title: Dynamic modeling of uteroplacental blood flow in IUGR indicates vortices and elevated pressure in the intervillous space - a pilot study.
abstract: Ischemic placental disease is a concept that links intrauterine growth retardation (IUGR) and preeclampsia (PE) back to insufficient remodeling of uterine spiral arteries. The rheological consequences of insufficient remodeling of uterine spiral arteries were hypothesized to mediate the considerably later manifestation of obstetric disease. However, the micro-rheology in the intervillous space (IVS) cannot be examined clinically and rheological animal models of the human IVS do not exist. Thus, an in silico approach was implemented to provide in vivo inaccessible data. The morphology of a spiral artery and the inflow region of the IVS were three-dimensionally reconstructed to provide a morphological stage for the simulations. Advanced high-end supercomputing resources were used to provide blood flow simulations at high spatial resolution. Our simulations revealed turbulent blood flow (high-velocity jets and vortices) combined with elevated blood pressure in the IVS and increased wall shear stress at the villous surface in conjunction with insufficient spiral artery remodeling only. Post-hoc histological analysis of uterine veins showed evidence of increased trophoblast shedding in an IUGR placenta. Our data support that rheological alteration in the IVS is a relevant mechanism linking ischemic placental disease to altered structural integrity and function of the placenta.
authors.affiliation: Technical University of Munich, Institute for Computational Mechanics, 85748 Garching, Germany.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Roth
authors.affiliation: Ludwig-Maximilians-University of Munich, Department of Anatomy II, 80336 Munich, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Haeussner
authors.affiliation: Hospital Dritter Orden, Gynecology and Obstetrics, 80638 Munich, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Ruebelmann
authors.affiliation: Hospital Dritter Orden, Gynecology and Obstetrics, 80638 Munich, Germany.
authors.forename: Franz V
authors.initials: FV
authors.lastname: Koch
authors.affiliation: Ludwig-Maximilians-University of Munich, Department of Anatomy II, 80336 Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.affiliation: Ludwig-Maximilians-University of Munich, Department of Anatomy II, 80336 Munich, Germany.
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Frank
authors.affiliation: Technical University of Munich, Institute for Computational Mechanics, 85748 Garching, Germany.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Wall
mesh_terms: D000465:Algorithms; D001706:Biopsy; D001783:Blood Flow Velocity; D001794:Blood Pressure; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008954:Models, Biological; D010865:Pilot Projects; D010920:Placenta / Q000098:blood supply* / Q000473:pathology*; D010922:Placenta Diseases / Q000473:pathology* / Q000503:physiopathology*; D011247:Pregnancy; D012039:Regional Blood Flow; D033081:Shear Strength; D014327:Trophoblasts; D055988:Uterine Artery / Q000503:physiopathology