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Open Access Published by De Gruyter December 1, 2006

Normal and abnormal transformation of the spiral arteries during pregnancy

  • Jimmy Espinoza , Roberto Romero , Yeon Mee Kim , Juan Pedro Kusanovic , Sonia Hassan , Offer Erez , Francesca Gotsch , Nandor Gabor Than , Zoltan Papp and Chong Jai Kim


This article reviews the anatomy and physiology of the uterine circulation, with emphasis on the remodeling of spiral arteries during normal pregnancy, and the timing and anatomical pathways of trophoblast invasion of the spiral arteries. We review the definitions of the placental bed and basal plate of the placenta, their relevance to the study of the physiologic transformation of the spiral arteries, as well as the methods to obtain and examine placental bed biopsy specimens. We also examine the role of the extravillous trophoblast in normal and abnormal pregnancies, and the criteria used to diagnose failure of physiologic transformation of the spiral arteries. Finally, we comment on the use of uterine artery Doppler velocimetry as a surrogate marker of chronic uteroplacental ischemia.


Corresponding author: Roberto Romero, MD Chief, Perinatology Research Branch Intramural Division, NICHD, NIH, DHHS National Institute of Child Health and Human Development Perinatology Research Branch Hutzel Women's Hospital–4th Floor 3990 John R Detroit, MI 48201/USA Tel.: +1 (313) 993-2700 Fax: +1 (313) 993-2694


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Published Online: 2006-12-01
Published in Print: 2006-12-01

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