胎盘异常可导致早产(PTB),新生儿发病率和死亡率的主要原因。本研究旨在了解基于不同胎龄的PTB类别之间的胎盘变化。
方法:一项为期三年的回顾性研究对按胎龄分类的PTB胎盘进行了详细的临床病理分析:极早产(EPTB,<28周),非常早产(VPTB,28至31+6周),中度早产(MPTB,32至33+6周),和晚期早产(LPTB,34~36+6周)。来自病理记录的宏观参数和评估母体和胎儿基质血管病变的显微镜检查,炎性和低氧性病变和其他。未产/宫内死亡和多胎妊娠被排除。从医疗记录中收集临床数据。
结果:共接受了645例早产胎盘,纳入了538例。大多数是LPTB(46.3%),而EPTB,VPTB和MPTB占5.8%,分别为28.4%和19.5%。低出生体重和低Apgar在EPTB中普遍存在(p<0.001),而其他PTB类别的产科并发症较高。VPTB和MPTB患者胎盘梗死发生率较高(p=0.006)。在显微镜下,产妇(48.4%),胎儿(29%)炎症反应和绒毛水肿(48.4%)在EPTB中更高(分别为p=0.04和p<0.001),而VPTB和MPTB的母体基质血管病变较高(67.3%和64.8%,p<0.001)。绒毛成熟延迟(17.7%,p=0.02),慢性绒毛膜羊膜炎(11.3%,p=0.02),膜缺氧(38.6%,p=0.007),和大量纤维蛋白沉积(10.8%,p<0.001)在LPTB中表现较高。
结论:急性炎症病理常见于EPTB,强烈提示引发分娩的炎症。VPTB和MPTB中常见的产科并发症和母体基质血管病变可能强调了该组中母体血管受损。绒毛成熟缺陷,慢性绒毛膜羊膜炎,LPTB中大量纤维蛋白沉积和膜缺氧,可能导致长期新生儿发病。
Placental abnormalities can precipitate preterm birth (PTB), a principal contributor to neonatal morbidity and mortality. This study targets understanding placental variations among different gestational age-based categories of PTB.
METHODS: A three-year retrospective study conducted a detailed clinicopathological analysis of PTB placentas categorized by gestational age: extremely preterm (EPTB,<28 weeks), very preterm (VPTB, 28 to 31 + 6 weeks), moderate preterm (MPTB, 32 to 33 + 6 weeks), and late preterm (LPTB, 34 to 36 + 6 weeks). Macroscopic parameters sourced from pathology records and microscopic examination assessed for maternal and fetal stromal-vascular lesions, inflammatory and hypoxic lesions and others. Stillbirths/intrauterine demise and multifetal gestation were excluded. Clinical data were gathered from medical records.
RESULTS: A total of 645 preterm placentas were received and 538 were included. The majority were LPTB(46.3 %), while EPTB, VPTB and MPTB accounted for 5.8 %, 28.4 % and 19.5 % respectively. Low birth weight and low Apgar were prevalent in EPTB(p < 0.001), while obstetric complications were higher in other PTB categories. Placental infarction was higher in VPTB and MPTB(p = 0.006). On microscopy, maternal (48.4 %), fetal (29 %) inflammatory response and villous edema (48.4 %) was higher in EPTB(p = 0.04 & p < 0.001 respectively), while maternal stromal-vascular lesions were higher in VPTB and MPTB(67.3 % & 64.8 %, p < 0.001). Delayed villous maturation (17.7 %,p = 0.02), chronic chorioamnionitis (11.3 %,p = 0.02), membrane hypoxia (38.6 %,p = 0.007), and massive fibrin deposition (10.8 %,p < 0.001) featured higher in LPTB.
CONCLUSIONS: Acute inflammatory pathology was common in EPTB, strongly suggesting inflammation in triggering parturition. Frequent obstetric complications and maternal stromal-vascular lesions in VPTB and MPTB may underscore maternal vascular compromise in this group. Villous maturation defects, chronic chorioamnionitis, massive fibrin deposition and membrane hypoxia in LPTB, likely contribute to long-term neonatal morbidity.