Hansen A R, Collins M H, Genest D, Heller D, Schwarz S, Banagon P, Allred E N, Leviton A
Division of Newborn Medicine, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
Pediatr Dev Pathol. 2000 Sep-Oct;3(5):419-30. doi: 10.1007/s100240010043.
Our objective was to relate pathology of the very low birthweight (VLBW) infant's placenta to pregnancy and fetal characteristics. We correlated the pathologic features of 1146 placentas from infants with birth weights of 500-1500 g who were born between 1/1/91 and 12/31/93 to the number of gestations per pregnancy, initiator of preterm delivery, gestational age, birth weight Z score, and duration of rupture of membrane (ROM). Placental correlates of acute inflammation and villous edema were associated with preterm labor (PTL), prelabor premature rupture of membranes (PROM), lower gestational age, and higher birth weight Z score. In PTL pregnancies delivered within 1 h of membrane rupture, 61% of placentas already had membrane inflammation. Placental correlates of pregnancy-induced hypertension (PIH) were seen more commonly with PIH pregnancies, older gestational age, and lower birth weight Z score. We found a more prominent histopathologic signature for singleton than for multiple gestation placentas. The placental pathologic findings associated with the clinical diagnoses of infection, PIH, and low-birth weight Z scores in our VLBW/preterm population are similar to those in the literature regarding term pregnancies. The presence of multiple histologic findings consistent with inflammation in placentas of PTL pregnancies with duration of ROM lasting <1 h suggests that some cases of PTL are precipitated by a more long-standing infection than that previously suspected. Morphologic placental features appear to be correlates of the phenomena leading to premature delivery. Examination of the VLBW infant's placenta provides insight into the etiology and management of VLBW/preterm deliveries.
我们的目标是将极低出生体重（VLBW）婴儿胎盘的病理学与妊娠及胎儿特征联系起来。我们将1991年1月1日至1993年12月31日期间出生体重为500 - 1500克的1146例婴儿的胎盘病理特征与每次妊娠的妊娠次数、早产引发因素、孕周、出生体重Z评分以及胎膜破裂时间（ROM）进行了关联分析。急性炎症和绒毛水肿的胎盘相关因素与早产（PTL）、临产前胎膜早破（PROM）、较低的孕周以及较高的出生体重Z评分相关。在胎膜破裂后1小时内分娩的PTL妊娠中，61%的胎盘已经存在胎膜炎症。妊娠高血压综合征（PIH）的胎盘相关因素在PIH妊娠、较大的孕周以及较低的出生体重Z评分中更为常见。我们发现单胎胎盘的组织病理学特征比多胎胎盘更为显著。我们VLBW/早产人群中与感染、PIH临床诊断以及低出生体重Z评分相关的胎盘病理发现与足月妊娠文献中的发现相似。ROM持续时间<1小时的PTL妊娠胎盘存在多种与炎症一致的组织学发现，这表明某些PTL病例是由比先前怀疑的更长期的感染引发的。胎盘的形态学特征似乎与导致早产的现象相关。对VLBW婴儿胎盘的检查有助于深入了解VLBW/早产分娩的病因及管理。
