Journal Article

Framing Postpartum Hemorrhage as a Consequence of Human Placental Biology: An Evolutionary and Comparative Perspective

Rutherford, Julienne N., Abrams, Elizabeth T.

2011

Overview

Postpartum hemorrhage (PPH), the leading cause of maternal mortality worldwide, is responsible for 35 percent of maternal deaths. Proximately, PPH results from the failure of the placenta to separate from the uterine wall properly, most often because of impairment of uterine muscle contraction. Despite its prevalence and its well-described clinical manifestations, the ultimate causes of PPH are not known and have not been investigated through an evolutionary lens. We argue that vulnerability to PPH stems from the intensely invasive nature of human placentation. The human placenta causes uterine vessels to undergo transformation to provide the developing fetus with a high plane of maternal resources; the degree of this transformation in humans is extensive. We argue that the particularly invasive nature of the human placenta increases the possibility of increased blood loss at parturition. We review evidence suggesting PPH and other placental disorders represent an evolutionary novel condition in hominins. La hemorragia posparto (HPP) es la principal causa de mortalidad materna en todo el mundo, responsable de 35% de las muertes maternas. Una causa de la HPP es la separación incompleta de la placenta de la pared uterina, principalmente debido a una contracción deficiente del músculo uterino. A pesar de su prevalencia, las causas exactas de la HPP no se conocen y aún no han sido investigadas usando una lente evolutiva. Sostenemos que la posibilidad para presentar HPP se debe a la naturaleza invasiva de la inserción placentaria humana. La placenta humana transforma los vasos uterinos incrementando el acceso fetal a nutrientes maternos; el grado de esta transformación en humanos es extenso. Sostenemos que la naturaleza particularmente invasiva de la placenta humana aumenta el riesgo de sangrado post partum. Finalmente, revisamos la evidencia que sugiere que la HPP y otros desórdenes placentarios representan una condición evolutiva sin precedente en humanos. Kutokwa na damu nyingi baada ya kijifungua (PPH) ni sababu kubwa ya vifo vya akina mama wakati wa uzazi duniani na ni 35% ya vifo hivyo. Kwa maelezo ya kisayansi sababu kubwa ya PPH hutokana na kondo la nyuma kushindwa kujiengua na mfuko wa uzazi, ambapo mará nyingi misuli ya mfuko huo hushindwa kubana i pasavyo. Pamoja na PPH kuwa ya kawaida na kuelezwa vizuri kitabibu, lakini tunaona sababu yake kwa msingi wa mtazamo mabadiliko ya maumbile (evolution) haijajulikana bado. Tunatoa hoja kuwa kondo la binadamu lina vyojikita na mabadiliko ya mishipa ya mfuko wa uzazi i naongeza uwezekano wa damu kutoka kwa wingi wakati wa uzazi ya kawaida kwa binadamu. Hatimaye tumepitia upya na kutafakari njia za asili za uzazi na mabadiliko ya jenetiki za kuzuia/punguza PPH.

• Publisher: Wiley Periodicals, Inc,Blackwell Publishing Inc,Blackwell Publishing Ltd
• Subject: Biological Evolution / Biology / Comparative analysis / comparative placentation / Death / Deaths / Disorders / Embryo Implantation / evolutionary medicine / Female / Fetus / Fetuses / Foetus / Hemorrhage / History, 20th Century / History, 21st Century / Hominids / Humans / implantation / Invasive / Maternal mortality / Maternal Mortality - ethnology / Maternal Mortality - history / Medicine / Mortality / Mortality Rates / Mothers / Physical anthropology / Placenta / Placentation / postpartum hemorrhage / Postpartum Hemorrhage - ethnology / Postpartum Hemorrhage - history / Postpartum period / Pregnancy / Reduction (Phonological or Phonetic) / Reproductive system / Transformation / trophoblast / Trophoblasts / Vulnerability / Women's Health - ethnology / Women's Health - history / Womens health