背景:妊娠多囊卵巢综合征(PCOS)患者发生多种产科并发症的风险增加,胎盘被认为在它们的发育中起着关键作用。我们旨在评估接受体外受精(IVF)的PCOS女性胎盘的胎盘组织病理学模式。
方法:这项回顾性研究利用了2009年至2017年在皇家维多利亚医院接受IVF治疗并分娩的所有女性胎盘的全面总体和组织病理学评估,无论并发症或分娩方式如何。病理结果包括解剖,炎症,绒毛成熟,和血管灌注不良的特征。将PCOS女性的胎盘与排卵对照组的胎盘进行比较。多因素logistic回归用于调整与显著胎盘和围产期特征相关的混杂因素的结果。
结果:与排卵对照组(n=1121)相比,患有PCOS的女性(n=47)更容易患妊娠期糖尿病(38.3%vs.9.8%,p<0.001)。来自PCOS女性的胎盘更有可能是环状胎盘(aOR8.3,95CI1.9-37.3),更有可能是脐带过度卷曲(aOR6.8,95CI1.3-36.8)和病因不明的绒毛炎(aOR6.1,95CI1.5-25.6)。脉络膜病的可能性增加(aOR2.7,95%CI1.3-5.8),基于一个标准的胎儿血管灌注不良的证据(aOR2.7,95CI1.1-7.4),或多个标准(aOR6.4,95CI1.6-25.9),更多的胎儿红细胞(aOR5.2,95CI1.1-24.5),与对照组相比,PCOS女性胎盘中发生脉络膜瘤的可能性更高(aOR9.4,95CI1.6-55.1)。
结论:IVF妊娠胎盘组织病理学特征受PCOS潜在诊断的显著影响,重要包含胎盘的解剖变更和血管异常。
Pregnant polycystic ovary syndrome (PCOS) patients are at increased risk for myriad obstetric complications, with the placenta thought to play a key role in their development. We aimed to evaluate placental histopathology patterns in placentas of women with PCOS who underwent in-vitro-fertilization (IVF).
This retrospective study utilized full gross and histopathologic assessment of placentas of all women who had IVF treatment and delivered at the Royal Victoria Hospital from 2009 to 2017, regardless of complications or mode of delivery. Pathologic findings included anatomic, inflammation, villous maturation, and vascular mal-perfusion features. Placentas of PCOS women were compared to those of ovulatory controls. Multivariate logistic regression was used to adjust results for confounding factors potentially associated with significant placental and perinatal characteristics.
Women with PCOS (n = 47) were more likely to develop gestational diabetes mellitus compared to ovulatory controls (n = 1121) (38.3% vs. 9.8%, p < 0.001). Placentas from PCOS women were more likely circumvallate placentas (aOR 8.3, 95%CI 1.9-37.3) and more likely to have a hypercoiled umbilical cord (aOR 6.8 95%CI 1.3-36.8) and villitis of unknown etiology (aOR 6.1, 95%CI 1.5-25.6). There was an increased likelihood of chorangiosis (aOR 2.7, 95% CI 1.3-5.8), evidence of fetal vascular malperfusion based on one criteria (aOR 2.7, 95%CI 1.1-7.4), or more than one criteria (aOR 6.4, 95%CI 1.6-25.9), more nucleated fetal red blood cells (aOR 5.2, 95%CI 1.1-24.5), and a higher likelihood of chorangiomas (aOR 9.4, 95%CI 1.6-55.1) in placentas from PCOS women than in controls.
IVF pregnancies\' placental histopathological characteristics are significantly impacted by an underlying diagnosis of PCOS, including important anatomic changes and vascular placental abnormalities.