title: Effects of local decidua on trophoblast invasion and spiral artery remodeling in focal placenta creta - an immunohistochemical study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Reproductive and Vascular Biology Group, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom. trezhannon@gmail.com
authors.forename: T
authors.initials: T
authors.lastname: Hannon
authors.forename: B A
authors.initials: BA
authors.lastname: Innes
authors.forename: G E
authors.initials: GE
authors.lastname: Lash
authors.forename: J N
authors.initials: JN
authors.lastname: Bulmer
authors.forename: S C
authors.initials: SC
authors.lastname: Robson
mesh_terms: D000328:Adult; D001158:Arteries / Q000378:metabolism / Q000473:pathology*; D015415:Biomarkers / Q000378:metabolism; D002465:Cell Movement; D003656:Decidua / Q000098:blood supply / Q000378:metabolism / Q000473:pathology*; D005260:Female; D015726:Giant Cells / Q000378:metabolism / Q000473:pathology; D006801:Humans; D006965:Hyperplasia; D007150:Immunohistochemistry; D009215:Myometrium / Q000098:blood supply / Q000378:metabolism / Q000473:pathology*; D010921:Placenta Accreta / Q000378:metabolism / Q000473:pathology*; D021041:Placental Circulation; D010929:Placentation; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000378:metabolism; D014327:Trophoblasts / Q000378:metabolism / Q000473:pathology*
chemical_list: D015415:Biomarkers; D011257:Pregnancy Proteins