CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(02): 157-163
DOI: 10.1055/s-0041-1734016
Original Article

Uterine Myometrial Preischemia: Yet Another Physiological Change of Pregnancy!

Kusum Jashnani
1   Department of Pathology, TNMC & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
Meherrituja Palve
2   Department of Pathology, KJSMC and Research Centre, Mumbai, Maharashtra, India
› Author Affiliations


Background The uterus shows tremendous increase in size during pregnancy to nurture the fetus within it. It may show a spectrum of physiological changes or pathological lesions that may affect the pregnancy favorably or adversely. The main purpose of our study was to analyze the physiological changes in the uterus during pregnancy and the postpartum period, thereby gaining deeper knowledge.

Materials and Methods We studied a total of 152 uterine specimens obtained from obstetric hysterectomies and maternal autopsies for the presence or absence of normal physiological changes. As a control group, an equal number of surgical uterine specimens received for abnormal uterine bleeding were studied.

Results Decidual change was observed from 6 weeks of gestation to 16 days postpartum. It was partially deficient to absent in four cases of placenta accreta. Myometrial hypertrophy was seen in 150 cases (98.68%) from 8 weeks of gestation till 30 days postpartum period. Vascular remodeling was partially deficient to absent in eight cases of pregnancy-induced hypertension. Preischemia of myometrial fibers was an unexpected finding noticed from 20 weeks of gestation to 16 days postpartum in 131 cases (86.18%). Cervical wall hemorrhages were seen in 84.84% cases of vaginal delivery and in only 17.64% cases of lower segment cesarean section.

Conclusion Ours is the first study to describe the duration of the routine physiological uterine changes during pregnancy. The relationship between cervical wall hemorrhages and vaginal delivery as well as between myometrial preischemia and gestational age, both being normal physiologic findings, was found to be statistically significant.

Authors' Contribution

KJ substantially contributed to the conception and design of the work, definition of intellectual content, and analysis and interpretation of data for the work. KJ also drafted the work and revised it critically for important intellectual content. KJ was involved in final approval of the version to be published. KJ agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

MP substantially contributed to the literature search and the acquisition, analysis, or interpretation of data for the work. MP also drafted the work or revised it critically for important intellectual content. MP was involved in final approval of the version to be published. MP agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Publication History

Article published online:
08 September 2021

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  • References

  • 1 Haines M, Taylor CW, Fox H, Wells M. Haines and Taylor Obstetrical and Gynaecological Pathology. 5th edition.. Edinburgh: Churchill Livingstone; 2003. . Chapter 39, Pathology of pregnant uterus; pp. 1327–1357
  • 2 Hustin J, Foidart JM, Lambotte R. Maternal vascular lesions in pre-eclampsia and intrauterine growth retardation: light microscopy and immunofluorescence. Placenta 1983; 4 (Spec No): 489-498
  • 3 Robertson WB, Khong TY, Brosens I, De Wolf F, Sheppard BL, Bonnar J. The placental bed biopsy: review from three European centers. Am J Obstet Gynecol 1986; 155 (02) 401-412
  • 4 Rushton DI, Dawson IM. The maternal autopsy. J Clin Pathol 1982; 35 (09) 909-921
  • 5 Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D. Williams Obstetrics. 23 rd edition.. New York: McGraw- Hill Medical; 2010. . Chapter 3, Implantation, Embryogenesis and Placental development; pp. 36–77
  • 6 Flake GP, Moore AB, Sutton D. et al. The natural history of uterine leiomyomas: light and electron microscopic studies of fibroid phases, interstitial ischemia, inanosis, and reclamation. Obstet Gynecol Int 2013; 2013: 528376 DOI: 10.1155/2013/528376.
  • 7 Pijnenborg R, Vercruysse L, Hanssens M. The uterine spiral arteries in human pregnancy: facts and controversies. Placenta 2006; 27 (9-10): 939-958
  • 8 Lyall F, Robson SC, Bulmer JN. Spiral artery remodeling and trophoblast invasion in preeclampsia and fetal growth restriction: relationship to clinical outcome. Hypertension 2013; 62 (06) 1046-1054
  • 9 Jashnani KD, Rupani AB, Wani RJ. Maternal mortality: an autopsy audit. J Postgrad Med 2009; 55 (01) 12-16
  • 10 Jashnani KD, Chandekar SA, Pawar A, Dalal AR, Wani RJ. Hepatitis E infection and pregnancy: a fatal combination. Int J Basic Appl Med Sci. 2015; 5 (02) 264-269
  • 11 Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science 2005; 308 (5728): 1592-1594
  • 12 Burton GJ, Woods AW, Jauniaux E, Kingdom JC. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta 2009; 30 (06) 473-482
  • 13 Burton GJ, Yung HW, Cindrova-Davies T, Charnock-Jones DS. Placental endoplasmic reticulum stress and oxidative stress in the pathophysiology of unexplained intrauterine growth restriction and early onset preeclampsia. Placenta 2009; 30 (Suppl A): S43-S48
  • 14 Meekins JW, Pijnenborg R, Hanssens M, McFadyen IR, van Asshe A. A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre-eclamptic pregnancies. Br J Obstet Gynaecol 1994; 101 (08) 669-674
  • 15 Pijnenborg R, Anthony J, Davey DA. et al. Placental bed spiral arteries in the hypertensive disorders of pregnancy. Br J Obstet Gynaecol 1991; 98 (07) 648-655
  • 16 Avagliano L, Bulfamante GP, Morabito A, Marconi AM. Abnormal spiral artery remodelling in the decidual segment during pregnancy: from histology to clinical correlation. J Clin Pathol 2011; 64 (12) 1064-1068