■子宫内膜异位症是不孕的主要原因之一,由于对卵泡形成和子宫内膜容受性的负面影响。文献显示,子宫内膜异位症可能与围产期并发症有关,例如早产(PTB)和先兆子痫(PE)。作者假设,通过辅助生殖技术(ART)治疗构思的子宫内膜异位症相关不孕症的女性胎盘疾病的频率更高。主要结果是通过ART治疗构思的子宫内膜异位症妇女的单胎妊娠中足月胎盘的组织病理学改变的发生。与通过ART构思的男性因素(MF)引起的不育症的健康女性和自发怀孕的健康女性相比。次要结果包括围产期并发症的发生以及子宫内膜异位症与胎盘组织病理学特征的关系。
■单中心,在大学医院中心妇产科(UHC)内收集并在同一医院病理科进行分析的足月胎盘病例对照研究,一位高级围产期病理学家。使用阿姆斯特丹胎盘研讨会小组共识报告了组织病理学分析。所有注意到的胎盘病变分为以下几类:解剖,炎症,绒毛成熟和血管灌注不良。所需样本量为80个胎盘,研究结果用描述符报告,用卡方分析,费舍尔精确检验和克鲁斯卡尔-沃利斯方差分析。在校正混杂因素的情况下进行多因素回归分析。道德批准:第520-03/24-01/83类。
■研究包括107名女性的足月胎盘,其中36位是通过ART构思的子宫内膜异位症妇女,31例接受ART治疗的MF不孕健康女性和40例自发妊娠健康女性。子宫内膜异位症妇女主要是初产妇,不孕持续时间较长。子宫内膜异位症组妊娠早期出血和即将早产的发生率较高。子宫内膜异位症和MF组的Cesarian分娩(CS)发生率更高,而子宫内膜异位症组的新生儿出生体重最低。子宫内膜异位症组胎盘索(PC)较短,合胞体打结和血管灌注不良疾病的发生率更高(绒毛膜下和绒毛膜下纤维蛋白,绒毛间血栓形成,高级别胎儿血管灌注不良)。最后,子宫内膜异位症显示与合胞结形成增加和PC过度卷曲有关,在多元回归分析中对混杂因素进行调整后。
■尽管围产期并发症发生率低,我们报道子宫内膜异位症有更高的合胞体打结和血管灌注不良胎盘疾病的发生率,与对照组相比。子宫内膜异位症还与合胞体打结和PC过度卷曲增加有关。需要进一步的研究来阐明子宫内膜异位症对胎盘疾病和围产期并发症中子宫内膜容受性和免疫发病机制的影响。要点子宫内膜异位症女性主要是初产妇,不孕持续时间较长。子宫内膜异位症组妊娠早期出血和即将早产的发生率较高。此外,子宫内膜异位症和MF组的Cesarian分娩发生率较高,而子宫内膜异位症组的新生儿出生体重最低。子宫内膜异位症组有较短的胎盘索,合胞体打结和血管灌注不良病变的发生率更高。子宫内膜异位症显示与合胞结形成增加和胎盘索过度卷曲有关。在对混杂因素进行调整后。
UNASSIGNED: Endometriosis is one of the leading causes of infertility, due to negative impact on ovarian folliculogenesis and endometrial receptivity. Literature show that endometriosis could be associated with perinatal complications such as preterm birth (PTB) and preeclampsia (PE). Authors hypothesized that women with endometriosis-related infertility conceived by assisted reproductive technology (ART) treatment have higher frequency of placental disorders. Main outcome is the occurrence of histopathologic alterations of term placentas in singleton pregnancies of women with endometriosis conceived by ART treatment, compared to healthy women with infertility due to male factor (MF) conceived by ART and to healthy women with spontaneous pregnancies. Secondary outcome include the occurrence of perinatal complications and the relationship of endometriosis and placental histopathologic characteristics.
UNASSIGNED: Single-center, case-control study of term placentas that were collected within Department of Obstetrics and Gynecology of University Hospital Center (UHC) Split and analyzed in the Pathology department of the same hospital, by one senior perinatal pathologist. Histopathologic analysis was reported using Amsterdam Placental Workshop Group Consensus. All the noted placental lesions were divided into following categories: anatomic, inflammatory, villous maturation and vascular malperfusion disorders. Required sample size was 80 placentas, and study results were reported with descriptives, and analyzed with chi-squared, Fisher\'s exact test and Kruskal-Wallis ANOVA. Multivariate regression analysis was carried with adjustment for confounding factors. Ethics approval: Class n. 520-03/24-01/83.
UNASSIGNED: Study included term placentas of 107 women, of which 36 were women with endometriosis conceived by ART, 31 were healthy women with MF infertility conceived by ART and 40 healthy women with spontaneous pregnancies. Endometriosis women were predominantly primiparas, with longer infertility duration. Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Endometriosis and MF groups had higher occurrence of Cesarian delivery (CS), while endometriosis group had newborns with lowest birthweight. Endometriosis group had shorter placental cords (PC), higher rates of increased syncytial knotting and vascular malperfusion disorders (subchorionic and perivillous fibrin, intervillous thrombosis, high grade fetal vascular malperfusion). Finally, endometriosis is showed to be associated with increased syncytial knots\' formation and PC hypercoiling, after adjustment for confounding factors in the multivariate regression analysis.
UNASSIGNED: Despite low rates of perinatal complications, we report endometriosis to have higher occurrence of increased syncytial knotting and vascular malperfusion placental disorders, compared to control groups. Endometriosis is also associated with increased syncytial knotting and PC hypercoiling. Further studies are needed to elucidate the endometriosis impact on endometrial receptivity and immunopathogenesis in placental disorders and perinatal complications.HighlightsEndometriosis women were predominantly primiparas, with longer infertility duration.Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Moreover, endometriosis and MF groups had higher occurrence of Cesarian delivery, while endometriosis group had newborns with lowest birthweight.Endometriosis group had shorter placental cords, higher rates of increased syncytial knotting and vascular malperfusion lesions.Endometriosis is showed to be associated with increased syncytial knots formation and hypercoiling of placental cord, after adjustment for confounding factor.