Al-Adnani M, Sebire N J
Department of Paediatric Pathology, Great Ormond Street Hospital, Camelia Botnar Laboratories, Great Ormond Street, London WC1N 3JH, UK.
Best Pract Res Clin Obstet Gynaecol. 2007 Jun;21(3):505-21. doi: 10.1016/j.bpobgyn.2007.02.001. Epub 2007 Apr 19.
Infectious agents are associated with a wide range of obstetric complications and pathological processes affecting the placenta, membranes and fetus. In some cases there will be associated maternal symptoms and signs indicating an infectious aetiology, but in the majority such infection is subclinical, and specific diagnosis or confirmation is achieved following pathological examination of the delivered placenta and/or fetus. There are two major groups of microorganism-related mechanisms associated with significant perinatal morbidity and mortality. First, ascending genital-tract infection, almost always bacterial, which ranges from localized choriodecidual inflammation to frank chorioamnionitis with fetal sepsis; this is a major cause of mid-trimester miscarriage and severe preterm delivery, and more recent data suggest that it may also have potentially important effects via cytokine release mediating neonatal cerebral injury. Second, haematogenous spread of maternal systemic infection--bacterial, viral or parasitic--which may result in isolated placental effects or transmission to the fetus with associated developmental abnormalities and neonatal complications. In many cases distinctive histopathological findings are described, and in addition a wide range of techniques is now available for culture and microscopy to confirm these diagnoses; such techniques include highly specific immunohistochemical markers and sensitive molecular diagnostic techniques such as the polymerase chain reaction. It is likely that with increasingly widespread availability of these investigative approaches to obstetric pathology, a greater understanding of the role of infectious agents in obstetric complications will become apparent.
感染因子与一系列影响胎盘、胎膜和胎儿的产科并发症及病理过程相关。在某些情况下，会伴有提示感染病因的母体症状和体征，但在大多数情况下，此类感染是亚临床的，在对娩出的胎盘和/或胎儿进行病理检查后才能实现特异性诊断或确诊。有两大类与围产期显著发病和死亡相关的微生物相关机制。首先，上行性生殖道感染，几乎总是细菌性的，范围从局限性绒毛膜蜕膜炎到伴有胎儿败血症的急性绒毛膜羊膜炎；这是孕中期流产和严重早产的主要原因，最近的数据表明，它还可能通过介导新生儿脑损伤的细胞因子释放产生潜在的重要影响。其次，母体全身性感染（细菌、病毒或寄生虫）的血行播散，这可能导致孤立的胎盘效应或传播给胎儿，并伴有发育异常和新生儿并发症。在许多情况下，会描述独特的组织病理学发现，此外，现在有多种技术可用于培养和显微镜检查以确诊这些诊断；此类技术包括高度特异性的免疫组化标记物和敏感的分子诊断技术，如聚合酶链反应。随着这些产科病理学研究方法越来越广泛地应用，对感染因子在产科并发症中的作用可能会有更深入的了解。
