Reyhan ASLANCAN BAYRAM, Selma ACAR, Şule Kevser DURSUN, Taha Yasin BAYRAM, Osman Murat GÜLER, İrem Deniz DERMAN, Verda ALPAY, Hakan ERENEL, Burak YÜCEL
Anatolian Journal of Obstetrics and Gynecology Research - 2026;3(1):21-28
Purpose: Placenta accreta spectrum (PAS) is a condition characterized by abnormal trophoblastic invasion of the decidua and is associated with significant maternal and fetal morbidity and mortality. Hypoxia-inducible factor 1-alpha (HIF-1 alpha) is a transcription factor that increases neovascularization in hypoxic environments. The aim of this study was to investigate the role of HIF-1alpha in abnormal trophoblastic invasion observed in PAS. Methods: This prospective study included 29 PAS-diagnosed patients (Group 1) and 29 healthy controls with a history of prior [cesarean section (CS); Group 2]. Decidual tissue samples from participants were collected and stained with anti-HIF-1 alpha antibody using immunohistochemical methods. Staining was evaluated both qualitatively and quantitatively. In qualitative assessment, the number of stained nuclei was determined by a pathologist. Quantitative assessment was performed using ImageJ and GraphPad Prism software, with staining intensity calculated in pixels. Results: Staining intensity graded as 2 or 3 was significantly higher in Group 1 compared to Group 2 in qualitative analysis (p=0.006, p<0.001, respectively). The percentage of positive staining area (%), the average positive region area (in pixels) and normalized average positive region area (%) were significantly greater in Group 1 compared to Group 2 on quantitative analysis (p<0.001, p=0.019, p=0.044, respectively). Conclusion: HIF-1alpha expression in decidual tissue is greater in PAS-diagnosed patients compared to healthy pregnant women with prior CS. This suggests that abnormal trophoblastic invasion in PAS may be due to hypoxia in the decidual tissue, which could lead to neovascularization driven by increased HIF-1 alpha expression.
