Failure of placentation and pregnancy complications: the role of feto-maternal immune balance

What is it about?

Highlights • Disorders of placentation are associated with a wide range of pathological manifestations • Immune cells in the decidua are critical in the aetiopathogenesis of inadequate placentation • Decidual cell immunophenotypes and function require multidisciplinary research • Diagnostic and therapeutic options derived from these findings could improve perinatal outcomes

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Why is it important?

Placentation, the physiological process of placental development, is crucial for reproductive success. Disorders during placentation are associated with a wide range of pathological manifestations, including miscarriage; complications that manifest in the second half of pregnancy (preeclampsia, intrauterine growth restriction, premature birth); and those that seriously complicate the peripartum period, such as different forms of pathological placental invasion. Dysregulated placentation is predominantly caused by the altered composition and/or function of decidual leukocytes, primarily natural killer cells, T lymphocytes, macrophages and dendritic cells. Their interaction with extravillous trophoblasts causes a disorder in the modification of the spiral arteries, which leads to oxidative damage to the placenta and changes in placental perfusion. Disruption of the regulation of immunocompetent cells of the decidua by the creation of an inadequate cytokine milieu is one of the mechanisms of semiallogeneic blastocyst rejection in recurrent miscarriages. Dysfunction of the decidua, caused by previous damage and scar formation, leads to trophoblast hyperinvasion in the placenta accreta spectrum.

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