Which pathological finding best explains the uteroplacental origin of pre-eclampsia?
- A Complete absence of trophoblast invasion with persistent villous cytotrophoblast plugs
- B Hyperplastic arteriolosclerosis of the myometrial arteries with fibrinoid necrosis
- C Failure of physiological transformation of spiral arteries, with change limited to the decidual segments and acute atherosis of the vessels ✓
- D Thrombosis of the uterine veins with secondary placental infarction
Correct answer: C. Failure of physiological transformation of spiral arteries, with change limited to the decidual segments and acute atherosis of the vessels
Explanation
In normal pregnancy, extravillous trophoblasts transform spiral arteries from muscular vessels into flaccid conduits along their entire length. In pre-eclampsia this transformation is incomplete and confined to the decidual portion, leaving myometrial segments musculature intact and responsive to vasoconstrictors. Acute atherosis, with fibrinoid necrosis and lipid-laden macrophages, may develop in these vessels. Hyperplastic arteriolosclerosis reflects malignant hypertension, and trophoblast invasion is reduced, not absent.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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