Decidual Vasculopathy

This microphoto is of maternal vessels in attached decidua in a roll of fetal membranes from a case of severe hypertension in pregnancy. The vessels show severe wall thickening and luminal narrowing. The intimal vacuoles represent lipid deposition for which the term atherosis is applied. Decidual vasculopathy is often associated with intrauterine growth retardation.

Hypertension can occur as a result of vascular diseases and hypertension causes vascular changes. It accelerates the process of arteriosclerosis but can also produce lesions of hyaline arteriolosclerosis and, when the hypertension is malignant, hyperplastic arteriolosclerosis and sometimes necrotizing vasculitis. Pre-eclampsia and eclampsia may occur during pregnancy. They are associated with hypertension, proteinuria, edema and, in eclampsia, with convulsions. When examining the placenta and membranes after delivery, the perinatal pathologist has the opportunity to study maternal vessels in the decidua. In some cases of eclampsia in which hypertension is severe, one can see fibrinoid necrosis or necrotizing vasculitis just as in malignant hypertension.