Division of Fetal-Maternal Medicine, Rosie Maternity-Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 2QQ, UK.
Virchows Arch. 2011 Jul;459(1):11-20. doi: 10.1007/s00428-011-1061-6. Epub 2011 Apr 12.
Whilst individual histological features are well described, there are no universally agreed criteria as to what constitutes a clinically significant histological lesion of the placenta in an uncomplicated pregnancy, nor has the presence of such histological findings been systematically related to quantitative morphological characteristics of the placenta (such as placental shape, cord insertion and cord coiling). This study aims to explore this relationship and further to describe the incidence of predefined categories of histological lesions of the placenta in an unselected obstetric population recruited prior to delivery. The study is based upon the placental examination of 1,156 women with singleton pregnancies recruited prospectively in a single unit. Placentas were analysed where deliveries occurred between 34-43 weeks. The incidence of normal histological findings and specific histological categories, such as ascending genital tract infection, chronic placental underperfusion, intervillous thrombus and villitis of unknown aetiology, were noted. The relationship between placental morphological indices: coiling index, cord centrality index (distance of cord insertion on the chorionic plate from the centre) and eccentricity (shape of the placenta) and histological lesions was investigated. There were no significant differences between cord centrality and eccentricity between placentas with and without histological lesions except an association between hypercoiling of the umbilical cord and intervillous thrombosis and villitis of unknown aetiology (p = 0.024 and p = 0.009, respectively). The macroscopic morphological features of the placenta cannot predict the presence or absence of the histological placental lesions, nor are these lesions in general associated with differences in cord centrality, placental eccentricity or cord coiling.
虽然个别组织学特征描述得很好，但对于在无并发症的妊娠中构成胎盘有临床意义的组织学病变的标准尚未达成共识，也没有系统地将这些组织学发现与胎盘的定量形态特征（如胎盘形状、脐带插入和脐带缠绕）相关联。本研究旨在探讨这种关系，并进一步描述在分娩前招募的未经选择的产科人群中胎盘组织学病变的预定分类的发生率。该研究基于对 1156 名单胎妊娠妇女的胎盘检查，这些妇女前瞻性地在一个单位中招募。在 34-43 周分娩时对胎盘进行了分析。注意到正常组织学发现和特定组织学分类的发生率，如生殖道上行感染、慢性胎盘灌注不足、绒毛间血栓和病因不明的绒毛膜炎。研究了胎盘形态学指数（缠绕指数、脐带中心指数（脐带插入胎盘的距离）和偏心度（胎盘形状）与组织学病变之间的关系。除了脐带缠绕与绒毛间血栓和病因不明的绒毛膜炎之间存在关联（分别为 p=0.024 和 p=0.009）外，在有或没有组织学病变的胎盘之间，脐带中心和偏心度之间没有显著差异。胎盘的宏观形态特征不能预测组织学胎盘病变的存在或不存在，而且这些病变通常与脐带中心、胎盘偏心度或脐带缠绕的差异无关。
