Kramer Michael S, Chen Moy Fong, Roy Indrojit, Dassa Clément, Lamoureux Julie, Kahn Susan R, McNamara Helen, Platt Robert W
Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Am J Obstet Gynecol. 2006 Dec;195(6):1674-9. doi: 10.1016/j.ajog.2006.03.095. Epub 2006 Jun 21.
Many previous studies of agreement in identifying placental histopathologic lesions have been based on small sample sizes, and none has examined whether individual histologic features cluster robustly together within and between observers.
We studied 767 placental specimens from case-control studies of preterm birth and preeclampsia nested within a prospective cohort of pregnant women recruited from 4 large Montreal maternity hospitals. The specimens were fixed, embedded, stained, and examined using a standardized protocol; a 10% random sample (n = 81) was then blindly reexamined at least 6 months later by the same pathologist and a second pathologist.
Intra- and interobserver agreement were high (kappa > or = 0.50) for membrane inflammation, funisitis, and umbilical cord vasculitis, and these 3 features were robustly clustered statistically, consistent with an underlying mechanism of ascending infection. Agreement and clustering were also high or moderate for features of placental underperfusion: infarction, decidual vasculopathy, and syncytial knotting.
Our results should help researchers to interpret future findings relating placental histopathology to preterm birth, preeclampsia, and other adverse pregnancy outcomes, and to their etiologic determinants and causal pathways.
以往许多关于胎盘组织病理学病变识别一致性的研究样本量较小，且尚无研究探讨个体组织学特征在观察者内部和之间是否能有力地聚集在一起。
我们研究了来自4家蒙特利尔大型妇产医院招募的孕妇前瞻性队列中的早产和子痫前期病例对照研究的767份胎盘标本。标本采用标准化方案进行固定、包埋、染色和检查；然后，一名病理学家和另一名病理学家在至少6个月后对10%的随机样本（n = 81）进行盲法复查。
观察者内部和之间对于绒毛膜羊膜炎、脐带炎和脐带血管炎的一致性较高（kappa≥0.50），并且这3种特征在统计学上有力地聚集在一起，与上行性感染的潜在机制一致。对于胎盘灌注不足的特征，即梗死、蜕膜血管病变和合体结节，一致性和聚集性也较高或中等。
我们的结果应有助于研究人员解释未来有关胎盘组织病理学与早产、子痫前期及其他不良妊娠结局及其病因决定因素和因果途径的研究结果。
