The placental bed in a historical perspective
نویسنده
چکیده
Placental vasculature, in particular the relationship between maternal and fetal blood circulations, has been a contentious issue for a long time. It was indeed a matter of dispute whether or not the fetal blood circulation was separate from or continuous with the circulation of the mother as stated by the Roman physician Galen (129–200). The Renaissance anatomist Julius Caesar Arantius (1530–1589) is usually quoted for being the first who explicitly denied the existence of any vascular connection between the mother and the fetus in utero [1,2]. Although this opinion was seemingly based on careful dissections of human placentas in situ, he obviously did not have the tools to trace small blood vessels in sufficient detail to provide full support for this idea. Moreover, before William Harvey (1578–1657) anatomists did not understand the relationship between arteries and veins, and thus their knowledge about the uteroplacental blood flow in the placenta must have been rather confused. The brothers William (1718–1783) and John Hunter (1728–1793) are credited for having demonstrated the separation of maternal and fetal circulations by using colored wax injections of human placentas in utero. It was probably the younger brother John who did all the work, and he claimed afterwards most of the credit for this finding [3]. In his magnificent Anatomy of the human gravid uterus (1774) William Hunter included the first drawing of spiral arteries (‘convoluted arteries’), in what must have been the very first illustration of a human placental bed (Fig. 1.1) [4]. These ‘convoluted arteries’ are embedded in the decidualized uterine mucosa, the term ‘decidua’ being used for the first time by William Hunter to describe the ‘membrane’ enveloping the conceptus, which is discarded at parturition (Latin decidere, to fall off). This obviously referred to the decidua capsularis, typical for humans and anthropoid apes, which is formed as a result of the deep interstitial implantation of the blastocyst in these species. John Hunter, however, pointed out that there is also a ‘decidua basalis’ underneath the placenta. In a tubal pregnancy case he noticed that a similar tissue had developed within the uterus, and he therefore concluded that the decidua originates from the uterine mucosa [5].
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تاریخ انتشار 2010