Abnormal Trophoblast Invasion: The Culprit of The Major Obstetrics Problems

Abstract

Pathogenesis of preeclampsia as the consequences of the interaction failure between trophoblast and womb, mainly in the 1 st trimester leads to a stress response in the placenta. This may cause poor growth and development of the villous tree, deteriorating transfer of oxygen and nutrients to the fetus. 1 In the simultaneous way huge number of placental debris as the result of necrotic-apoptotic process is released into maternal circulation. 1,2 That of phenomenon related to syncytiotrophoblastic stress is triggering endothelial dysregulation and extreme in fl ammation process, and so do the clinical respond related, such as: hypertension, proteinuria, edema, convulsion, cerebral edema, acute renal failure, acute liver dysfunction, thrombocytopenia (which are as the maternal complications) and fetal growth restriction, preterm delivery, still birth (which are as the fetal complications). 3 Fetal growth restriction (FGR) which could be develop solely or as one entity of early-onset preeclampsia is mostly caused by the poor attitude of extravillous trophoblast cells (EVT) in doing its work on maternal spiral artery remodeling process. 4 As we can see clear from the large data of scienti fi c evidence, the only signi fi cant modality to prevent FGR until recent is by giving low-dose aspirin before 16 weeks of gestational age in selected pregnancies with high resistance index of uterine artery shown by doppler velocimetry ultrasound. 5 Beyond that, only timely delivery after series of close monitoring that will give better perinatal outcome. 6 This will often end with preterm delivery, which increases the percentage of preterm birth in general. 6 In the placenta accreta spectrum (PAS) is a condition where the trophoblast invasion is too aggressive. The development of PAS is a complex multifactorial process related to the combination of decidual-myometrial (as the results of previous c-section or other gynecological surgery), absence the basal plate