Rheological and Physiological Consequences of Conversion of the Maternal Spiral Arteries for Uteroplacental Blood Flow during Human Pregnancy
By G. Burton, A. Woods, Eric Jauniaux, J. Kingdom. Placenta, 2009
1,118 citations recorded by the source corpus.
Physiological conversion of the maternal spiral arteries is key to a successful human pregnancy. It involves loss of smooth muscle and the elastic lamina from the vessel wall as far as the inner third of the myometrium, and is associated with a 5–10-fold dilation at the vessel mouth. Failure of conversion accompanies common complications of pregnancy, such as early-onset preeclampsia and fetal growth restriction. Here, we model the effects of terminal dilation on inflow of blood into the placental intervillous space at term, using dimensions in the literature derived from three-dimensional reconstructions. We observe that dilation slows the rate of flow from 2 to 3 m/s in the non-dilated part of an artery of 0.4–0.5 mm diameter to approximately 10 cm/s at the 2.5 mm diameter mouth, depending on the exact radius and viscosity. This rate predicts a transit time through the intervillous space of approximately 25 s, which matches observed times closely. The model shows that in the absence of conversion blood will enter the intervillous space as a turbulent jet at rates of 1–2 m/s. We speculate that the high momentum will damage villous architecture, rupturing anchoring villi and creating echogenic cystic lesions as evidenced by ultrasound. The retention of smooth muscle will also increase the risk of spontaneous vasoconstriction and ischaemia–reperfusion injury, generating oxidative stress. Dilation has a surprisingly modest impact on total blood flow, and so we suggest the placental pathology associated with deficient conversion is dominated by rheological consequences rather than chronic hypoxia.
Subfields: Obstetrics and Gynecology, Pediatrics, Perinatology and Child Health
View Paper: https://www.semanticscholar.org/paper/5dfaa176037ed13a6f94252ee7e11efef7646f42
How researchers see this paper
The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.
In Obstetrics and Gynecology
In Pediatrics, Perinatology and Child Health
Citations in the corpus
- Pathophysiology of placental‐derived fetal growth restriction (2018, background): “Mathematical modeling has shown that the normal dilation reduces the velocity by an order of magnitude, from approximately 2-3 m/s to around 10 cm/s.(24) This reduction ensures even perfusion of the villous trees and adequate transit time for exchange.”
- Placenta accreta spectrum: pathophysiology and evidence‐based anatomy for prenatal ultrasound imaging (2018, background): “80 American Journal of Obstetrics & Gynecology arcuate arteries remain highly vasoreactive throughout pregnancy.(49) If the numbers of interstitial EVTs are increased in PAS, by contrast spiral artery remodeling has been described as reduced, more so in cases of PASwithout local decidua.”