背景:胎盘的组织学检查通常在早产后进行。虽然胎盘检查不能改变指标妊娠结局,它可能告知在随后的妊娠中不良结局的风险.先前的研究已经检查了个体组织学病变与妊娠结局之间的关联,但没有一致的结果。
目的:本研究旨在确定胎盘病理组织学类型对复发性早产的独立作用。
方法:这是2009年1月至2018年3月在三级护理中心进行的一项回顾性队列研究。出生≥2人的个人,妊娠<37周的出生指数,并纳入了索引妊娠的胎盘病理报告。母体血管灌注不良的存在,胎儿血管灌注不良,急性炎症,从每个指标胎盘的病理报告中提取慢性炎症,并分类为无,低等级,或高品位。包含所有4种胎盘病理组织学类型的对数二项模型,胎龄指数,种族,和产妇年龄被用来估计每种胎盘组织学类型和复发性早产风险之间的关联.此外,研究了胎盘组织学类型之间的双向相互作用术语。此外,根据指数早产的特征完成了2次分层分析:(1)晚期早产(胎龄34-36周)与早期至中度早产(<34周)和(2)亚组分析自发性早产。
结果:共有924对妊娠符合纳入标准。只有高度慢性炎症与复发性早产的风险增加独立相关(调整后的风险比,1.37;95%置信区间,1.03-1.81)。按胎龄组进行的分层分析显示,仅在早期早产的人群中,母体血管灌注不良与复发性早产相关(调整后的风险比,1.40;95%置信区间,1.01-1.93)。在自发性早产的参与者中,病理组织学类型与早产风险之间未发现关联.
结论:在指数早产妊娠中,重度慢性胎盘炎症与复发性早产相关.低级别母体血管灌注不良与复发性早产相关,仅在早期或中度指数早产(<34孕周)的人群中。这些发现可能有助于确定个体患者的风险状况,并可能产生有关复发性早产发病机理的假设。
Histologic examination of the placenta is often performed after preterm birth. Although placental examination cannot change the index pregnancy outcome, it may inform the risk of adverse outcomes in a subsequent pregnancy. Previous research has examined the association between individual histologic lesions and pregnancy outcomes without consistent results.
This study aimed to determine the independent contributions of the major placental pathology histologic types to recurrent preterm birth.
This was a retrospective cohort study of deliveries at a tertiary care center from January 2009 to March 2018. Individuals with ≥2 births, an index birth of <37 weeks of gestation, and a placental pathology report from the index pregnancy were included. The presence of maternal vascular malperfusion, fetal vascular malperfusion, acute inflammation, and chronic inflammation was extracted from the pathology reports for each index placenta and classified as none, low grade, or high grade. A log-binomial model incorporating all 4 placental pathology histologic types, index gestational age, race, and maternal age was used to estimate the associations between each placental histologic type and risk of recurrent preterm birth. Moreover, 2-way interaction terms were studied among placental histologic types. In addition, 2 stratified analyses were completed on the basis of characteristics of the index preterm birth: (1) by late preterm (gestational age of 34-36 weeks) vs early-to-moderate preterm birth (<34 weeks) and (2) a subgroup analysis of those with spontaneous preterm birth.
A total of 924 pregnancy pairs met the inclusion criteria. Only high-grade chronic inflammation was independently associated with an increased risk of recurrent preterm birth (adjusted risk ratio, 1.37; 95% confidence interval, 1.03-1.81). Stratified analysis by gestational age group demonstrated maternal vascular malperfusion was associated with recurrent preterm birth only among those with early preterm birth (adjusted risk ratio, 1.40; 95% confidence interval, 1.01-1.93). Among participants with spontaneous preterm labor, no association was found between pathology histologic types and risk of preterm birth.
Among index preterm pregnancies, high-grade chronic placental inflammation was associated with recurrent preterm birth. Low-grade maternal vascular malperfusion was associated with recurrent preterm birth only among those with an early or moderate index preterm birth (<34 weeks of gestation). These findings may be useful in determining the risk profile for individual patients and may generate hypotheses as to the pathogenesis of recurrent preterm birth.