Decidual and vascular pathophysiology in pregnancy compromise.

Abstract

If a pregnancy is to be successful, it must have a normal developmental program and an efficient means of gaining access to and maintaining a nutrient pipeline derived from the maternal circulation. A continuous structural and functional development of the uteroplacental vasculature, including trophoblast invasion, spiral artery conversion, and constant adaptation to increasing levels of perfusion, is required. The mechanisms by which these invasive changes proceed necessitate an intricate balance of growth factors, hormones, cytokines, and peptides on a specific time course. This review focuses on the development of the maternal vascular structure and function from the nonpregnant to the pregnant state, and on the pathologic alterations of the uteroplacental vasculature identified in complicated pregnancies. This review also addresses how aberrations in the uterine vascular adaptation of pregnancy may be initiated or aggravated by heritable or acquired conditions affecting the atherosclerotic and coagulation/fibrinolytic pathways traditionally associated with cardiovascular disease.