胎盤の病理のトピックス

抄録

Recent studies have elucidated the pathophysiology of the common placental disorders. It is believed that gestational hypertension, also known as preeclampsia, is a two-stage disease. Inadequate migration of the trophoblasts induces defective remodeling of the uterine spiral arteries. The poorly perfused and re-perfused placenta (Stage 1) produces antiangiogenic factors that cause maternal endothelial dysfunction (Stage 2). It has been hypothesized that a luck of fetomaternal immune tolerance leads to insufficient trophoblastic differentiation.

Another placental disorder is chronic villitis or villitis of unknown etiology. The diagnosis of severe chronic villitis is important to the clinician because it causes intrauterine growth restriction, fetal death, and neonatal neurological impairment. These lesions could be of immune origin. It has been reported that the pathogenesis of chronic placentitis is the maternal anti-fetal cellular and antibody-mediated rejection.

Disorders of gestational immune tolerance underlie these two placental diorders.