Abstract：
OBJECTIVE: To identify which components of maternal vascular malperfusion (MVM) pathology are associated with adverse pregnancy outcomes and to investigate the morphological phenotypes of MVM placental pathology and their relationship with distinct clinical presentations of pre-eclampsia and/or fetal growth restriction (FGR).
METHODS: Retrospective cohort study.
METHODS: Tertiary care hospital in Toronto, Canada.
METHODS: Pregnant individuals with low circulating maternal placental growth factor (PlGF) levels (<100 pg/mL) and placental pathology analysis between March 2017 and December 2019.
METHODS: Association between each pathological finding and the outcomes of interest were calculated using the chi-square test. Cluster analysis and logistic regression was used to identify phenotypic clusters, and their association with adverse pregnancy outcomes. Cluster analysis was performed using the K-modes unsupervised clustering algorithm.
METHODS: Preterm delivery <34+0 weeks of gestation, early onset pre-eclampsia with delivery <34+0 weeks of gestation, birthweight <10th percentile (small for gestational age, SGA) and stillbirth.
RESULTS: The diagnostic features of MVM most strongly associated with delivery <34+0 weeks of gestation were: infarction, accelerated villous maturation, distal villous hypoplasia and decidual vasculopathy. Two dominant phenotypic clusters of MVM pathology were identified. The largest cluster (n = 104) was characterised by both reduced placental mass and hypoxic ischaemic injury (infarction and accelerated villous maturation), and was associated with combined pre-eclampsia and SGA. The second dominant cluster (n = 59) was characterised by infarction and accelerated villous maturation alone, and was associated with pre-eclampsia and average birthweight for gestational age.
CONCLUSIONS: Patients with placental MVM disease are at high risk of pre-eclampsia and FGR, and distinct pathological findings correlate with different clinical phenotypes, suggestive of distinct subtypes of MVM disease.
METHODS: Retrospective cohort study.
METHODS: Tertiary care hospital in Toronto, Canada.
METHODS: Pregnant individuals with low circulating maternal placental growth factor (PlGF) levels (<100 pg/mL) and placental pathology analysis between March 2017 and December 2019.
METHODS: Association between each pathological finding and the outcomes of interest were calculated using the chi-square test. Cluster analysis and logistic regression was used to identify phenotypic clusters, and their association with adverse pregnancy outcomes. Cluster analysis was performed using the K-modes unsupervised clustering algorithm.
METHODS: Preterm delivery <34+0 weeks of gestation, early onset pre-eclampsia with delivery <34+0 weeks of gestation, birthweight <10th percentile (small for gestational age, SGA) and stillbirth.
RESULTS: The diagnostic features of MVM most strongly associated with delivery <34+0 weeks of gestation were: infarction, accelerated villous maturation, distal villous hypoplasia and decidual vasculopathy. Two dominant phenotypic clusters of MVM pathology were identified. The largest cluster (n = 104) was characterised by both reduced placental mass and hypoxic ischaemic injury (infarction and accelerated villous maturation), and was associated with combined pre-eclampsia and SGA. The second dominant cluster (n = 59) was characterised by infarction and accelerated villous maturation alone, and was associated with pre-eclampsia and average birthweight for gestational age.
CONCLUSIONS: Patients with placental MVM disease are at high risk of pre-eclampsia and FGR, and distinct pathological findings correlate with different clinical phenotypes, suggestive of distinct subtypes of MVM disease.
摘要：
目的：确定母体血管灌注不良（MVM）病理的哪些组成部分与不良妊娠结局相关，并研究MVM胎盘病理的形态学表型及其与先兆子痫和/或胎儿生长受限（FGR）的不同临床表现的关系。
方法：回顾性队列研究。
方法：多伦多三级护理医院，加拿大。
方法：2017年3月至2019年12月期间，母体胎盘生长因子（PlGF）水平低（<100pg/mL）的孕妇和胎盘病理分析。
方法：使用卡方检验计算每个病理发现与目标结果之间的关联。聚类分析和逻辑回归用于识别表型簇，以及它们与不良妊娠结局的关系。使用K模式无监督聚类算法进行聚类分析。
方法：早产<34+0孕周，早发型先兆子痫，分娩<34+0孕周，出生体重<10%(小于胎龄，SGA）和死产。
结果：与妊娠<34+0周分娩密切相关的MVM的诊断特征是：梗塞，加速绒毛成熟，远端绒毛发育不全和蜕膜血管病变。确定了MVM病理学的两个显性表型簇。最大的簇（n=104）的特征是胎盘质量减少和缺氧缺血性损伤（梗塞和绒毛成熟加速）。并与合并先兆子痫和SGA有关。第二个优势簇（n=59）的特征是仅梗塞和绒毛成熟加速，并与子痫前期和胎龄平均出生体重相关。
结论：患有胎盘MVM疾病的患者存在先兆子痫和FGR的高风险，和不同的病理结果与不同的临床表型相关，提示MVM疾病的不同亚型。
方法：回顾性队列研究。
方法：多伦多三级护理医院，加拿大。
方法：2017年3月至2019年12月期间，母体胎盘生长因子（PlGF）水平低（<100pg/mL）的孕妇和胎盘病理分析。
方法：使用卡方检验计算每个病理发现与目标结果之间的关联。聚类分析和逻辑回归用于识别表型簇，以及它们与不良妊娠结局的关系。使用K模式无监督聚类算法进行聚类分析。
方法：早产<34+0孕周，早发型先兆子痫，分娩<34+0孕周，出生体重<10%(小于胎龄，SGA）和死产。
结果：与妊娠<34+0周分娩密切相关的MVM的诊断特征是：梗塞，加速绒毛成熟，远端绒毛发育不全和蜕膜血管病变。确定了MVM病理学的两个显性表型簇。最大的簇（n=104）的特征是胎盘质量减少和缺氧缺血性损伤（梗塞和绒毛成熟加速）。并与合并先兆子痫和SGA有关。第二个优势簇（n=59）的特征是仅梗塞和绒毛成熟加速，并与子痫前期和胎龄平均出生体重相关。
结论：患有胎盘MVM疾病的患者存在先兆子痫和FGR的高风险，和不同的病理结果与不同的临床表型相关，提示MVM疾病的不同亚型。
