Skip to main content
SpringerLink
Log in

Pathology of the Placenta: A Continuum Spectrum of Inflammation from Physiology to Disease

  • Chapter
Metabolic Syndrome and Complications of Pregnancy

  • 1103 Accesses

Abstract

Successful pregnancy is the result of a delicate balance between fetal demands and maternal supply. The feto-maternal interface is the no man’s land for this dialogue. Immune cells set the rules of the feto-maternal cross talk, pipeline development, cell functions, and reactions to unexpected third parties. A dynamic and coordinate modification of number, morphology, function, and distribution of any type of inflammatory cells sustains the normal evolution of pregnancy and eventually helps to bring it to parturition. Abnormalities in the equilibrium of the inflammatory microenvironment can lead to placental histological lesions and adverse pregnancy outcome. Beyond acute infections, chronic villitis, chronic chorioamnionitis, chronic intervillositis, and chronic deciduitis often coexist as a tetrad, suggesting an abnormal immune response. Maternal characteristics such as visceral obesity could set the ground for the development of these placental lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Red-Horse K, Zhou Y, Genbacev O, Prakobphol A, Foulk R, McMaster M, Fisher SJ. Trophoblast differentiation during embryo implantation and formation of the maternal-fetal interface. J Clin Invest. 2004;114(6):744–54.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Gellersen B, Brosens IA, Brosens JJ. Decidualization of the human endometrium: mechanisms, functions, and clinical perspectives. Semin Reprod Med. 2007;25(6):445–53.

    Article  CAS  PubMed  Google Scholar 

  3. Huppertz B. The anatomy of the normal placenta. J Clin Pathol. 2008;61(12):1296–302.

    Article  CAS  PubMed  Google Scholar 

  4. Oreshkova T, Dimitrov R, Mourdjeva M. A cross-talk of decidual stromal cells, trophoblast, and immune cells: a prerequisite for the success of pregnancy. Am J Reprod Immunol. 2012;68:366–73.

    Article  CAS  PubMed  Google Scholar 

  5. Mor G. Inflammation and pregnancy. The role of toll-like receptors I trophoblast-immune interaction. Ann N Y Acad Sci. 2008;1127:121–8.

    Article  CAS  PubMed  Google Scholar 

  6. Rapacz-Leonard A, DÄ…browska M, Janowski T. Major histocompatibility complex I mediates immunological tolerance of the trophoblast during pregnancy and may mediate rejection during parturition. Mediators Inflamm. 2014;2014:821530.

    PubMed Central  Google Scholar 

  7. Erlebacher A. Immunology of the maternal-fetal interface. Ann Rev Immunol. 2013;31:387–411.

    Article  CAS  Google Scholar 

  8. Tuckerman E, Mariee N, Prakash A, Li TC, Laird S. Uterine natural killer cells in peri-implantation endometrium from women with repeated implantation failure after IVF. J Reprod Immunol. 2010;87:60–6.

    Article  CAS  PubMed  Google Scholar 

  9. Quenby S, Bates M, Doig T, Brewster J, Lewis-Jones DI, Johnson PM, Vince G. Pre-implantation endometrial leukocytes in women with recurrent miscarriage. Hum Reprod. 1999;14:2386–91.

    Article  CAS  PubMed  Google Scholar 

  10. Williams PJ, Bulmer JN, Searle RF, Innes BA, Robson SC. Altered decidual leucocyte populations in the placental bed in pre-eclampsia and foetal growth restriction: a comparison with late normal pregnancy. Reproduction. 2009;138:177–84.

    Article  CAS  PubMed  Google Scholar 

  11. Mantovani A, Sica A, Sozzani S, Allavena P, Vecchi A, Locati M. The chemokine system in diverse forms of macrophage activation and polarization. Trends Immunol. 2004;25:677–86.

    Article  CAS  PubMed  Google Scholar 

  12. Gustafsson C, Mjösberg J, Matussek A, Geffers R, Matthiesen L, Berg G, Sharma S, Buer J, Ernerudh J. Gene expression profiling of human decidual macrophages: evidence for immunosuppressive phenotype. PLoS One. 2008;3:e2078.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Tang Z, Abrahams VM, Mor G, Guller S. Placental Hofbauer cells and complications of pregnancy. Ann N Y Acad Sci. 2011;1221:103–8.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Seval Y, Korgun ET, Demir R. Hofbauer cells in early human placenta: possible implications in vasculogenesis and angiogenesis. Placenta. 2007;28:841–5.

    Article  CAS  PubMed  Google Scholar 

  15. Anteby EY, et al. Human placental Hofbauer cells express sprouty proteins: a possible modulating mechanism of villous branching. Placenta. 2005;26:476–83.

    Article  CAS  PubMed  Google Scholar 

  16. Saito S, Nakashima A, Shima T, Ito M. Th1/Th2/Th17 and regulatory T-cell paradigm in pregnancy. Am J Reprod Immunol. 2010;63:601–10.

    Article  CAS  PubMed  Google Scholar 

  17. Wegmann TG, Lin H, Guilbert L, Mosmann TR. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today. 1993;14:353–6.

    Article  CAS  PubMed  Google Scholar 

  18. Wilczynski JR. Th1/Th2 cytokines balance – yin and yang of reproductive immunology. Eur J Obstet Gynecol Reprod Biol. 2005;122:136–43.

    Article  CAS  PubMed  Google Scholar 

  19. Sykes L, MacIntyre DA, Yap XJ, Teoh TG, Bennett PR. The Th1:th2 dichotomy of pregnancy and preterm labour. Mediators Inflamm. 2012;2012:967629. doi: 10.1155/2012/967629. Epub 2012 Jun 7. Review. PMID: 22719180

  20. Guerin LR, Prins JR, Robertson SA. Regulatory T-cells and immune tolerance in pregnancy: a new target for infertility treatment? Hum Reprod Update. 2009;15:517–35.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. La Rocca C, Carbone F, Longobardi S, Matarese G. The immunology of pregnancy: regulatory T cells control maternal immune tolerance toward the fetus. Immunol Lett. 2014;162:41–8.

    Article  PubMed  Google Scholar 

  22. Williams Z. Inducing tolerance to pregnancy. N Engl J Med. 2012;367:1159–61.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Samstein RM, Josefowicz SZ, Arvey A, Treuting PM, Rudensky AY. Extrathymic generation of regulatory T cells in placental mammals mitigates maternal-fetal conflict. Cell. 2012;150:29–38.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Askelund K, Liddell HS, Zanderigo AM, Fernando NS, Khong TY, Stone PR, et al. CD83(+) dendritic cells in the decidua of women with recurrent miscarriage and normal pregnancy. Placenta. 2004;25:140–5.

    Article  CAS  PubMed  Google Scholar 

  25. Fettke F, Schumacher A, Costa SD, Zenclussen AC. B cells: the old new players in reproductive immunology. Front Immunol. 2014;5:285.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Fest S, Aldo PB, Abrahams VM, Visintin I, Alvero A, Chen R, Chavez SL, Romero R, Mor G. Trophoblast-macrophage interactions: a regulatory network for the protection of pregnancy. Am J Reprod Immunol. 2007;57:55–66.

    Article  PubMed  Google Scholar 

  27. Kraus FT, Redline R, Gersell DJ, Nelson DM, Dicke JM. Atlas of nontumor pathology: placental pathology. First series. Fascicle 3. Washington DC: American Registry of Pathology; 2004.

    Google Scholar 

  28. Redline RW, Faye-Petersen O, Heller D, Qureshi F, Savell V, Vogler C, Society for Pediatric Pathology, Perinatal Section, Amniotic Fluid Infection Nosology Committee. Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol. 2003;6(5):435–48.

    Article  PubMed  Google Scholar 

  29. Goldenberg RL, Andrews WW, Hauth JC. Choriodecidual infection and preterm birth. Nutr Rev. 2002;60:S19–25.

    Article  PubMed  Google Scholar 

  30. Shatrov JG, Birch SC, Lam LT, Quinlivan JA, McIntyre S, Mendz GL. Chorioamnionitis and cerebral palsy: a meta-analysis. Obstet Gynecol. 2010;116:387–92.

    Article  PubMed  Google Scholar 

  31. Oggé G, Romero R, Lee DC, Gotsch F, Than NG, Lee J, Chaiworapongsa T, Dong Z, Mittal P, Hassan SS, Kim CJ. Chronic chorioamnionitis displays distinct alterations of the amniotic fluid proteome. J Pathol. 2011;223:553–65.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Redline RW. Villitis of unknown etiology: noninfectious chronic villitis in the placenta. Hum Pathol. 2007;38:1439–46.

    Article  PubMed  Google Scholar 

  33. van der Hoorn ML, Lashley EE, Bianchi DW, Claas FH, Schonkeren CM, Scherjon SA. Clinical and immunologic aspects of egg donation pregnancies: a systematic review. Hum Reprod Update. 2010;16:704–12.

    Article  PubMed  Google Scholar 

  34. Katzman PJ. Chronic inflammatory lesions of the placenta. Semin Perinatol. 2015;39:20–6.

    Article  PubMed  Google Scholar 

  35. Goldenberg R, Hautth J, Andrews W. Intrauterine infection and preterm delivery. N Engl J Med. 2000;342:1500–7.

    Article  CAS  PubMed  Google Scholar 

  36. Staff AC, Redman CW. IFPA Award in Placentology Lecture: preeclampsia, the decidual battleground and future maternal cardiovascular disease. Placenta. 2014;35:S26–31. doi: 10.1016/j.placenta.2013.12.003. Epub 2013 Dec 18. PMID: 24411701

  37. Staff AC, Dechend R, Pijnenborg R. Learning from the placenta: acute atherosis and vascular remodeling in preeclampsia-novel aspects for atherosclerosis and future cardiovascular health. Hypertension. 2010;56:1026e34.

    Article  Google Scholar 

  38. Kim CJ, Romero R, Kusanovic JP, Yoo W, Dong Z, Topping V, Gotsch F, Yoon BH, Chi JG, Kim JS. The frequency, clinical significance, and pathological features of chronic chorioamnionitis: a lesion associated with spontaneous preterm birth. Mod Pathol. 2010;23:1000–11.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Healt Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy

    Gaetano Pietro Bulfamante MD & Laura Avagliano MD, PhD

Authors
  1. Gaetano Pietro Bulfamante MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Avagliano MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gaetano Pietro Bulfamante MD .

Editor information

Editors and Affiliations

  1. Woman, Mother and Neonate Department, University of Milan, Buzzi Children's Hospital, Milan, Italy

    Enrico Ferrazzi

  2. Inflammation Research Foundation, Marblehead, Massachusetts, USA

    Barry Sears

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Bulfamante, G.P., Avagliano, L. (2015). Pathology of the Placenta: A Continuum Spectrum of Inflammation from Physiology to Disease. In: Ferrazzi, E., Sears, B. (eds) Metabolic Syndrome and Complications of Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-16853-1_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-16853-1_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16852-4

  • Online ISBN: 978-3-319-16853-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation