spiral artery remodeling between areas with and without decidua at the placental implantation site. Study design Sixteen (12 creta, 4 non-creta) caesarean hysterectomy specimens were studied immunohistochemically. Invasive EVT and multinucleate trophoblast giant cells (MTGC) were quantified; confluent EVT (>5 opposed EVTs) and spiral artery remodeling were assessed semi-quantitatively. Results In 6 cases, placenta creta was focal. Compared to placenta creta with local decidua, cases without local decidua had increased interstitial EVT cells (×200 field) (SEM 45.6 [4.9] vs. 80.5 [3.9], p  < 0.0001), fewer multinucleate trophoblast giant cells (expressed as a percentage of total EVT) (0.8 [0.3] vs. 31.5 [2.2]% p  < 0.0001) and EVT was more confluent ( p  < 0.0001). In contrast, placenta creta cases with local decidua had a greater degree of spiral artery remodeling (mean remodeling score 1.65 [0.07] vs. 1.13 [0.05], p  < 0.0001) associated with increased intramural trophoblast ( p  = 0.0008). The only difference between placenta creta with local decidua and normal placentation cases was an increased number of interstitial EVT cells in creta cases (45.6 [4.9] vs. 24.8 [3.2], p  = 0.04). Conclusions Numbers of interstitial EVT are increased in placenta creta, more so in cases without local decidua. Despite this spiral artery modeling is reduced in placenta creta cases with no decidua. The results emphasize the crucial role of decidua in control of trophoblast invasion and spiral artery remodeling.