Priming and remodelling of human placental bed spiral arteries during pregnancy--a review.

It is now well known that in order to establish human hemochorial placentation and to provide a progressive increase in blood supply to the growing fetus, the uterine spiral arteries must undergo considerable alterations. This physiological modification is thought to be brought about by the interaction of invasive cytotrophoblast with the spiral artery vessel wall. Despite intensive research our understanding of the mechanisms that control human trophoblast invasion in normal, let alone abnormal pregnancy, are still poorly understood. This is partly due to difficulties in obtaining "true" placental bed biopsies and most investigators have relied on in vitro models of trophoblast invasion. Clearly interpretation of such studies must be tempered with a degree of caution. This review outlines why the placental bed is important, how we can sample and study it, what morphology actually occurs in the placental bed spiral arteries during pregnancy and then briefly summarise the findings on the placental bed in pre-eclampsia.