Decidua

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Decidua
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Diagrammatic sections of the uterine mucous membrane: A. The non-pregnant uterus. B. Decidua parietalis; the mucous membrane in the pregnant uterus and not beneath the placenta.
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Sectional plan of the gravid uterus in the third and fourth month
Identifiers
MeSH D003656
TE E6.0.1.4.0.0.7
FMA 85538
Anatomical terminology

The decidua is the modified mucosal lining of the uterus (that is, modified endometrium) that forms every month, in preparation for pregnancy. It is shed off each month when there is no fertilised egg to support. [1] The decidua is under the influence of progesterone. Endometrial cells become highly characteristic. The decidua forms the maternal part of the placenta and remains for the duration of the pregnancy. After birth the decidua is shed together with the placenta. [1]

Contents

Structure

The part of the decidua that interacts with the trophoblast is the decidua basalis (also called decidua placentalis), while the decidua capsularis grows over the embryo on the luminal side, enclosing it into the endometrium. The remainder of the decidua is termed the decidua parietalis or decidua vera, and it will fuse with the decidua capsularis by the fourth month of gestation.

Three morphologically distinct layers of the decidua basalis can then be described:

Within the decidua, occasional fibrinoid deposits form where the syncytiotrophoblast is damaged. The region of fibrinoid deposition where trophoblasts meet the compact portion of the decidua basalis is called Rohr's layer, while the fibrinoid deposits that occur between the compact and spongy layer of the decidua basalis is termed Nitabuch's layer (for Raissa Nitabuch). This layer is absent in placenta accreta. [2]

Micrograph of decidualized endometrium due to exogenous progesterone. H&E stain. Endometrium ocp use3.jpg
Micrograph of decidualized endometrium due to exogenous progesterone. H&E stain.

The decidua has a histologically-distinct appearance, displaying large polygonal decidual cells in the stroma. These are enlarged endometrial stromal cells, which resemble epithelium (and are referred to as "epithelioid").

Decidualization includes the process of differentiation of the spindle-shape stromal fibroblasts into the plump secretory decidual cells, which create a pericellular extracellular matrix rich in fibronectin and laminin (similar to epithelial cells).

Vascularity, as well as vascular permeability, is enhanced in the decidualizing endometrium.

Its leukocyte population is distinct, with the presence of large endometrial granular leukocytes being predominant, while polynuclear leukocytes and B cells are scant.

The large granular lymphocytes (CD56 bright) are called uterine natural killer cells| (uNK cells).

Development

After ovulation, in placental mammals, the endometrial lining becomes hypertrophic and vascular under the influence of the sex hormones, estrogen and progesterone.

In animals exhibiting hemochorial placentation, the endometrium undergoes decidualization following implantation. If implantation does not occur, the secretory lining will be absorbed (estrous cycle) or shed (menstrual cycle).

The decidua is shed with the placenta during birth.

Function

As the maternal interface to the embryo the decidua participates in the exchanges of nutrition, gas, and waste with the gestation. It also protects the pregnancy from the maternal immune system. Further, the decidua has to allow a very controlled invasion of the trophoblast.

In invasive placental disorders like placenta accreta decidualization have been consistently found to be deficient.

Hormone production

The decidua secretes hormones, growth factors, and cytokines. It has receptors for estrogen, progesterone, growth hormone, and others.

Among its products are hormones commonly associated with other organs such as cortisol, CRF, GnRH, prolactin, and relaxin. Decidual prolactin is not under dopaminergic control.

Insulin-like growth factor-binding protein 1 (IGFBP1) also called placental protein 12, and PAEP (glycodelin) appear to be specific products of the secretory and decidual lining.

Other factors released include interleukin-15 and vascular endothelial growth factor (VEGF). A reasonable understanding of the role and interplay of these hormones and factors has not been evolved.

Other

Micrograph of decidua in a lymph node. H&E stain. Decidua in a lymph node - very high mag.jpg
Micrograph of decidua in a lymph node. H&E stain.

Clinical significance

A long-lasting infection of the decidua, chronic deciduitis, is associated with pre-term labour. [4]

History

The word comes from Latin deciduus 'falling off / shedding'.

Additional images

Related Research Articles

<span class="mw-page-title-main">Endometrium</span> Inner mucous membrane of the mammalian uterus

The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The functional layer thickens and then is shed during menstruation in humans and some other mammals, including other apes, Old World monkeys, some species of bat, the elephant shrew and the Cairo spiny mouse. In most other mammals, the endometrium is reabsorbed in the estrous cycle. During pregnancy, the glands and blood vessels in the endometrium further increase in size and number. Vascular spaces fuse and become interconnected, forming the placenta, which supplies oxygen and nutrition to the embryo and fetus. The speculated presence of an endometrial microbiota has been argued against.

<span class="mw-page-title-main">Uterus</span> Female sex organ in mammals

The uterus or womb is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more embryos until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.

<span class="mw-page-title-main">Placenta</span> Organ that connects the fetus to the uterine wall

The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate maternal and fetal circulations, and is an important endocrine organ, producing hormones that regulate both maternal and fetal physiology during pregnancy. The placenta connects to the fetus via the umbilical cord, and on the opposite aspect to the maternal uterus in a species-dependent manner. In humans, a thin layer of maternal decidual (endometrial) tissue comes away with the placenta when it is expelled from the uterus following birth. Placentas are a defining characteristic of placental mammals, but are also found in marsupials and some non-mammals with varying levels of development.

<span class="mw-page-title-main">Menstrual cycle</span> Natural changes in the human female reproductive system

The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible. The ovarian cycle controls the production and release of eggs and the cyclic release of estrogen and progesterone. The uterine cycle governs the preparation and maintenance of the lining of the uterus (womb) to receive an embryo. These cycles are concurrent and coordinated, normally last between 21 and 35 days, with a median length of 28 days, and continue for about 30–45 years.

<span class="mw-page-title-main">Chorion</span> Outermost fetal membrane around the embryo in amniotes

The chorion is the outermost fetal membrane around the embryo in mammals, birds and reptiles (amniotes). It develops from an outer fold on the surface of the yolk sac, which lies outside the zona pellucida, known as the vitelline membrane in other animals. In insects, it is developed by the follicle cells while the egg is in the ovary. Some mollusks also have chorions as part of their eggs. For example, fragile octopus eggs have only a chorion as their envelope.

<span class="mw-page-title-main">Corpus luteum</span> Temporary endocrine structure in ovaries

The corpus luteum is a temporary endocrine structure in female ovaries involved in the production of relatively high levels of progesterone, and moderate levels of estradiol, and inhibin A. It is the remains of the ovarian follicle that has released a mature ovum during a previous ovulation.

<span class="mw-page-title-main">Luteal phase</span> The latter part of the menstrual cycle associated with ovulation and an increase in progesterone

The menstrual cycle is on average 28 days in length. It begins with menses during the follicular phase, followed by ovulation and ending with the luteal phase. Unlike the follicular phase which can vary in length among individuals, the luteal phase is typically fixed at approximately 14 days and is characterized by changes to hormone levels, such as an increase in progesterone and estrogen levels, decrease in gonadotropins such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), changes to the endometrial lining to promote implantation of the fertilized egg, and development of the corpus luteum. In the absence of fertilization by sperm, the corpus luteum degenerates leading to a decrease in progesterone and estrogen, an increase in FSH and LH, and shedding of the endometrial lining (menses) to begin the menstrual cycle again.

<span class="mw-page-title-main">Syncytiotrophoblast</span> Embryonic cell of the placental surface

The syncytiotrophoblast is the epithelial covering of the highly vascular embryonic placental villi, which invades the wall of the uterus to establish nutrient circulation between the embryo and the mother. It is a multinucleate, terminally differentiated syncytium, extending to 13 cm.

<span class="mw-page-title-main">Cytotrophoblast</span> Layer of an embryo

"Cytotrophoblast" is the name given to both the inner layer of the trophoblast or the cells that live there. It is interior to the syncytiotrophoblast and external to the wall of the blastocyst in a developing embryo.

<span class="mw-page-title-main">Implantation (embryology)</span> First stage of pregnancy

Implantation, also known as nidation, is the stage in the mammalian embryonic development in which the blastocyst hatches, attaches, adheres, and invades into the endometrium of the female's uterus. Implantation is the first stage of gestation, and, when successful, the female is considered to be pregnant. An implanted embryo is detected by the presence of increased levels of human chorionic gonadotropin (hCG) in a pregnancy test. The implanted embryo will receive oxygen and nutrients in order to grow.

<span class="mw-page-title-main">Decidualization</span> Physiological process in the endometrium

Decidualization is a process that results in significant changes to cells of the endometrium in preparation for, and during, pregnancy. This includes morphological and functional changes to endometrial stromal cells (ESCs), the presence of decidual white blood cells (leukocytes), and vascular changes to maternal arteries. The sum of these changes results in the endometrium changing into a structure called the decidua. In humans, the decidua is shed during childbirth.

<span class="mw-page-title-main">Uterine gland</span>

Uterine glands or endometrial glands are tubular glands, lined by a simple columnar epithelium, found in the functional layer of the endometrium that lines the uterus. Their appearance varies during the menstrual cycle. During the proliferative phase, uterine glands appear long due to estrogen secretion by the ovaries. During the secretory phase, the uterine glands become very coiled with wide lumens and produce a glycogen-rich secretion known as histotroph or uterine milk. This change corresponds with an increase in blood flow to spiral arteries due to increased progesterone secretion from the corpus luteum. During the pre-menstrual phase, progesterone secretion decreases as the corpus luteum degenerates, which results in decreased blood flow to the spiral arteries. The functional layer of the uterus containing the glands becomes necrotic, and eventually sloughs off during the menstrual phase of the cycle.

Before the fertilized ovum reaches the uterus, the mucous membrane of the body of the uterus undergoes important changes and is then known as the decidua. The thickness and vascularity of the mucous membrane are greatly increased; its glands are elongated and open on its free surface by funnel-shaped orifices, while their deeper portions are tortuous and dilated into irregular spaces. The interglandular tissue is also increased in quantity, and is crowded with large round, oval, or polygonal cells, termed decidual cells. Their enlargement is due to glycogen and lipid accumulation in the cytoplasm allowing these cells to provide a rich source of nutrition for the developing embryo. Decidual cells are also thought to control the invasion of the endometrium by trophoblast cells.

Arcuate arteries located in the uterus branch out and supply blood to different layers of the uterus. These arteries meet the myometrial-endometrial junction and lead to straight and endometrial arteries. The endometrium receives blood from endometrial arteries which are also called spiral arteries. Endometrial arteries proliferate rapidly and react to different hormones released. These hormones are progesterone and estrogen released by the ovaries and produced by the endocrine system. The endometrial arteries not only supply blood to the endometrium but are also important during pregnancy. They are the initial site of transportation of blood from the mother to the baby.

<span class="mw-page-title-main">Placental expulsion</span>

Placental expulsion occurs when the placenta comes out of the birth canal after childbirth. The period from just after the baby is expelled until just after the placenta is expelled is called the third stage of labor.

Menstruation is the shedding of the uterine lining (endometrium). It occurs on a regular basis in uninseminated sexually reproductive-age females of certain mammal species.

Endometrial cups form during pregnancy in mares and are the source of equine chorionic gonadotropin (eCG) and a placenta-associated structure, which is derived from the fetus. Their purpose is to increase the immunological tolerance of the mare in order to protect the developing foal.

Ectopic decidua are decidual cells found outside inner lining of the uterus. This condition was first described in 1971 by Walker and the name 'ectopic decidua' was coined by Tausig. While ectopic decidua is most commonly seen during pregnancy, it rarely occurs in non-pregnant people, accompanied by bleeding and pain.

Decidua menstrualis is the diffuse hyperplasia of the decidua of the uterus in the absence of a demonstrable pregnancy. In anatomical terms, it is called diffuse polypoid decidual endometritis. The probable cause of decidua menstrualis is pathologically prolonged progestin stimulation in the absence of a preceding pregnancy. Clinically, the patient presents with prolonged, profused white discharge mixed with blood. It is not clear whether this discharge occurs due to nutritional inadequacy or the involution of corpus luteum.

Extravillous trophoblasts(EVTs), are one form of differentiated trophoblast cells of the placenta. They are invasive mesenchymal cells which function to establish critical tissue connection in the developing placental-uterine interface. EVTs derive from progenitor cytotrophoblasts (CYTs), as does the other main trophoblast subtype, syncytiotrophoblast (SYN). They are sometimes called intermediate trophoblast.

References

  1. 1 2 "Definition of DECIDUA". www.merriam-webster.com. Retrieved 25 October 2022.
  2. Cunningham, F. Gary, ed. (2005). Williams obstetrics (22nd ed.). New York; Toronto: McGraw-Hill Professional. ISBN   9780071413152.
  3. Wu, DC.; Hirschowitz, S.; Natarajan, S. (May 2005). "Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall". Arch Pathol Lab Med. 129 (5): e117–20. doi:10.5858/2005-129-e117-EDOPLN. PMID   15859655.
  4. Edmondson, N.; Bocking, A.; Machin, G.; Rizek, R.; Watson, C.; Keating, S. (2009). "The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis". Pediatr Dev Pathol. 12 (1): 16–21. doi:10.2350/07-04-0270.1. PMID   18171100. S2CID   25693917.