What is pseudovascularization in the context of preeclampsia?

Updated: Nov 29, 2018
  • Author: Kee-Hak Lim, MD; Chief Editor: Ronald M Ramus, MD  more...
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In normal pregnancies, a subset of cytotrophoblasts called invasive cytotrophoblasts migrate through the implantation site and invade decidua tunica media of maternal spiral arteries and replace its endothelium in a process called pseudovascularization. [24] The trophoblast differentiation along the invasive pathway involves alteration in the expression of a number of different classes of molecules, including cytokines, adhesion molecules, extracellular matrix, metalloproteinases, and the class Ib major histocompatibility complex (MHC) molecule, HLA-G. [25, 26]

For example, during normal differentiation, invading trophoblasts alter their adhesion molecule expression from those that are characteristic of epithelial cells (integrins alpha 6/beta 1, alpha V/beta 5, and E-cadherin) to those of endothelial cells (integrins alpha 1/beta 1, alpha V/beta 3, and VE-cadherin).

As a result of these changes, the maternal spiral arteries undergo transformation from small, muscular arterioles to large capacitance, low-resistance vessels. This allows increased blood flow to the maternal-fetal interface. Remodeling of these arterioles probably begins in the first trimester and ends by 18-20 weeks' gestation. However, the exact gestational age at which the invasion stops is unknown.

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