Rheological and Physiological Consequences of Conversion of the Maternal Spiral Arteries for Uteroplacental Blood Flow during Human Pregnancy

Burton, G.J. and Woods, A. W. and Jauniaux, E. and Kingdom, J.C.P. (2009) Rheological and Physiological Consequences of Conversion of the Maternal Spiral Arteries for Uteroplacental Blood Flow during Human Pregnancy. Placenta, 30 (6). pp. 473-482. ISSN 0143-4004 DOI 10.1016/j.placenta.2009.02.009

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Abstract

Physiological conversion of the maternal spiral arteries is key to a successful human pregnancy. It involves loss of smooth muscle and the elastic lamina from the vessel wall as far as the inner third of the myometrium, and is associated with a 5-10-fold dilation at the vessel mouth. Failure of conversion accompanies common complications of pregnancy, such as early-onset preeclampsia and fetal growth restriction. Here, we model the effects of terminal dilation on inflow of blood into the placental intervillous space at term, using dimensions in the literature derived from three-dimensional reconstructions. We observe that dilation slows the rate of flow from 2 to 3 m/s in the non-dilated part of an artery of 0.4-0.5 mm diameter to approximately 10 cm/s at the 2.5 mm diameter mouth, depending on the exact radius and viscosity. This rate predicts a transit time through the intervillous space of approximately 25 s, which matches observed times closely. The model shows that in the absence of conversion blood will enter the intervillous space as a turbulent jet at rates of 1-2 m/s. We speculate that the high momentum will damage villous architecture, rupturing anchoring villi and creating echogenic cystic lesions as evidenced by ultrasound. The retention of smooth muscle will also increase the risk of spontaneous vasoconstriction and ischaemia-reperfusion injury, generating oxidative stress. Dilation has a surprisingly modest impact on total blood flow, and so we suggest the placental pathology associated with deficient conversion is dominated by rheological consequences rather than chronic hypoxia.

Item Type: Article
Uncontrolled Keywords: 09AREP; BPI
Subjects: 99 - Other
Divisions: 99 - Other
Journal or Publication Title: Placenta
Volume: 30
Page Range: pp. 473-482
Identification Number: 10.1016/j.placenta.2009.02.009
Depositing User: Sarah Humbert
Date Deposited: 22 Jul 2010 11:34
Last Modified: 23 Jul 2013 09:57
URI: http://eprints.esc.cam.ac.uk/id/eprint/1499

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