Mehta Rajeev, Nanjundaswamy Shakuntala, Shen-Schwarz Susan, Petrova Anna
Department of Pediatrics, Robert Wood Johnson Medical School-University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey 08903, USA.
Indian J Pediatr. 2006 Jan;73(1):25-8. doi: 10.1007/BF02758255.
To investigate the association between gestational age, placental pathology and outcome among preterm births.
Medical records and placental pathology results of 165 preterm infants (gestational age pound 34 weeks) were used to analyze the development of intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis, in association with placental findings in the gestational age categories of 22-27 (n=71) and 28-33 (n=93) weeks.
Significant differences were found in placental findings based on gestational age and neonatal morbidity. Lower gestational age was associated with increased infection-related lesions such as chorionic vasculitis (47.9%, P< 0.001) and acute chorioamnionitis (67.6%, P< 0.001). Placental lesions reflecting disturbances of fetal-placental blood flow (infarction, chorionic plate thrombi and basal perivillous fibrin) were predominantly seen in the 28-33 week gestational age category (P< 0.05-0.01). Despite the high prevalence of chorioamnionitis (38.8%), no significant association was found between this lesion and the tested preterm morbidity after controlling for gestational age. Only, villous edema and chorionic vasculitis were identified as independent predictors for the development of IVH (49.2%, ORA 2.57, 95% CI 1.01, 6.58 and 39.3%, ORA1.95, 95% CI 1.01, 4.21, respectively).
Villous edema and chorionic vasculitis are significant risk factors for the development of the IVH among neonates born at gestational age pound 34 weeks.
探讨孕周、胎盘病理与早产结局之间的关联。
采用165例孕周小于34周早产儿的病历及胎盘病理结果，分析脑室内出血（IVH）、支气管肺发育不良（BPD）、早产儿视网膜病变（ROP）、动脉导管未闭（PDA）和败血症的发生情况，并与22 - 27周（n = 71）和28 - 33周（n = 93）孕周组的胎盘检查结果进行关联分析。
基于孕周和新生儿发病率的胎盘检查结果存在显著差异。孕周越小，与感染相关的病变如绒毛膜血管炎（47.9%，P < 0.001）和急性绒毛膜羊膜炎（67.6%，P < 0.001）的发生率越高。反映胎儿 - 胎盘血流紊乱的胎盘病变（梗死、绒毛膜板血栓和基底绒毛周围纤维蛋白）主要见于28 - 33周孕周组（P < 0.05 - 0.01）。尽管绒毛膜羊膜炎的发生率较高（38.8%）,但在控制孕周后，该病变与所检测的早产发病率之间未发现显著关联。仅绒毛水肿和绒毛膜血管炎被确定为IVH发生的独立预测因素（分别为49.2%，OR 2.57，95% CI 1.01，6.58和39.3%，OR 1.95，95% CI 1.01，4.21）。
绒毛水肿和绒毛膜血管炎是孕周小于34周出生新生儿发生IVH的重要危险因素。
