胎盘早剥综合症的生物学和病理生理学。

IF 5.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Yalda Afshar,Lior Kashani Ligumsky,Helena C Bartels,Deborah Krakow
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引用次数: 0

摘要

胎盘增生谱(PAS)疾病是一项重大的临床挑战,其特征是继发于子宫瘢痕的异常胎盘粘附子宫壁。随着全球剖宫产率的上升,这种医源性疾病的发病率也在增加,强调了对其病理生理学的了解,以便为管理和预防策略提供信息的迫切需要。正常的胎盘形成依赖于严格调控的上皮外滋养细胞侵入蜕膜、螺旋动脉重塑、与细胞外基质的相互作用和免疫调节。子宫瘢痕破坏了这种平衡,造成了一个缺乏协调着床和去个体化所需的关键调节信号的环境。在PAS中,抑制性蜕膜信号的缺失和边界限制的缺陷允许滋养细胞无限制地进入异常蜕膜环境。信号失调,以及瘢痕组织中的炎症环境,加剧了胎盘的异常发育。目前的产前影像学主要关注过多的纤维蛋白沉积、细胞外基质重塑和不完全螺旋动脉转化的出现,作为PAS风险分层的替代品。新兴的单细胞RNA测序和蛋白质组学分析提供了对生物标志物和途径的见解,使有针对性的干预成为可能。预防工作应优先减少剖宫产率,以限制子宫瘢痕形成。再生医学和生物工程的进展,包括细胞外基质调节生物材料、生长因子疗法和抗纤维化干预,有望改善疤痕愈合和降低PAS风险。本文综述了基础科学和临床应用之间的联系,强调了潜在的胎盘生物学和病理生理学在检测、治疗和预防PAS方面的重要性。在这种日益普遍的医源性疾病中,解决异常胎盘的驱动因素对于改善孕产妇和新生儿结局至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Biology and Pathophysiology of Placenta Accreta Spectrum Disorder.
Placenta accreta spectrum (PAS) disorders present a significant clinical challenge, characterized by abnormal placental adherence to the uterine wall secondary to uterine scarring. With the rising global cesarean delivery rates, the incidence of this iatrogenic disorder has increased, underscoring the critical need for an understanding of its pathophysiology to inform management and prevention strategies. Normal placentation depends on tightly regulated extravillous trophoblast invasion into the decidua, spiral artery remodeling, interactions with the extracellular matrix, and immune modulation. Uterine scarring disrupts this balance, creating an environment deficient in key regulatory signals required for coordinated implantation and decidualization. In PAS, the loss of inhibitory decidual cues and deficient boundary limits permits unrestrained trophoblast into the abnormal decidual environment. Dysregulated signaling, along with an inflammatory milieu in scarred tissues, exacerbates abnormal placental development. Current prenatal imaging focuses on the appearance of excessive fibrinoid deposition, extracellular matrix remodeling, and incomplete spiral artery transformation as surrogates of PAS risk stratification. Emerging single-cell RNA sequencing and proteomic profiling offer insights into biomarkers and pathways that enable targeted interventions. Preventive efforts should prioritize reducing cesarean delivery rates to limit uterine scarring. Advances in regenerative medicine and bioengineering, including extracellular matrix-modulating biomaterials, growth factor therapies, and antifibrotic interventions, hold promise for improving scar healing and reducing PAS risk. This review bridges foundational science and clinical application, emphasizing the importance of the underlying placental biology and pathophysiology to make a clinical difference in detecting, treating, and preventing PAS. Addressing drivers of abnormal placentation is critical for improving maternal and neonatal outcomes with this increasingly prevalent iatrogenic condition.
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来源期刊
Obstetrics and gynecology
Obstetrics and gynecology 医学-妇产科学
CiteScore
11.10
自引率
4.20%
发文量
867
审稿时长
1 months
期刊介绍: "Obstetrics & Gynecology," affectionately known as "The Green Journal," is the official publication of the American College of Obstetricians and Gynecologists (ACOG). Since its inception in 1953, the journal has been dedicated to advancing the clinical practice of obstetrics and gynecology, as well as related fields. The journal's mission is to promote excellence in these areas by publishing a diverse range of articles that cover translational and clinical topics. "Obstetrics & Gynecology" provides a platform for the dissemination of evidence-based research, clinical guidelines, and expert opinions that are essential for the continuous improvement of women's health care. The journal's content is designed to inform and educate obstetricians, gynecologists, and other healthcare professionals, ensuring that they stay abreast of the latest developments and best practices in their field.
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