Goldenberg Robert L, Faye-Petersen Ona, Andrews William W, Goepfert Alice R, Cliver Suzanne P, Hauth John C
Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA.
J Matern Fetal Neonatal Med. 2007 May;20(5):391-5. doi: 10.1080/14767050701236365.
Laminar necrosis, a band-like distribution of coagulative necrosis, has been reported at the choriodecidual interface of the free membranes of placentas of women with various adverse neonatal outcomes. Our goal in this study was to evaluate the frequency of an equivalent feature in the decidua basalis, diffuse decidual leukocytoclastic necrosis (DDLN), a diffuse coagulative necrosis admixed with karyorrhectic debris, in preterm births <32 weeks, and to determine its association with various obstetric conditions, markers of placental inflammation, and newborn outcome.
Four hundred and forty-six mother/infant dyads who delivered between 23 and 32 weeks gestational age (GA) had their medical records abstracted, a variety of placental and cord blood cultures performed, cord interleukin-6 (IL-6) levels determined, and the placentas evaluated histologically by a single pathologist (OFP).
Women with DDLN (27%) were significantly more likely than other women to have preeclampsia (57.6 vs. 24.8%, p < 0.0001), an indicated preterm birth in this pregnancy (61.9 vs. 26.4%, p < 0.0001), and a prior indicated preterm birth (12.7 vs. 4.1%, p = 0.001), but were not more likely to have an abruption, diabetes, to smoke or be Black. Among DDLN-positive vs. DDLN-negative women, birth weight was significantly lower (1,069 +/- 373 vs. 1,171 +/- 389 g, p = 0.014), despite the GAs being similar (28.6 +/- 2.2 vs. 28.6 +/- 2.3 weeks, p = NS). Women with DDLN were less likely to have a positive placental culture for any organism (50.0 vs. 61.3%p = 0.03), Ureaplasma urealyticum and Mycoplasma hominis in either the placenta or cord blood (29.7 vs. 42.1%, p = 0.02), or an elevated cord blood IL-6 (21.5 vs. 32.9%, p = 0.059). They also were less likely to have acute inflammation of the membranes (27.4 vs. 56.4%, p < 0.0001), chorionic plate (17.0 vs. 48.6%, p < 0.0001) or cord (15.7 vs. 36.6%, p < 0.0001). Decidual necrosis in the free membranes also occurred more frequently in the presence vs. absence of DDLN (25.2 vs. 9.2%, p < 0.0001). Infants whose placentas had DDLN were significantly less likely to have neonatal systemic inflammatory response syndrome (20.7 vs. 35.2%, p = 0.004), but were not significantly different for other neonatal outcomes including respiratory distress syndrome, intraventricular hemorrhage or death.
DDLN of the decidua basalis is relatively common in placentas of 23-32 week newborns, and, when present, is inversely associated with inflammatory maternal and newborn conditions and positively associated with preeclampsia, indicated preterm birth, and lower birth weight. The positive correlation of DDLN with obstetrical and neonatal conditions associated with underperfusion of the placental bed, suggests that DDLN may be a marker of vascular compromise.
层状坏死是一种凝固性坏死的带状分布，在患有各种不良新生儿结局的女性胎盘游离膜的绒毛膜蜕膜界面处已有报道。本研究的目的是评估基底蜕膜中一种等效特征，即弥漫性蜕膜白细胞破碎性坏死（DDLN）的频率，DDLN是一种伴有核碎裂碎片的弥漫性凝固性坏死，在孕周小于32周的早产中进行评估，并确定其与各种产科情况、胎盘炎症标志物及新生儿结局的关联。
对446例孕23至32周分娩的母婴对进行病历摘要分析，进行多种胎盘和脐血培养，测定脐血白细胞介素-6（IL-6）水平，并由一名病理学家（OFP）对胎盘进行组织学评估。
患有DDLN的女性（27%）比其他女性更易患先兆子痫（57.6%对24.8%，p<0.0001）、本次妊娠有指征的早产（61.9%对26.4%，p<0.0001）及既往有指征的早产（12.7%对4.1%，p = 0.001），但发生胎盘早剥、糖尿病、吸烟或为黑人的可能性并无增加。在DDLN阳性与DDLN阴性女性中，出生体重显著较低（1069±373对1171±389g，p = 0.014），尽管孕周相似（28.6±2.2对28.6±2.3周，p = 无显著差异）。患有DDLN的女性胎盘培养出任何微生物的可能性较小（50.0%对61.3%，p = 0.03），胎盘或脐血中解脲脲原体和人型支原体感染的可能性较小（29.7%对42.1%，p = 0.02），脐血IL-6升高的可能性较小（21.5%对32.9%，p = 0.059）。她们发生胎膜急性炎症（27.4%对56.4%，p<0.0001）、绒毛膜板炎症（17.0%对48.6%，p<0.0001）或脐带炎症（15.7%对36.6%，p<0.0001）的可能性也较小。游离膜中的蜕膜坏死在有DDLN与无DDLN时也更频繁发生（25.2%对9.2%，p<0.0001）。胎盘有DDLN的婴儿发生新生儿全身炎症反应综合征的可能性显著较小（20.7%对35.2%，p = 0.
