Ananth Cande V, Oyelese Yinka, Prasad Vinay, Getahun Darios, Smulian John C
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital, NJ 08901-1977, USA.
Eur J Obstet Gynecol Reprod Biol. 2006 Sep-Oct;128(1-2):15-21. doi: 10.1016/j.ejogrb.2006.01.016. Epub 2006 Mar 2.
Clinicians widely regard placental abruption as an acute event, though accumulating data point towards abruption being the end-result of chronic processes early in pregnancy, and perhaps even extending to conception. The Collaborative Perinatal Project was a prospective cohort study performed from 1959 to 1966 in the United States. Since enrolled pregnancies were managed without the biases created by modern perinatal surveillance and interventions, the natural history of disease in these data is ideal to study obstetrical complications such as placental abruption.
We assessed the associations versus contributions of the clinical feature of early gestational vaginal bleeding and histologic lesions (chronic and acute) with placental abruption.
Women enrolled in the Collaborative Perinatal Project (1959-1966) were used, restricting the analysis to those that delivered singleton births (n=46,364). Risks of placental abruption were compared between women with and without vaginal bleeding at <20 weeks gestation. We also examined the relationships between placental abruption and chronic and acute histologic lesions, including infarcts, decidual necrosis, presence of macrophages in the decidua, amnion or chorion, and neutrophil infiltration in the amnion, chorion, placental surface, and umbilical vein.
Any episode of vaginal bleeding at <20 weeks in pregnancy conferred an increased risk of placental abruption (adjusted relative risk (RR) 1.6, 95% confidence interval (CI) 1.3, 1.8). The greatest risk occurred with bleeding in both the first two trimesters (RR 3.1, 95% CI 2.3, 4.1). The presence of histologic lesions in the placenta, cord and membranes similarly carried an increased risk of placental abruption, even in the absence of vaginal bleeding. The risk of abruption was, however, highest in the presence of both histologic lesions and vaginal bleeding early in pregnancy.
Vaginal bleeding early in pregnancy and histologic lesions of the placenta, umbilical cord, and membranes are associated with increased risk of placental abruption in later pregnancy. However, the increased risk associated with placental lesions, especially chronic inflammatory lesions, even in the absence of early vaginal bleeding, suggests that prolonged inflammation may be implicated in placental abruption.
临床医生普遍认为胎盘早剥是一种急性事件，尽管越来越多的数据表明胎盘早剥是妊娠早期慢性过程的最终结果，甚至可能延伸至受孕阶段。协作围产期项目是1959年至1966年在美国进行的一项前瞻性队列研究。由于纳入的妊娠在管理过程中没有受到现代围产期监测和干预所产生的偏差影响，这些数据中疾病的自然史对于研究胎盘早剥等产科并发症而言是理想的。
我们评估了妊娠早期阴道出血的临床特征以及组织学病变（慢性和急性）与胎盘早剥之间的关联及影响。
采用协作围产期项目（1959 - 1966年）中登记的女性数据，并将分析限制在单胎分娩的女性（n = 46,364）。比较妊娠20周前有阴道出血和无阴道出血的女性发生胎盘早剥的风险。我们还研究了胎盘早剥与慢性和急性组织学病变之间的关系，包括梗死、蜕膜坏死、蜕膜、羊膜或绒毛膜中巨噬细胞的存在以及羊膜、绒毛膜、胎盘表面和脐静脉中的中性粒细胞浸润。
妊娠20周前的任何一次阴道出血都会增加胎盘早剥的风险（调整后相对风险（RR）为1.6，95%置信区间（CI）为1.3，1.8）。在前两个孕期都有出血时风险最高（RR为3.1，95%CI为2.3，4.1）。胎盘、脐带和胎膜中存在组织学病变同样会增加胎盘早剥的风险，即使没有阴道出血。然而，在妊娠早期同时存在组织学病变和阴道出血时，胎盘早剥的风险最高。
妊娠早期阴道出血以及胎盘、脐带和胎膜的组织学病变与后期妊娠胎盘早剥风险增加有关。然而，即使没有早期阴道出血，与胎盘病变尤其是慢性炎症病变相关的风险增加表明，长期炎症可能与胎盘早剥有关。
