Inan Sevinc, Sanci Muzaffer, Can Deniz, Vatansever Seda, Oztekin Ozgur, Tinar Sivekar
Department of Histology & Embryology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
Acta Med Okayama. 2002 Aug;56(4):177-86. doi: 10.18926/AMO/31683.
To compare morphological changes in the umbilical cords from chronic hypertensive and preeclamptic patients having normal or pathological umbilical artery Doppler ultrasonographic results. Umbilical cords from 34 normotensive, 31 chronic hypertensive and 70 preeclamptic women with normal and abnormal Doppler flow velocity waveforms (FVW) at 35-40 gestational weeks were studied. Morphological changes in the umbilical cords were examined on formalin-fixed, paraffin-embedded sections. The total umbilical cord area, total vessel area, and wall thickness of umbilical vessels were measured in systematic random samples using unbiased stereology methods. An ANOVA test was used for statistical analysis. In the chronic hypertensive and preeclamptic groups with normal Doppler FVW, the thickness of the umbilical cord vessels remained nearly constant, whereas both the total area and the lumen area were reduced. These changes correlate with the histopathological findings, suggesting a mainly vasoconstrictive effect. By contrast, analysis of the preeclamptic group with pathologic Doppler FVW showed a comparable reduction of all parameters of the umbilical cord. Histopathological findings were related to smaller, contracted smooth muscle cells of the vessel wall, which is suggestive of a predominant hypoplastic mechanism. As a result of reduced uteroplacental perfusion, fetal hypoxia and intrauterine growth retardation become unavoidable in preeclampsia. The histopathological changes in the umbilical cord between the chronic hypertensive and preeclamptic patients depend on the Doppler results. In conclusion, the umbilical artery Doppler FVW indices provide good values for predicting intrauterine growth retardation in preeclamptic patients.
比较慢性高血压患者和先兆子痫患者脐带的形态学变化，这些患者的脐动脉多普勒超声检查结果正常或异常。研究对象为34名血压正常、31名慢性高血压以及70名先兆子痫孕妇的脐带，这些孕妇在孕35 - 40周时多普勒血流速度波形（FVW）正常和异常。在福尔马林固定、石蜡包埋的切片上检查脐带的形态学变化。使用无偏倚的体视学方法在系统随机样本中测量脐带总面积、血管总面积以及脐血管壁厚度。采用方差分析进行统计分析。在多普勒FVW正常的慢性高血压组和先兆子痫组中，脐血管壁厚度基本保持不变，而总面积和管腔面积均减小。这些变化与组织病理学结果相关，提示主要是血管收缩效应。相比之下，对多普勒FVW异常的先兆子痫组分析显示，脐带所有参数均有类似程度的减小。组织病理学结果与血管壁较小且收缩的平滑肌细胞有关，提示主要是发育不全机制。由于子宫胎盘灌注减少，先兆子痫患者不可避免地会出现胎儿缺氧和宫内生长受限。慢性高血压患者和先兆子痫患者脐带的组织病理学变化取决于多普勒检查结果。总之，脐动脉多普勒FVW指标为预测先兆子痫患者的宫内生长受限提供了良好的参考价值。
