Edmondson Nadeen, Bocking Alan, Machin Geoffrey, Rizek Rose, Watson Carole, Keating Sarah
Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
Pediatr Dev Pathol. 2009 Jan-Feb;12(1):16-21. doi: 10.2350/07-04-0270.1. Epub 2008 Jan 2.
Preterm labor is a major cause of perinatal mortality and morbidity, and in approximately 30% of cases a clinical cause is not identified. Acute chorioamnionitis is found histologically in a significant percentage of placentas from preterm deliveries, and the mother is often asymptomatic. Although such subclinical acute chorioamnionitis is known to play a role in preterm labor, this study explores the hypothesis that chronic deciduitis with plasma cells is seen more frequently in cases of preterm labor than in control placentas. Thirty-nine singleton placentas from patients with idiopathic preterm labor were examined microscopically and compared in a blinded fashion with 39 gestational age-matched control placentas. Cases of clinical acute chorioamnionitis and known chronic maternal diseases were excluded. Thirty-nine control singleton placentas were obtained from patients undergoing induction of labor for fetal structural abnormalities, excluding aneuploidy. The presence or absence of acute chorioamnionitis, acute fetal inflammatory response, chronic deciduitis, chronic villitis, infarction, and decidual vasculopathy was noted. Immunohistochemical staining was undertaken to further define leukocyte subtypes. Forty-one percent of cases and 15% of controls showed chronic deciduitis (P = 0.022). Forty-six percent of cases and 18% of controls showed histologic acute chorioamnionitis (P = 0.015). There were 8 cases demonstrating acute fetal inflammatory response but only 1 control (P = 0.029). Little difference was seen in the distribution of lymphocyte subsets between cases and control placentas. Our findings suggest that chronic deciduitis plays a role in the etiology of some cases of preterm labor.
早产是围产期死亡率和发病率的主要原因，约30%的病例无法确定临床病因。在早产分娩的相当一部分胎盘组织学检查中发现急性绒毛膜羊膜炎，而母亲通常无症状。尽管已知这种亚临床急性绒毛膜羊膜炎在早产中起作用，但本研究探讨了这样一种假说，即与对照组胎盘相比，早产病例中浆细胞性慢性蜕膜炎更为常见。对39例特发性早产患者的单胎胎盘进行显微镜检查，并与39例孕周匹配的对照胎盘进行盲法比较。排除临床急性绒毛膜羊膜炎病例和已知的慢性母体疾病。39例对照单胎胎盘取自因胎儿结构异常（不包括非整倍体）而引产的患者。记录有无急性绒毛膜羊膜炎、急性胎儿炎症反应、慢性蜕膜炎、慢性绒毛炎、梗死和蜕膜血管病变。进行免疫组织化学染色以进一步确定白细胞亚型。41%的病例和15%的对照显示有慢性蜕膜炎（P = 0.022）。46%的病例和18%的对照显示有组织学急性绒毛膜羊膜炎（P = 0.015）。有8例显示急性胎儿炎症反应，而对照仅1例（P = 0.029）。病例组和对照组胎盘淋巴细胞亚群分布差异不大。我们的研究结果表明，慢性蜕膜炎在某些早产病例的病因中起作用。
