Thorp, John M., Jr. (2001). Placental Vascular Compromise: Unifying the Etiologic Pathways of Perinatal Compromise. Current Problems in Obstetrics, Gynecology and Fertility, 24(6)
Evidence suggests that spontaneous and indicated preterm births may have multiple independent and interacting causes. We propose placental vascular compromise as a candidate for at least one unifying pathologic process that could explain much of the observed phenomena. Four broad pathophysiologic processes can compromise placental vascular function and ultimately affect pregnancy. All are detectable on histologic examination of the placenta. These 4 processes are acute inflammation, chronic inflammation, coagulopathy, and atherosclerotic lesions of the uteroplacental vasculature. Clinical conditions that can manifest themselves as placental vascular compromise include acute infection, chronic infection, pertubations in immune endocrinology, altered homocysteine metabolism, dyslipidemia, and insulin resistance. In this review, we explore linkages between these disturbances, compromise of the uteroplacental vasculature, and poor perinatal outcome. In so doing, evidence is woven from disparate fields to propose an etiology theory for perinatal compromise. This theory can be tested in observational studies and offers numerous therapeutic possibilities.
Current Problems in Obstetrics, Gynecology and Fertility
Thorp, John M., Jr.