The Pathology of Feto-Placental Insufficiency in Hypertensive Pregnancy
In seeking a rational approach to the pathology, and hence the treatment, of dysmaturity attributable to placental insufficiency, it may be a good idea to reflect carefully upon the pathology of one cause of placental insufficiency where there is now a better understanding of the morphological lesions associated with placental disease and consequent fetal dysmaturity. The term placental insufficiency is perhaps an unfortunate one as, to many, it implies intrinsic disease of the placenta itself whereas in a large proportion of cases of “small-for-dates” babies the ultimate cause will probably be found to be due to defective interaction between fetal and maternal tissues in the uterus. In hypertensive disease of pregnancy it is now generally agreed that the critical defect is to be found on the maternal side of the placenta, with due allowance being made for the undetermined part played by fetal tissues in the aetiology of pre-eclampsia. This being so it is obvious that we must look for lesions in the maternal blood vessels supplying the placenta that can be related to lesions in the placenta to explain the undernutrition of the fetus and its frequent hypoxia. In the same way we concentrate our attention on the coronary arteries to explain the myocardial lesions of ischaemic heart disease.
KeywordsEssential Hypertension Spiral Artery Placental Insufficiency Intervillous Space Hypertensive Pregnancy
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