title: Decidual vasculopathy in preeclampsia: lesion characteristics relate to disease severity and perinatal outcome.
abstract: OBJECTIVE
  In a proportion of patients with preeclampsia, unremodeled spiral arteries develop additional pathological changes, termed decidual vasculopathy (DV), or acute atherosis. DV has been correlated to adverse clinical outcome and increased placental pathology. However, it was unclear whether these effects pertained to individual features of DV.
  
  
  METHODS
  We performed a reanalysis of placental samples from preeclamptic pregnancies (n = 76), recording the number of vessels with DV, their location in the decidua and their morphological features. Results were correlated with clinical and placental parameters, using Spearman's rho test. P-value < 0.05 was considered significant.
  
  
  RESULTS
  Total number of vessels with DV (totalDV) correlated with higher diastolic blood pressure, higher urine protein-to-creatinine ratio, shorter gestational age, lower birth weight, 5 min APGAR score and umbilical artery pH, and with increased accelerated villous maturity, infarction and hematoma formation, but not with HELLP syndrome markers. Additionally, there was a striking correlation of increased perinatal mortality with the number of vessels located in the decidua basalis (DVbas), and with vessels showing DV with thrombosis (DVthrom). Other morphological features, such as foam cell infiltration, did not increase correlation strength.
  
  
  CONCLUSIONS
  In our study of preeclamptic placental samples, totalDV related to worse clinical outcome and increased placental pathology. Moreover, DVbas and DVthrom related to perinatal death. DV could be a manifestation of an underlying (vascular) pathology, increasing the risk of adverse pregnancy outcome.
  
  
  CONCLUSIONS
  In preeclampsia, totalDV, DVbas and DVthrom correlated with increased placental pathology and adverse maternal and fetal outcome, most relevantly with perinatal mortality.
authors.affiliation: Radboud University Nijmegen Medical Centre, Department of Obstetrics & Gynaecology, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. d.stevens@obgyn.umcn.nl
authors.forename: D U
authors.initials: DU
authors.lastname: Stevens
authors.forename: S
authors.initials: S
authors.lastname: Al-Nasiry
authors.forename: J
authors.initials: J
authors.lastname: Bulten
authors.forename: M E A
authors.initials: ME
authors.lastname: Spaanderman
mesh_terms: D000328:Adult; D001485:Basement Membrane / Q000098:blood supply / Q000276:immunology / Q000473:pathology; D001724:Birth Weight; D003656:Decidua / Q000098:blood supply* / Q000276:immunology / Q000473:pathology; D005260:Female; D005487:Foam Cells / Q000276:immunology / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D008262:Macrophage Activation; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D054238:Perinatal Mortality; D010920:Placenta / Q000098:blood supply / Q000276:immunology / Q000473:pathology; D011225:Pre-Eclampsia / Q000276:immunology / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000209:etiology; D011507:Proteinuria / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013927:Thrombosis / Q000209:etiology; D014652:Vascular Diseases / Q000209:etiology*
keywords: Acute atherosis; Clinical outcome; DV; DVbas; DVthrom; Placenta pathology; Preeclampsia; Vasculopathy; decidual vasculopathy; number of vessels with decidual vasculopathy and thrombosis; number of vessels with decidual vasculopathy in decidua basalis; total number of vessels with decidual vasculopathy; totalDV