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

Lookup NU author(s): Dr Therese Hannon, Barbara Innes, Dr Gendie Lash, Dr Judith Bulmer, Professor Stephen Robson

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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 (x200 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. (C) 2012 Elsevier Ltd. All rights reserved.


Publication metadata

Author(s): Hannon T, Innes BA, Lash GE, Bulmer JN, Robson SC

Publication type: Article

Publication status: Published

Journal: Placenta

Year: 2012

Volume: 33

Issue: 12

Pages: 998-1004

Print publication date: 01/12/2012

ISSN (print): 0143-4004

ISSN (electronic): 1532-3102

Publisher: Elsevier Ltd

URL: http://dx.doi.org/10.1016/j.placenta.2012.09.004

DOI: 10.1016/j.placenta.2012.09.004


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