Placental Analytics, LLC, 93 Colonial Avenue, Larchmont, NY 10538, USA.
Placenta. 2010 Nov;31(11):958-62. doi: 10.1016/j.placenta.2010.09.005. Epub 2010 Oct 8.
In clinical practice, variability of placental surface shape is common. We measure the average placental shape in a birth cohort and the effect deviations from the average have on placental functional efficiency. We test whether altered placental shape improves the specificity of histopathology diagnoses of maternal uteroplacental and fetoplacental vascular pathology for clinical outcomes.
1225 Placentas from a prospective cohort had chorionic plate digital photographs with perimeters marked at 1-2 cm intervals. After exclusions of pre-term (n = 202) and velamentous cord insertion (n = 44), 979 (95.7%) placentas were analyzed. Median shape and mean perimeter were estimated. The relationship of fetal and placental weight was used as an index of placental efficiency termed "β". The principal placental histopathology diagnoses of maternal uteroplacental and fetoplacental vascular pathologies were coded by review of individual lesion scores. Acute fetal inflammation was scored as a "negative control" pathology not expected to affect shape. ANOVA with Bonferroni tests for subgroup comparisons were used.
The mean placental chorionic shape at term was round with a radius estimated at 9.1 cm. Increased variability of the placental shape was associated with lower placental functional efficiency. After stratifying on placental shape, the presence of either maternal uteroplacental or fetoplacental vascular pathology was significantly associated with lower placental efficiency only when shape was abnormal.
Quantifying abnormality of placental shape is a meaningful clinical tool. Abnormal shapes are associated with reduced placental efficiency. We hypothesize that such shapes reflect deformations of placental vascular architecture, and that an abnormal placental shape serves as a marker of maternal uteroplacental and/or fetoplacental vascular pathology of sufficiently long standing to impact placental (and by extension, potentially fetal) development.
在临床实践中，胎盘表面形状的变化很常见。我们测量了一个出生队列中的平均胎盘形状，并研究了偏离平均值对胎盘功能效率的影响。我们测试了改变胎盘形状是否可以提高组织病理学诊断对母体胎盘和胎儿胎盘血管病理学的特异性，从而改善临床结局。
对一个前瞻性队列的 1225 个胎盘进行了绒毛板数字摄影，并在 1-2 厘米的间隔处标记了胎盘的周长。排除早产（n=202）和帆状脐带插入（n=44）后，分析了 979 个（95.7%）胎盘。估计了中位数形状和平均周长。胎儿和胎盘重量的关系被用作胎盘效率的指标，称为“β”。通过回顾单个病变评分，对母体胎盘和胎儿胎盘血管病理学的主要胎盘组织病理学诊断进行了编码。急性胎儿炎症被评为一种“阴性对照”病理学，预计不会影响形状。使用方差分析和 Bonferroni 检验进行亚组比较。
足月时胎盘绒毛形状呈圆形，半径估计为 9.1 厘米。胎盘形状的变异性增加与胎盘功能效率降低有关。在对胎盘形状进行分层后，只有当形状异常时，母体胎盘或胎儿胎盘血管病理学的存在才与胎盘效率降低显著相关。
量化胎盘形状的异常是一种有意义的临床工具。异常形状与胎盘效率降低有关。我们假设这种形状反映了胎盘血管结构的变形，并且异常的胎盘形状是母体胎盘和/或胎儿胎盘血管病理学的标志物，其持续时间足以影响胎盘（并因此可能影响胎儿）的发育。
