Madazli R, Somunkiran A, Calay Z, Ilvan S, Aksu M F
Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.
Placenta. 2003 May;24(5):510-6. doi: 10.1053/plac.2002.0945.
The aim of the present study was to evaluate the histomorphology of the placenta and the placental bed and to correlate this with the Doppler study of the uterine and umbilical arteries of intrauterine growth restricted pregnancies. The study group consisted of 47 women with intrauterine growth restricted foetuses. Twenty-five uneventful pregnancies with appropriate for gestational age foetuses were selected as controls. Doppler studies of umbilical and uterine arteries were performed within the last week before delivery. Placental bed biopsies were obtained at Caesarean section with direct visualization of the placental site. The incidence of pathologic bed biopsies in control, IUGR with normal uterine artery Doppler velocimetry and IUGR with abnormal uterine artery Doppler velocimetry was 0 per cent, 16.6 per cent and 79.3 per cent respectively (P< 0.001). Placentae from IUGR cases with abnormal umbilical artery Doppler velocimetries had a significantly increased number of villous infarcts, cytotrophoblast proliferation and thickening of the villous trophoblastic basal membrane (P=0.001, P=0.038 and P=0.02 respectively). Abnormal placental bed biopsy pathology was significantly associated with abnormal uterine artery velocimetry (OR 33.7, 6.5-173.6; P< 0.001). Abnormal placental pathology was significantly associated with abnormal umbilical artery Doppler velocimetry (OR 21.04, 3.8-115.9;P< 0.001). Women with both abnormal uterine and umbilical artery Doppler velocimetries were delivered earlier and their babies had lower mean birth and placental weight (P< 0.001). In conclusion, placental bed biopsy and placental pathologies are best reflected by abnormal uterine and umbilical artery velocity waveforms, respectively. The most severe clinical outcomes and perinatal mortality are present when both uterine and umbilical districts are altered.
本研究的目的是评估胎盘和胎盘床的组织形态学，并将其与宫内生长受限妊娠的子宫和脐动脉多普勒研究结果相关联。研究组由47例宫内生长受限胎儿的孕妇组成。选取25例妊娠情况正常、胎儿大小与孕周相符的孕妇作为对照组。在分娩前最后一周内进行脐动脉和子宫动脉的多普勒研究。在剖宫产时直接观察胎盘部位，获取胎盘床活检样本。对照组、子宫动脉多普勒测速正常的宫内生长受限组和子宫动脉多普勒测速异常的宫内生长受限组中，病理活检的发生率分别为0%、16.6%和79.3%（P<0.001）。脐动脉多普勒测速异常的宫内生长受限病例的胎盘绒毛梗死数量显著增加、细胞滋养层细胞增殖以及绒毛滋养层基底膜增厚（分别为P=0.001、P=0.038和P=0.02）。胎盘床活检病理异常与子宫动脉测速异常显著相关（比值比33.7，6.5 - 173.6；P<0.001）。胎盘病理异常与脐动脉多普勒测速异常显著相关（比值比21.04，3.8 - 115.9；P<0.001）。子宫和脐动脉多普勒测速均异常的孕妇分娩时间更早，其婴儿的平均出生体重和胎盘重量更低（P<0.001）。总之，胎盘床活检和胎盘病理分别最好地反映在子宫和脐动脉速度波形异常上。当子宫和脐区均发生改变时，会出现最严重的临床结局和围产儿死亡率。
