Abstract：
Placental vascular disease, characterized by Maternal Vascular Malperfusion (MVM) lesions, is considered to be the underlying cause of pregnancy complications. Aim is to evaluate the relationship between the cumulative number of MVM lesion types, and adverse pregnancy- and neonatal outcomes.
This retrospective cohort study included 272 women with singleton gestations who gave birth at a Dutch tertiary hospital between 2017 and 2018 with available placental histopathology reports. Analyzed according to the Amsterdam Placental Workshop Group Consensus Statement, placentas were divided into groups based on the cumulative number of MVM lesions: no lesions (n = 124), 1-2 types (n = 124) and 3-5 types of lesions (n = 24).
The proportion of placenta syndrome (PS) was highest (95.8%) in the 3-5 MVM lesions group (p < 0.001). The presence of MVM lesions was highly associated with PS during pregnancy (aOR 6.81, 95% CI 3.76-12.33). Furthermore, every additional type of MVM lesion corresponded with a threefold increased odds for the occurrence of PS (aOR 3.00, 95% CI 2.10-4.29). The group with 3-5 types of MVM lesions showed the highest incidence of adverse neonatal outcomes, lower mean birth weight, prolonged hospitalization, NICU admissions and neonatal deaths (aOR 6.47, 95% CI 0.33-127.68), corresponding with a fourfold increased odds for the occurrence of neonatal death for every additional MVM lesion (aOR 4.19, 95% CI 1.39-12.68).
A higher number of MVM lesion types is strongly associated with an increased incidence of adverse pregnancy- and neonatal outcomes, indicating that guidelines should focus also on the amount of MVM lesion types for the monitoring/management of subsequent pregnancies.
This retrospective cohort study included 272 women with singleton gestations who gave birth at a Dutch tertiary hospital between 2017 and 2018 with available placental histopathology reports. Analyzed according to the Amsterdam Placental Workshop Group Consensus Statement, placentas were divided into groups based on the cumulative number of MVM lesions: no lesions (n = 124), 1-2 types (n = 124) and 3-5 types of lesions (n = 24).
The proportion of placenta syndrome (PS) was highest (95.8%) in the 3-5 MVM lesions group (p < 0.001). The presence of MVM lesions was highly associated with PS during pregnancy (aOR 6.81, 95% CI 3.76-12.33). Furthermore, every additional type of MVM lesion corresponded with a threefold increased odds for the occurrence of PS (aOR 3.00, 95% CI 2.10-4.29). The group with 3-5 types of MVM lesions showed the highest incidence of adverse neonatal outcomes, lower mean birth weight, prolonged hospitalization, NICU admissions and neonatal deaths (aOR 6.47, 95% CI 0.33-127.68), corresponding with a fourfold increased odds for the occurrence of neonatal death for every additional MVM lesion (aOR 4.19, 95% CI 1.39-12.68).
A higher number of MVM lesion types is strongly associated with an increased incidence of adverse pregnancy- and neonatal outcomes, indicating that guidelines should focus also on the amount of MVM lesion types for the monitoring/management of subsequent pregnancies.
摘要：
胎盘血管疾病,以母体血管灌注不良（MVM）病变为特征，被认为是妊娠并发症的根本原因。目的是评估MVM病变类型的累积数量之间的关系，以及不良妊娠和新生儿结局。
这项回顾性队列研究包括2017年至2018年在荷兰三级医院分娩的272名单胎妊娠妇女，并提供胎盘组织病理学报告。根据阿姆斯特丹胎盘研讨会小组共识声明进行分析，胎盘根据MVM病变的累积数量分为：无病变（n=124），1-2型（n=124）和3-5型病变（n=24）。
在3-5例MVM病变组中，胎盘综合征（PS）的比例最高（95.8％）（p<0.001）。妊娠期间MVM病变的存在与PS高度相关（aOR6.81，95％CI3.76-12.33）。此外，每增加一种MVM病变类型,发生PS的几率增加了3倍(aOR3.00,95%CI2.10~4.29).3-5型MVM病变组新生儿不良结局发生率最高,较低的平均出生体重，住院时间延长,NICU入院和新生儿死亡（aOR6.47，95％CI0.33-127.68），与每增加一个MVM病变发生新生儿死亡的几率增加四倍相对应(aOR4.19,95%CI1.39-12.68).
更多的MVM病变类型与不良妊娠和新生儿结局的发生率增加密切相关。这表明在后续妊娠的监测/管理中,指南还应关注MVM病变类型的数量.
这项回顾性队列研究包括2017年至2018年在荷兰三级医院分娩的272名单胎妊娠妇女，并提供胎盘组织病理学报告。根据阿姆斯特丹胎盘研讨会小组共识声明进行分析，胎盘根据MVM病变的累积数量分为：无病变（n=124），1-2型（n=124）和3-5型病变（n=24）。
在3-5例MVM病变组中，胎盘综合征（PS）的比例最高（95.8％）（p<0.001）。妊娠期间MVM病变的存在与PS高度相关（aOR6.81，95％CI3.76-12.33）。此外，每增加一种MVM病变类型,发生PS的几率增加了3倍(aOR3.00,95%CI2.10~4.29).3-5型MVM病变组新生儿不良结局发生率最高,较低的平均出生体重，住院时间延长,NICU入院和新生儿死亡（aOR6.47，95％CI0.33-127.68），与每增加一个MVM病变发生新生儿死亡的几率增加四倍相对应(aOR4.19,95%CI1.39-12.68).
更多的MVM病变类型与不良妊娠和新生儿结局的发生率增加密切相关。这表明在后续妊娠的监测/管理中,指南还应关注MVM病变类型的数量.
