What is the role of pseudovascularization in the pathogenesis of preeclampsia?

Updated: Nov 29, 2018
  • Author: Kee-Hak Lim, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

Answer

The shallow placentation noted in preeclampsia results from the fact that the invasion of the decidual arterioles by cytotrophoblasts is incomplete. This is due to a failure in the alterations in molecular expression necessary for the differentiation of the cytotrophoblasts, as required for pseudovascularization. For example, the upregulation of matrix metalloproteinase-9 (MMP-9) and HLA-G, 2 molecules noted in normally invading cytotrophoblasts, does not occur.

The invasive cytotrophoblasts therefore fail to replace tunica media, which means that mostly intact arterioles, which are capable of vasoconstriction, remain. Histologic evaluation of the placental bed demonstrates few cytotrophoblasts beyond the decidual layer.

The primary cause for the failure of these invasive cytotrophoblasts to undergo pseudovascularization and invade maternal blood vessels is not clear. However, immunologic and genetic factors have been proposed. Early hypoxic insult to differentiating cytotrophoblasts has also been proposed as a contributing factor.


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