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. Author manuscript; available in PMC: 2023 Feb 1.
Published in final edited form as: Am J Obstet Gynecol. 2022 Feb;226(2 Suppl):S844–S866. doi: 10.1016/j.ajog.2021.11.1356

Figure 4.

Figure 4.

A. Diagram of maternal blood supply to the placenta. The spiral arteries undergo physiologic changes in normal pregnancy (grey). In preeclampsia, the myometrial segment of the spiral artery fails to undergo physiological transformation (blue), which is thought to explain the uteroplacental ischemia observed in preeclampsia. Moreover, non-transformed spiral arteries are prone to atherosis (yellow), characterized by the presence of lipid-laden macrophages within the lumen. Placental basal plate spiral arteries with hematoxylin-eosin stain (B, C, and D). B. Transformed spiral arteries are characterized by the presence of intramural trophoblasts (arrowheads) and fibrinoid degeneration (arrows) of the arterial wall. C. Non-transformed spiral arteries lack intramural trophoblasts and fibrinoid degeneration, and they retain smooth muscle. Arrowheads indicate the presence of trophoblasts in myometrium, but not in the wall of the spiral artery. D. Acute atherosis in decidual spiral artery. Many lipid-laden macrophages (arrows) are seen in the spiral artery with the lack of invasion of the trophoblast (arrowhead) into myometrial segment of the spiral artery. Images (B, C, and D) stained with cytokeratin 7 (brown) and periodic acid–Schiff (pink), original magnification ×200. Immunohistochemistry of placental basal plate spiral arteries (E, F, and G). E. Presence of endothelium (arrow, blue) in vessels with normal trophoblastic invasion, original magnification × 640. F. spiral artery with presence of endothelium (blue, arrowhead) and smooth muscle cells (green, arrow), original magnification ×640. G. Atherosis lesions show the presence of numerous macrophages CD36-reactive (red reactivity, blue arrow) and smooth muscle cells in the vessel wall (green reactivity, yellow arrow), original magnification x400. *lumen of spiral artery. Modified from McMaster-Fay RA. Uteroplacental vascular syndromes: theories, hypotheses and controversies. Clin Obstet Gynecol Reprod Med 2018;4:1–5. Espinoza J et al. Normal and abnormal transformation of the spiral arteries during pregnancy. J Perinat Med. 2006;34(6):447-58. Labarrere CA et al. Failure of physiologic transformation of spiral arteries, endothelial and trophoblast cell activation, and acute atherosis in the basal plate of the placenta. Am J Obstet Gynecol. 2017 Mar;216(3):287.e1-287.e16.