Ghidini Alessandro, Salafia Carolyn M
Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC 20007, USA.
Acta Obstet Gynecol Scand. 2005 Jun;84(6):547-50. doi: 10.1111/j.0001-6349.2005.00694.x.
The aim of this study was to evaluate whether particular placental histopathology lesions are associated with recurrent preterm birth.
We analyzed a database of 413 consecutive singleton pregnancies delivered at <32 weeks with past reproductive history available. After the exclusion of nulliparous women, the pregnancies were divided according to the obstetrical history into group 1 (n = 328), women without prior preterm delivery (PTD); group 2 (n = 49), women with one prior preterm childbirth; and group 3 (n = 36), women with > or =2 prior preterm deliveries. Demographic and clinical variables were compared among the three groups by using Kruskal-Wallis test and chi-square test for trend. Finally, the individual placental lesions (i.e. 42 lesions of acute or chronic inflammation, uteroplacental vascular pathology, and intraplacental villous lesions) were correlated with the number of prior preterm deliveries by using regression analysis. A two-tailed P < 0.05 was considered significant.
No differences were found among the three groups in demographic or clinical variables. Regression analysis of scored placental lesions corrected for gestational age at delivery showed that the number of prior preterm deliveries was correlated only with chronic marginating choriodeciduitis (correlation coefficient = 0.13; P = 0.01) and acute choriodeciduitis (correlation coefficient = 0.14; P = 0.008).
Among women delivered at <32 weeks, those with prior preterm birth have histologic findings compatible with acute or chronic inflammatory involvement of the uterine cavity, suggesting that a prepregnancy endometrial infection rather than an ascending intrapregnancy pathway may be responsible for some recurrences of PTD.
本研究的目的是评估特定的胎盘组织病理学病变是否与复发性早产相关。
我们分析了一个包含413例连续单胎妊娠的数据库，这些妊娠在孕32周前分娩，且有既往生育史。排除初产妇后，根据产科病史将这些妊娠分为1组（n = 328），即无既往早产史的妇女；2组（n = 49），有一次既往早产史的妇女；3组（n = 36），有两次或两次以上既往早产史的妇女。使用Kruskal-Wallis检验和趋势卡方检验对三组之间的人口统计学和临床变量进行比较。最后，通过回归分析将个体胎盘病变（即42种急性或慢性炎症、子宫胎盘血管病变和胎盘内绒毛病变）与既往早产次数相关联。双侧P < 0.05被认为具有统计学意义。
三组在人口统计学或临床变量方面未发现差异。对分娩时孕周校正后的胎盘病变评分进行回归分析显示，既往早产次数仅与慢性边缘性绒毛膜羊膜炎（相关系数 = 0.13；P = 0.01）和急性绒毛膜羊膜炎（相关系数 = 0.14；P = 0.008）相关。
在孕32周前分娩的妇女中，有既往早产史的妇女具有与子宫腔急性或慢性炎症累及相符的组织学表现，这表明孕前子宫内膜感染而非孕期上行感染途径可能是某些复发性早产的原因。
