Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (646 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
The hormone-responsive glandular layer of endometrium that sloughs off at each menstrual flow (decidua menstrualis) or at the termination of pregnancy. During pregnancy, the thickest part of the decidua forms the maternal portion of the placenta, thus named decidua placentalis. The thin portion of the decidua covering the rest of the embryo is the decidua capsularis.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Deciduas; Deciduum.
Where it fits in the MeSH classification
- Broader topics
- Endometrium; Placenta
- Narrower topics
- Deciduoma
Related concepts
Research landscape
PubMed indexes 6,911 records tagged with the MeSH heading “Decidua” (counts retrieved 2026-10-31). 1,121 of them (16.2%) were published from 2020 onward, and the busiest period so far is through 1999 with 3,079 records.
Reviews account for 606 records (8.8%) and meta-analyses for 3. Randomized controlled trials number 11 (0.2%) as a share of all records on the topic. Randomized trials make up only a small share of this literature, so much of what is known comes from laboratory, observational or descriptive work.
Show the data
| Period | Records |
|---|---|
| through 1999 | 3,079 |
| 2000-2009 | 1,271 |
| 2010-2019 | 1,440 |
| 2020 onward | 1,121 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 606 | 8.8% |
| Meta-analyses | 3 | 0.0% |
| Randomized controlled trials | 11 | 0.2% |
Method: PubMed query "Decidua"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-31.
Reading the evidence in anatomy and physiology
Anatomy describes how body structures are built and physiology describes how they normally work, so most findings here are descriptive or mechanistic rather than evidence about treatment. Much of what is known comes from dissection, imaging, tissue studies and experiments in animals, and measurements in healthy volunteers can differ from those in people with disease or at different ages. Normal ranges vary between individuals and populations. Check whether a result was measured in people or in another species, the age and health of the participants, and the method used.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
| Study / authors | Year | Source label / design | Europe PMC citations | Licence / source |
|---|---|---|---|---|
| Dynamic Function and Composition Changes of Immune Cells During Normal and Pathological Pregnancy at the Maternal-Fetal Interface | 2019 | Review article Design not recorded in structured metadata | 351 | cc by PMID 31681264 · DOI · PMC6813251 |
| Endometrial Decidualization: The Primary Driver of Pregnancy Health | 2020 | Review article Design not recorded in structured metadata | 268 | cc by PMID 32521725 · DOI · PMC7312091 |
| Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium | 2017 | Research article Design not recorded in structured metadata | 264 | cc by PMID 29227245 · DOI · PMC5724991 |
| Single-cell mapping of human endometrium and decidua reveals epithelial and stromal contributions to fertility | 2026 | Research article Design not recorded in structured metadata | 8 | cc by PMID 41574608 · DOI · PMC12892900 |
Dynamic Function and Composition Changes of Immune Cells During Normal and Pathological Pregnancy at the Maternal-Fetal Interface [1]
Abstract reading summary — source excerpts
- Opening excerpt
- A successful pregnancy requires a fine-tuned and highly regulated balance between immune activation and embryonic antigen tolerance.
- Closing excerpt
- This review summarizes information from previous studies, which may lay the foundation for the diagnosis of pathological pregnancy and put forward new ideas for future studies.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (196 words)
A successful pregnancy requires a fine-tuned and highly regulated balance between immune activation and embryonic antigen tolerance. Since the fetus is semi-allogeneic, the maternal immune system should exert tolerant to the fetus while maintaining the defense against infection. The maternal-fetal interface consists of different immune cells, such as decidual natural killer (dNK) cells, macrophages, T cells, dendritic cells, B cells, and NKT cells. The interaction between immune cells, decidual stromal cells, and trophoblasts constitute a vast network of cellular connections. A cellular immunological imbalance may lead to adverse pregnancy outcomes, such as recurrent spontaneous abortion, pre-eclampsia, pre-term birth, intrauterine growth restriction, and infection. Dynamic changes in immune cells at the maternal-fetal interface have not been clearly stated. While many studies have described changes in the proportions of immune cells in the normal maternal-fetus interface during early pregnancy, few studies have assessed the immune cell changes in mid and late pregnancy. Research on pathological pregnancy has provided clues about these dynamic changes, but a deeper understanding of these changes is necessary. This review summarizes information from previous studies, which may lay the foundation for the diagnosis of pathological pregnancy and put forward new ideas for future studies.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 31681264 · DOI · PMC6813251
Endometrial Decidualization: The Primary Driver of Pregnancy Health [2]
Abstract reading summary — source excerpts
- Opening excerpt
- Interventions to prevent pregnancy complications have been largely unsuccessful.
- Closing excerpt
- We hypothesize, therefore, that the primary driver of pregnancy health is the quality of the soil, not the seed.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (140 words)
Interventions to prevent pregnancy complications have been largely unsuccessful. We suggest this is because the foundation for a healthy pregnancy is laid prior to the establishment of the pregnancy at the time of endometrial decidualization. Humans are one of only a few mammalian viviparous species in which decidualization begins during the latter half of each menstrual cycle and is therefore independent of the conceptus. Failure to adequately prepare (decidualize) the endometrium hormonally, biochemically, and immunologically in anticipation of the approaching blastocyst-including the downregulation of genes involved in the pro- inflammatory response and resisting tissue invasion along with the increased expression of genes that promote angiogenesis, foster immune tolerance, and facilitate tissue invasion-leads to abnormal implantation/placentation and ultimately to adverse pregnancy outcome. We hypothesize, therefore, that the primary driver of pregnancy health is the quality of the soil, not the seed.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 32521725 · DOI · PMC7312091
Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium [3]
Abstract reading summary — source excerpts
- Opening excerpt
- In cycling human endometrium, menstruation is followed by rapid estrogen-dependent growth.
- Closing excerpt
- Our findings reveal that acute decidual senescence governs endometrial rejuvenation and remodeling at embryo implantation, and suggest a critical role for uNK cells in maintaining homeostasis in cycling endometrium.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (149 words)
In cycling human endometrium, menstruation is followed by rapid estrogen-dependent growth. Upon ovulation, progesterone and rising cellular cAMP levels activate the transcription factor Forkhead box O1 (FOXO1) in endometrial stromal cells (EnSCs), leading to cell cycle exit and differentiation into decidual cells that control embryo implantation. Here we show that FOXO1 also causes acute senescence of a subpopulation of decidualizing EnSCs in an IL-8 dependent manner. Selective depletion or enrichment of this subpopulation revealed that decidual senescence drives the transient inflammatory response associated with endometrial receptivity. Further, senescent cells prevent differentiation of endometrial mesenchymal stem cells in decidualizing cultures. As the cycle progresses, IL-15 activated uterine natural killer (uNK) cells selectively target and clear senescent decidual cells through granule exocytosis. Our findings reveal that acute decidual senescence governs endometrial rejuvenation and remodeling at embryo implantation, and suggest a critical role for uNK cells in maintaining homeostasis in cycling endometrium.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 29227245 · DOI · PMC5724991
Single-cell mapping of human endometrium and decidua reveals epithelial and stromal contributions to fertility [4]
Abstract reading summary — source excerpts
- Opening excerpt
- The human endometrium undergoes dynamic changes across the menstrual cycle to establish a receptive state for embryo implantation.
- Closing excerpt
- Together, these findings provide a high-resolution transcriptomic atlas of the receptive and early pregnant endometrium and shed light on key molecular pathways underlying successful implantation.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (161 words)
The human endometrium undergoes dynamic changes across the menstrual cycle to establish a receptive state for embryo implantation. Using bulk and single-cell RNA-Seq, we characterized gene expression dynamics in the cycling endometrium and the decidua from early pregnancy. We demonstrated that during the mid-secretory phase - the period encompassing the window of implantation - secretory glandular epithelial cells undergo notable transcriptional changes and alterations in cell-cell communication. Through comprehensive analyses, we identified the glandular epithelium receptivity module (GERM) signature, comprising 556 genes associated with endometrial receptivity. This GERM signature was consistently perturbed across datasets of endometrial samples from women with impaired fertility, validating its relevance as a marker of receptivity. In addition to epithelial changes, we observed shifts in stromal cell populations, notably involving decidual and senescent subsets, which also play key roles in modulating implantation. Together, these findings provide a high-resolution transcriptomic atlas of the receptive and early pregnant endometrium and shed light on key molecular pathways underlying successful implantation.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 41574608 · DOI · PMC12892900
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article Mechanisms of implantation: strategies for successful pregnancy [5]
- Research article Cyclic decidualization of the human endometrium in reproductive health and failure [6]
- Research article Immune responses at the maternal-fetal interface [7]
- Research article Decidualization of the human endometrium: mechanisms, functions, and clinical perspectives [8]
- Research article Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance [9]
- Research article The role of decidual immune cells on human pregnancy [10]
References
- Yang F, Zheng Q, Jin L. Dynamic Function and Composition Changes of Immune Cells During Normal and Pathological Pregnancy at the Maternal-Fetal Interface. . 2019. PMID 31681264 · DOI · PMC6813251
- Ng SW, Norwitz GA, Pavlicev M, Tilburgs T, Simón C, Norwitz ER. Endometrial Decidualization: The Primary Driver of Pregnancy Health. . 2020. PMID 32521725 · DOI · PMC7312091
- Brighton PJ, Maruyama Y, Fishwick K, Vrljicak P, Tewary S, Fujihara R, et al.. Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium. . 2017. PMID 29227245 · DOI · PMC5724991
- Burns GW, Paul EN, Persaud M, Zhao Q, Li R, Blackledge K, et al.. Single-cell mapping of human endometrium and decidua reveals epithelial and stromal contributions to fertility. . 2026. PMID 41574608 · DOI · PMC12892900
- Cha J, Sun X, Dey SK. Mechanisms of implantation: strategies for successful pregnancy. Nat Med. 2012. PMID 23223073 · DOI · PMC6322836
- Gellersen B, Brosens JJ. Cyclic decidualization of the human endometrium in reproductive health and failure. Endocr Rev. 2014. PMID 25141152 · DOI
- Ander SE, Diamond MS, Coyne CB. Immune responses at the maternal-fetal interface. Sci Immunol. 2019. PMID 30635356 · DOI · PMC6744611
- Gellersen B, Brosens IA, Brosens JJ. Decidualization of the human endometrium: mechanisms, functions, and clinical perspectives. Semin Reprod Med. 2007. PMID 17960529 · DOI
- Kim CJ, Romero R, Chaemsaithong P, Chaemsaithong P, Kim JS. Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance. Am J Obstet Gynecol. 2015. PMID 26428503 · DOI · PMC4782598
- Liu S, Diao L, Huang C, Li Y, Zeng Y, Kwak-Kim JYH. The role of decidual immune cells on human pregnancy. J Reprod Immunol. 2017. PMID 29055791 · DOI
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-10-31.
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Evidence strength
EvidenceHelix's computed view of the study designs behind this topic: how common meta-analyses, randomized trials and reviews are, how recent the literature is, and a plain-language reading. It describes the design mix of the literature. It is not a quality appraisal of any study, and it is not medical advice.