目的:关于妊娠合并局限性胎盘镶嵌(CPM)的胎盘功能,有相互矛盾的证据。因此,我们旨在比较CPM和非CPM妊娠的胎盘功能。通过磁共振成像(MRI)估计的胎盘体积和胎盘横向松弛时间(T2*值)研究胎盘功能,超声估计胎儿体重(EFW)和子宫动脉搏动指数(UtAPI)。此外,在MRI和出生时评估胎儿胎盘比率(FP比率).
方法:该队列共包括901例妊娠(123例CPM妊娠和78例非CPM妊娠)。MRI和超声检查在中位胎龄32.6(IQR=24.7-35.3)周进行。通过学生t检验或针对胎龄校正的多元线性回归研究各组之间胎盘功能的差异。在CPM怀孕组中,通过Wilcoxon秩和检验对高危CPM妊娠(2,3,7,13和16号染色体)和低危CPM妊娠(5,18和45X号染色体)进行了比较.
结果:在MRI时,CPM胎盘的特征是胎盘T2*Z评分较低(p=0.00403),较低的FP比率(p=0.03)和较高的UtAPIZ分数(p=0.0317),与非CPM胎盘相比。出生时,与非CPM妊娠相比,CPM妊娠的FP比率显著降低(p=0.02),胎盘重量增加(p=0.0216).此外,高危CPM妊娠显示胎盘T2*Z评分降低(p=0.0053),较低的出生体重Z评分(p=0.032),与低风险CPM妊娠相比,出生时的胎龄较低(p=0.0345)和UtAPIZ评分较高(p=0.0432)。然而,低危CPM妊娠与非CPM妊娠无差异.
结论:CPM妊娠的特征是胎盘增大和功能失调。胎盘功能与CPM的染色体类型高度相关,因为胎盘功能障碍主要见于高危CPM妊娠,包括2号、3号、7号、13号和16号染色体。本文受版权保护。保留所有权利。
Evidence regarding placental function in pregnancies complicated by confined placental mosaicism (CPM) is conflicting. We aimed to compare placental function between CPM and non-CPM pregnancies prenatally and at birth. A secondary objective was to evaluate the relationship between placental function and chromosomal subtype of CPM.
This was a retrospective study of pregnancies with CPM and control pregnancies delivered at a tertiary hospital in Denmark between 2014 and 2017. Placental volume and placental transverse relaxation time (T2*) were estimated on magnetic resonance imaging (MRI), fetal weight and uterine artery pulsatility index (UtA-PI) were estimated on ultrasound and fetoplacental ratio was assessed on MRI and at birth. These estimates of placental function were adjusted for gestational age and compared between groups using the Wilcoxon rank-sum test. Within the group of CPM pregnancies, measures of placental function were compared between those at high risk (chromosome numbers 2, 3, 7, 13 and 16) and those at low risk (chromosome numbers 5, 18 and 45X).
A total of 90 pregnancies were included, of which 12 had CPM and 78 were controls. MRI and ultrasound examinations were performed at a median gestational age of 32.6 weeks (interquartile range, 24.7-35.3 weeks). On MRI assessment, CPM placentae were characterized by a lower placental T2* Z-score (P = 0.004), a lower fetoplacental ratio (P = 0.03) and a higher UtA-PI Z-score (P = 0.03), compared with non-CPM placentae. At birth, the fetoplacental ratio was significantly lower (P = 0.02) and placental weight Z-score was higher (P = 0.01) in CPM pregnancies compared with non-CPM pregnancies. High-risk CPM pregnancies showed a reduced placental T2* Z-score (P = 0.003), lower birth-weight Z-score (P = 0.041), earlier gestational age at delivery (P = 0.019) and higher UtA-PI Z-score (P = 0.028) compared with low-risk CPM pregnancies. Low-risk CPM pregnancies did not differ in any of these parameters from non-CPM pregnancies.
CPM pregnancies are characterized by an enlarged and dysfunctional placenta. Placental function was highly related to the chromosomal type of CPM; placental dysfunction was seen predominantly in high-risk CPM pregnancies in which chromosomes 2, 3, 7, 13 or 16 were involved. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.