Horn Lars-Christian, Faber Renaldo, Stepan Holger, Simon Eike, Robel Ralf, Wittekind Christian
Institute of Pathology, University Hospital of Leipzig, Leipzig, Germany.
Pediatr Dev Pathol. 2006 Jan-Feb;9(1):20-4. doi: 10.2350/08-05-0095.1. Epub 2006 Apr 4.
Little attention has been paid to the pathologic features of the umbilical cord, which might fatally damage the fetus. We determined the association of hypercoiling (more than 1 coil per 5 cm) and thinning with consecutive constriction of the umbilical vessels (thin cord syndrome; TCS) and intrauterine fetal death (IUFD). Three hundred and three cases of consecutive fetal autopsies over a 5-year period, including spontaneous and induced abortions of the 2nd trimester of pregnancy, were examined using a standardized protocol. The mean maternal age was 28.5 years and the mean gestational age was 19.1 weeks (range: 12.6 to 24.5 weeks). Thirty-six percent of all cases were induced abortions because of congenital malformations, and 8.9% resulted from legal abortions, as regulated by German law. One hundred sixty-seven cases (55.1%) were spontaneous abortion specimens. The leading cause for IUFD in the spontaneous abortion group was an amnion infection (34.7%), followed by abruptio placentae (15.6%). In 25.1% of cases, placental dysmaturity with consecutive placental insufficiency was responsible for IUFD. Pathologies of the umbilical cord as the cause of IUFD were seen in 10.2% of the cases. Most of these cases (15/17) involved TCS. In 14.4% of all spontaneous abortion specimens the cause of IUFD could not be determined by autopsy. There was an apparent difference in the frequency of TCS in the spontaneous abortion group (15/167 = 9%) compared to the nonspontaneous group (2/136 = 1.5%). A remarkably high percentage (17/303 = 5.6%) of all cases showed TCS. In cases of spontaneous abortions, TCS was causative for intrauterine death in 9% of cases (15/167). Careful pathologic examination of the umbilical cord is recommended to detect TCS and to reduce the cases with unexplained intrauterine death.
脐带的病理特征很少受到关注，而这可能会对胎儿造成致命伤害。我们确定了脐带过度卷曲（每5厘米超过1个卷曲）和变细与脐血管连续受压（细脐带综合征；TCS）及宫内胎儿死亡（IUFD）之间的关联。采用标准化方案对5年期间连续进行的303例胎儿尸检病例进行了检查，包括妊娠中期的自然流产和人工流产。产妇平均年龄为28.5岁，平均孕周为19.1周（范围：12.6至24.5周）。所有病例中36%是因先天性畸形而进行的人工流产，8.9%是根据德国法律规定的合法流产。167例（55.1%）是自然流产标本。自然流产组中IUFD的主要原因是羊膜感染（34.7%），其次是胎盘早剥（15.6%）。在25.1%的病例中，胎盘发育不成熟伴连续胎盘功能不全是IUFD的原因。作为IUFD原因的脐带病理情况在10.2%的病例中可见。这些病例中的大多数（15/17）涉及TCS。在所有自然流产标本中，14.4%的IUFD原因无法通过尸检确定。与非自然流产组（2/136 = 1.5%）相比，自然流产组中TCS的发生率存在明显差异。所有病例中有相当高的比例（17/303 = 5.6%）显示有TCS。在自然流产病例中，TCS导致9%的病例发生宫内死亡（15/167）。建议对脐带进行仔细的病理检查以检测TCS并减少原因不明的宫内死亡病例。
