Vergani P, Patanè L, Doria P, Borroni C, Cappellini A, Pezzullo J C, Ghidini A
Department of Obstetrics and Gynecology, Istituto di Scienze Biomediche San Gerardo, Monza, Italy.
Placenta. 2000 May;21(4):402-7. doi: 10.1053/plac.1999.0499.
In this study we aimed to establish which clinical and histopathological factors are associated with early-onset neonatal intraventricular haemorrhage (IVH) in non-iatrogenic preterm delivery before 32 weeks of gestation. We retrospectively reviewed all singleton pregnancies delivered before 32 weeks of gestation after spontaneous onset of preterm labour or preterm membrane rupture during the period January 1993 to June 1997. Clinical and histopathological data in cases with IVH diagnosed at neonatal cranial ultrasound within 72 h of birth (n = 17) were compared with those of neonates not experiencing this complication (non-IVH) (n = 54). Histological lesions analysed were those of acute inflammation and those on a uteroplacental vascular basis. Statistical methods included the Wilcoxon rank sum test, Fisher's exact test, and logistic regression analysis. A P<0.05 was considered significant.IVH and non-IVH groups were not significantly different in birthweight, gestational age at delivery, cord pH at birth, rates of 5-min Apgar score below 7, caesarean delivery, diagnosis of clinical chorioamnionitis or antenatal administration of steroids. Respiratory distress syndrome was more frequently diagnosed in the IVH than non-IVH group (64 per cent versus 33 per cent, P=0.02). Placental acute inflammatory or uteroplacental vascular lesions were present in 100 per cent of IVH neonates versus 22 per cent of non-IVH cases (P<0.001). Logistic regression analysis demonstrated that only respiratory distress syndrome (P = 0.04) and histological evidence of acute placental inflammation (P = 0.02) were significantly and independently associated with IVH. Histopathological evidence of acute inflammatory placental lesions is the best predictor of occurrence of neonatal IVH.
在本研究中，我们旨在确定哪些临床和组织病理学因素与妊娠32周前非医源性早产的早发型新生儿脑室内出血（IVH）相关。我们回顾性分析了1993年1月至1997年6月期间因早产或胎膜早破自发发作而在妊娠32周前分娩的所有单胎妊娠。将出生后72小时内通过新生儿颅脑超声诊断为IVH的病例（n = 17）的临床和组织病理学数据与未发生该并发症的新生儿（非IVH）（n = 54）的数据进行比较。分析的组织学病变为急性炎症病变和基于子宫胎盘血管的病变。统计方法包括Wilcoxon秩和检验、Fisher精确检验和逻辑回归分析。P<0.05被认为具有统计学意义。IVH组和非IVH组在出生体重、分娩时的孕周、出生时脐带血pH值、5分钟阿氏评分低于7分的比例、剖宫产、临床绒毛膜羊膜炎诊断或产前使用类固醇方面无显著差异。IVH组比非IVH组更频繁地诊断出呼吸窘迫综合征（64%对33%，P = 0.02）。100%的IVH新生儿存在胎盘急性炎症或子宫胎盘血管病变，而非IVH病例为22%（P<0.001）。逻辑回归分析表明，只有呼吸窘迫综合征（P = 0.04）和胎盘急性炎症的组织学证据（P = 0.02）与IVH显著且独立相关。胎盘急性炎症病变的组织病理学证据是新生儿IVH发生的最佳预测指标。
