Abstract | OBJECTIVE:
Placenta accreta is clinically associated with maternal uterine scar. Our objective was to investigate the biochemical contribution of maternal scarring to hyperinvasive trophoblast. We hypothesised that trophoblast over-invasion in placenta accreta is associated with aberrant invasion-site signalling of growth and angiogenic factors known to be involved in wound healing and promotion of cell invasion through the epithelial to mesenchymal cellular programme. DESIGN: Cross-sectional series. SETTING: Yale-New Haven Hospital. POPULATION: Women with histologically confirmed normal and abnormal placentation. METHODS: MAIN OUTCOME MEASURES: Differences in median H-score by immunostaining and in mean serum level by immunoassay. RESULTS: By immunostaining, placenta accreta samples demonstrated intervillous endoglin shedding and increased trophoblast expression of its cleavage protein matrix metalloproteinase-14. Absent decidual HIF1α and endostatin were observed in areas of VEGF upregulation. TGFβ1 was present in myocytes but not in collagen bundles into which accreta trophoblast invaded. Maternal serum endoglin decreased in praevia and accreta when corrected for gestational age. CONCLUSION: Angiogenic and growth factors at the placental invasion site are altered in accreta, both by decidual absence and within myometrial scar. We postulate this promotes the invasive phenotype of placenta accreta by activating hyperinvasive trophoblast and by dysregulating placental vascular remodelling. FUNDING: Yale Department of Obstetrics, Gynecology and Reproductive Sciences funds. TWEETABLE ABSTRACT:
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Authors | C M Duzyj, I A Buhimschi, C A Laky, G Cozzini, G Zhao, M Wehrum, C S Buhimschi |
Journal | BJOG : an international journal of obstetrics and gynaecology
(BJOG)
Vol. 125
Issue 11
Pg. 1441-1448
(Oct 2018)
ISSN: 1471-0528 [Electronic] England |
PMID | 29469945
(Publication Type: Journal Article)
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Copyright | © 2018 Royal College of Obstetricians and Gynaecologists. |
Chemical References |
- Angiogenesis Inducing Agents
- Intercellular Signaling Peptides and Proteins
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Topics |
- Adult
- Angiogenesis Inducing Agents
(metabolism)
- Cell Movement
- Cross-Sectional Studies
- Decidua
(metabolism, pathology)
- Female
- Humans
- Intercellular Signaling Peptides and Proteins
(metabolism)
- Myometrium
(pathology)
- Placenta
(metabolism, pathology)
- Placenta Accreta
(metabolism, pathology)
- Pregnancy
- Trophoblasts
(cytology, pathology)
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