Pathologic abnormalities of deep placentation in the great obstetrical syndromes: Implications for understanding the pathophysiology, risk assessment in early pregnancy, and personalized prevention
Year: 2026
Type: article
Abstract: The concept of the Great Obstetrical Syndromes was introduced to explain the unique nature of obstetrical disease, which differs fundamentally from disorders in other areas of medicine. These syndromes, including preeclampsia, fetal growth restriction, fetal death, and spontaneous preterm birth, represent clinical endpoints rather than single diseases and share defining characteristics: they arise from multiple etiologies, have a prolonged subclinical phase, involve the fetus as an active participant, are adaptive in nature, and result from complex genetic and environmental interactions between the mother and fetus. Among the diverse mechanisms leading to these syndromes, abnormalities of the maternal supply line to the placenta constitute one major etiology and are often caused by vascular disorders affecting the maternal cardiovascular system and uterine spiral arteries, resulting in placental lesions of maternal vascular malperfusion. The most severe spiral artery lesion is atherosis, which closely resembles atherosclerosis and links obstetrical syndromes to maternal vascular disease. Disorders of deep placentation associated with maternal vascular malperfusion are accompanied by characteristic alterations in angiogenic balance, and the ratio of placental growth factor to soluble fms-like tyrosine kinase-1 in the maternal circulation serves as a biomarker of this pathophysiologic process. Importantly, each obstetrical syndrome is associated with a stereotypic temporal pattern of angiogenic imbalance that reflects differences in disease burden, timing, and clinical expression. While substantial progress has been made in the prediction and prevention of preeclampsia, these concepts extend to other obstetrical syndromes, including fetal growth restriction, fetal death, and spontaneous preterm labor, supporting a unified biologic framework for early risk assessment and personalized prevention.
Institutions: Semmelweis University, National Institutes of Health, University of Michigan, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Michigan State University, Institute of Molecular Life Sciences, HUN-REN Research Centre for Natural Sciences, University of Pecs, Wayne State University, Széchenyi István University, Ben-Gurion University of the Negev, Soroka Medical Center
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,690
Funders: Hungarian Research Network, U.S. Department of Health and Human Services, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, European Commission, Magyarország Kormánya, Innovációs és Technológiai Minisztérium, National Institutes of Health, Nemzeti Kutatási, Fejlesztési és Innovaciós Alap, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NHLBI Division of Intramural Research
OpenAlex ID: W7126036976