ResearchObstetricsAccreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast
Section snippets
Study design and patient population
In a case-control study design we analyzed maternal blood serum samples from 90 women enrolled prospectively at Yale–New Haven Hospital between May 2005 and January 2010. Our study group consisted of 45 consecutive singleton patients (gestational age [GA] median, 31; interquartile range, 28–34 weeks) who were admitted with a diagnosis of vaginal bleeding due to CPP. Blood specimens from 45 healthy women (GA, 31; interquartile range, 28–33 weeks) pregnant with singletons were matched for GA and
Clinical characteristics of women
We present the demographic, clinical, and pregnancy outcome characteristics of our cohort in Table. Women with CPP were significantly older, were of significantly higher gravidity and parity, and had a significantly higher number of prior CDs when compared to controls. The vast majority of the women with CPP experienced at least one episode of vaginal bleeding during pregnancy (episodes of bleeding: 1 [1-2]). The fetuses of both CPP and control women were of appropriate growth for GA. Women
Comment
Herein, we found that women with CPP have circulatory levels of sFlt-1, PlGF, and VEGF similar to those expected for GA. That the process of excessive myometrial invasion in the setting of CPP is characterized by significantly lower maternal serum levels of VEGF was an unexpected finding.
Following apposition and attachment of the blastocyst to the uterine wall, the process of normal placentation requires a symbiotic interaction between fetal and maternal tissues. This process includes among
Acknowledgments
We are indebted to the nurses, fellows, residents, and faculty at Yale–New Haven Hospital, the Department of Obstetrics and Gynecology and Reproductive Sciences, and to all patients who participated in the study.
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This work was supported by National Institutes of Health Grant no. R01 HD 047321 (I.A.B.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine. C.S.B. was supported by the Yale Women's Reproductive Health Research Career Development Center (K12 HD 1027766) and NIH RO3 HD 50249.
The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
Cite this article as: Wehrum MJ, Buhimschi IA, Salafia C, et al. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2011;204:411.e1-11.