Ovarian Morphology in Early and Late Human Pregnancy

Jørgen Starup, Jakob Visfeldt
Acta obstetricia et gynecologica Scandinavica · 1974 · vol. 53(3) , pp. 211–218 · doi:10.3109/00016347409162159 · PMID:4843715 · W2118399088
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This study examined ovarian morphology in early and late human pregnancy, finding normal follicular development from nine weeks onward and luteinization of theca cells surrounding antral and atretic follicles.

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Abstract

Abstract. Representative ovarian biopsies were obtained from 30 pregnant women aged 15 to 40. Group I consisted of 6 women with pregnancies of a gestational age of 9 to 18 weeks, and group II consisted of 24 women with pregnancies of a gestational age of 36 to 42 weeks. The number of primordial follicles varied considerably in both groups, but seemed to be mainly dependent on the age of the individual woman. We did not examine the follicular development before the 9th week of pregnancy, but at least from that time a normal development of follicles up to the stage of Graafian follicles was observed in the great majority of women. A typical decidual reaction in the ovarian cortex was found in all women in group II, but this reaction may also occasionally occur very early in pregnancy. For instance, we observed a marked decidual reaction in one woman in the 9th week of pregnancy. The decidual reaction was always located beneath or adjacent to the surface epithelium, and usually it was of the nodular form, but it might also occur as single cells or as more diffuse and confluent formations of decidual cells. In all cases of typical decidual reaction, the macroscopic appearance of the ovary was characteristic; the ovarian surface presented a gyriform appearance due to a network of thin, pale red ridges and small nodules. An interesting observation in group I was that the decidual reaction in all cases seemed to be preceded by the existence of nodules or more confluent areas characterized by a loose, proliferative connective tissue containing many fibroblasts and capillaries. The most consistent finding in both groups was the proliferation and luteinization of the theca cells surrounding both the growing and atretic follicles. However, it should be emphasized that these luteinized theca cells were only found around antral and Graafian follicles and atretic follicles of similar size, but never around even the largest primary follicles. We are not convinced of the significance of the previously described so‐called surface cell proliferation, even if similar changes were observed in 57% of the 30 women investigated. These changes were mainly observed in areas where the epithelium covered depressed or retracted parts of the ovarian stroma. On the other hand, the prominent decidual nodules were covered by a thin layer of flattened epithelial cells. We therefore believe that the changes in the surface epithelium is merely an unspecific phenomenon.

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