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| {{more citations needed|date=June 2014}} | | {{Short description|The decidua is the uterine lining during pregnancy}} |
| {{Infobox anatomy
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| | Name = Decidua
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| | Latin =
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| | Image = Gray33.png
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| | Caption = 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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| | Image2 = Gray34.png
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| | Caption2 = Sectional plan of the gravid uterus in the third and fourth month
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| | System =
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| The '''decidua''' is the modified [[mucous membrane|mucosal lining]] of the [[uterus]] known as the [[endometrium]] that forms in preparation for [[pregnancy]]. It is formed in a process called [[decidualization]] 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. It is shed off during [[childbirth]] — hence why the term is used, "decidua" having the meaning of ''falling away'', as in the word [[deciduous]]. | | The '''decidua''' is the modified mucosal lining of the [[uterus]] (endometrium) that forms in preparation for and during [[pregnancy]]. It plays a crucial role in supporting the developing [[embryo]] and [[fetus]] and is shed during childbirth. |
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| ==Structure== | | ==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 lumenal 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. | | The decidua is divided into three regions based on their location relative to the [[embryo]] and [[placenta]]: |
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| Three morphologically distinct layers of the decidua basalis can then be described:
| | * '''Decidua basalis''': This is the part of the decidua that interacts directly with the [[chorion]] and contributes to the formation of the [[placenta]]. It is located beneath the implanted [[embryo]]. |
| * Compact outer layer (''stratum compactum'') | |
| * Intermediate layer (''stratum spongiosum'')
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| * Boundary layer adjacent to the [[myometrium]] (''stratum basalis'')
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| 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. This layer is absent in [[placenta accreta]].<ref>{{cite book|title=Williams obstetrics|publisher=McGraw-Hill Professional|year=2005|isbn=9780071413152|editor-last=Cunningham|editor-first=F. Gary|edition=22nd|location=New York; Toronto}}</ref>[[File:Endometrium ocp use3.jpg|thumb|right|[[Micrograph]] of decidualized [[endometrium]] due to [[exogenous]] [[progesterone]]. [[H&E stain]].]]
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| The decidua has a [[histology|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").
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| [[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). | | * '''Decidua capsularis''': This portion surrounds the [[embryo]] and [[amniotic sac]], covering the side facing the uterine cavity. As the [[gestational sac]] grows, the decidua capsularis stretches and eventually fuses with the decidua parietalis. |
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| Vascularity, as well as vascular permeability, is enhanced in the decidualizing endometrium.
| | * '''Decidua parietalis''': This is the remaining part of the decidua lining the rest of the uterine cavity. It eventually fuses with the decidua capsularis as the [[pregnancy]] progresses. |
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| Its [[leukocyte]] population is distinct, with the presence of large endometrial granular leukocytes being predominant, while polynuclear leukocytes and [[B cell]]<nowiki/>s are scant.
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| The large granular lymphocytes ([[neural cell adhesion molecule|CD56]] bright) are called "uterine [[natural killer cell]]s" or "uNK cells" in mice, and "decidual NK cells" or "dNK cells" in humans.
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| ==Development==
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| After [[ovulation]], in placental [[mammal]]s, the endometrial lining becomes hypertrophic and vascular under the influence of the [[sex hormone]]s, [[estrogen]] and [[progesterone]].
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| In animals exhibiting [[hemochorial placentation]], the endometrium undergoes [[decidualization]] following [[Implantation (human embryo)|implantation]]. If implantation does not occur, the secretory lining will be absorbed ([[estrous cycle]]) or shed ([[menstrual cycle]]).
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| The decidua is shed with the placenta during [[birth]].
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| ==Function== | | ==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.
| | The decidua serves several important functions during [[pregnancy]]: |
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| In invasive placental disorders like [[placenta accreta]] decidualization have been consistently found to be deficient.
| | * '''Nutritional support''': It provides nutrients to the developing [[embryo]] before the [[placenta]] is fully functional. |
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| ===Hormone production===
| | * '''Immunological protection''': The decidua helps protect the [[embryo]] from the maternal immune system, which might otherwise recognize it as a foreign body. |
| The decidua secretes [[hormones]], [[growth factor]]s, and [[cytokine]]s. It has receptors for [[estrogen]], [[progesterone]], [[growth hormone]], and others. | |
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| Among its products are hormones commonly associated with other organs such as [[cortisol]], [[Corticotropin-releasing hormone|CRF]], [[GnRH]], [[prolactin]], and [[relaxin]]. Decidual prolactin is not under [[dopamine]]rgic control.
| | * '''Hormonal support''': It produces hormones such as [[prolactin]] and [[relaxin]], which are important for maintaining [[pregnancy]]. |
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| [[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. | | * '''Structural support''': The decidua helps anchor the [[placenta]] and provides a stable environment for the developing [[fetus]]. |
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| 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.
| | ==Development== |
| | | The transformation of the endometrium into the decidua is known as decidualization. This process is triggered by the [[hormone]] [[progesterone]] following [[ovulation]] and is further stimulated by the implantation of the [[blastocyst]]. Decidualization involves changes in the [[endometrial stroma]], including increased vascularization and the accumulation of [[glycogen]] and [[lipids]] in the stromal cells. |
| ===Other=== | |
| [[File:Decidua in a lymph node - very high mag.jpg|thumb|right|[[Micrograph]] of decidua in a lymph node. [[H&E stain]].]]
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| *In case of an [[extrauterine pregnancy]], the endometrium nevertheless becomes decidualized. A woman may shed the lining in the form of a decidual cast, which may be mistaken as a [[miscarriage]], when, in fact, the [[ectopic pregnancy|ectopic]] pregnancy still persists.
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| *A [[decidual reaction]] can be observed in tissue of the [[peritoneum]] and [[ovary]] during a pregnancy, and represents a response of [[stromal]] tissue to [[progesterone]].
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| *Decidua in a [[lymph node]] may mimic [[metastasis|metastatic]] [[carcinoma]].<ref name=pmid15859655>{{Cite journal | last1 = Wu | first1 = DC. | last2 = Hirschowitz | first2 = S. | last3 = Natarajan | first3 = S. | title = Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall | journal = Arch Pathol Lab Med | volume = 129 | issue = 5 | pages = e117–20 |date=May 2005 | doi = 10.1043/1543-2165(2005)129<E117:EDOPLN>2.0.CO;2 | pmid = 15859655 | doi-broken-date = 2019-08-20 }}</ref>
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| ==Clinical significance== | | ==Clinical significance== |
| [[File:Chronic deciduitis - intermed mag.jpg|thumb|right|[[Micrograph]] of [[chronic deciduitis]]. [[H&E stain]].]] | | Abnormalities in the decidua can lead to complications in [[pregnancy]], such as [[miscarriage]], [[preeclampsia]], and [[placental abruption]]. Proper formation and function of the decidua are essential for a successful [[pregnancy]]. |
| A long-lasting [[infection]] of the decidua, [[chronic deciduitis]], is associated with [[preterm birth|pre-term labour]].<ref name=pmid18171100>{{Cite journal | last1 = Edmondson | first1 = N. | last2 = Bocking | first2 = A. | last3 = Machin | first3 = G. | last4 = Rizek | first4 = R. | last5 = Watson | first5 = C. | last6 = Keating | first6 = S. | title = The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis | journal = Pediatr Dev Pathol | volume = 12 | issue = 1 | pages = 16–21 | month = | year = 2009| doi = 10.2350/07-04-0270.1 | pmid = 18171100 }}</ref>
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| ==History==
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| The word comes {{ety|la|deciduus|falling off / shedding}}.
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| ==Additional images==
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| <gallery>
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| File:Gray39.png|Scheme of placental circulation.
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| </gallery>
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| ==References==
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| {{Reflist}}
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| ==External links==
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| * {{URL|http://www-medlib.med.utah.edu/WebPath/PLACHTML/PLAC094.html|Histologic picture at med.utah.edu}}
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| * {{GraySubject|12}}
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| * {{BUHistology|19904loa}}
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| {{Extraembryonic and fetal membranes}}
| | ==Related pages== |
| {{Authority control}}
| | * [[Endometrium]] |
| | * [[Placenta]] |
| | * [[Pregnancy]] |
| | * [[Embryo]] |
| | * [[Fetus]] |
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| [[Category:Mammal female reproductive system]] | | [[Category:Reproductive system]] |
| [[Category:Obstetrics]] | | [[Category:Pregnancy]] |
| [[Category:Midwifery]]
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The decidua is the uterine lining during pregnancy
The decidua is the modified mucosal lining of the uterus (endometrium) that forms in preparation for and during pregnancy. It plays a crucial role in supporting the developing embryo and fetus and is shed during childbirth.
Structure[edit]
The decidua is divided into three regions based on their location relative to the embryo and placenta:
- Decidua basalis: This is the part of the decidua that interacts directly with the chorion and contributes to the formation of the placenta. It is located beneath the implanted embryo.
- Decidua capsularis: This portion surrounds the embryo and amniotic sac, covering the side facing the uterine cavity. As the gestational sac grows, the decidua capsularis stretches and eventually fuses with the decidua parietalis.
- Decidua parietalis: This is the remaining part of the decidua lining the rest of the uterine cavity. It eventually fuses with the decidua capsularis as the pregnancy progresses.
Function[edit]
The decidua serves several important functions during pregnancy:
- Nutritional support: It provides nutrients to the developing embryo before the placenta is fully functional.
- Immunological protection: The decidua helps protect the embryo from the maternal immune system, which might otherwise recognize it as a foreign body.
- Structural support: The decidua helps anchor the placenta and provides a stable environment for the developing fetus.
Development[edit]
The transformation of the endometrium into the decidua is known as decidualization. This process is triggered by the hormone progesterone following ovulation and is further stimulated by the implantation of the blastocyst. Decidualization involves changes in the endometrial stroma, including increased vascularization and the accumulation of glycogen and lipids in the stromal cells.
Clinical significance[edit]
Abnormalities in the decidua can lead to complications in pregnancy, such as miscarriage, preeclampsia, and placental abruption. Proper formation and function of the decidua are essential for a successful pregnancy.
Related pages[edit]
