Perrone Serafina, Toti Paolo, Toti Maria Stefania, Badii Silvia, Becucci Elisa, Gatti Maria Gabriella, Marzocchi Barbara, Picardi Anna, Buonocore Giuseppe
Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
J Matern Fetal Neonatal Med. 2012 Apr;25 Suppl 1:110-3. doi: 10.3109/14767058.2012.664344. Epub 2012 Mar 13.
Placental pathology assists in characterizing the antenatal environment and may provide information about the baby's subsequent development. We aim to assess whether histological patterns of placenta are associated with an increased risk of perinatal diseases and to evaluate how different patterns of placental dysfunction can affect the neurodevelopmental outcome.
We analyzed the histopathological characteristics of 105 singleton placentas from infants born between 23 and 31 weeks of gestation and we assessed pair-wise correlations with perinatal diseases. Estimated relative risks were calculated from odds ratios.
Histological chorioamnionitis (CA group) was detected on 51 of 100 placentas tested. Lesions of uteroplacental circulation (abruption, infarction or thrombosis, perivillous fibrin deposition, syncytial knots; vasculopathy group) were detected on 29. 25 normal placentas served as controls. The incidence of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) was higher in CA than in control group. The risk of developing retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and PDA was higher in CA than in vasculopathy group.
At low gestational age CA, rather than placental lesions of vasculopathy, negatively impacts perinatal outcome. Clinical significance of histologic vasculopathy remains questionable. Other pathophysiological mechanisms than those associated with placental changes may occur following dysfunction of uteroplacental circulation.
胎盘病理学有助于描述产前环境，并可能提供有关婴儿后续发育的信息。我们旨在评估胎盘的组织学模式是否与围产期疾病风险增加相关，并评估不同模式的胎盘功能障碍如何影响神经发育结局。
我们分析了105例妊娠23至31周出生婴儿的单胎胎盘的组织病理学特征，并评估了与围产期疾病的成对相关性。从比值比计算估计相对风险。
在100个检测的胎盘中，51个检测到组织学绒毛膜羊膜炎（CA组）。29个检测到子宫胎盘循环病变（胎盘早剥、梗死或血栓形成、绒毛周围纤维蛋白沉积、合体细胞结节；血管病变组）。25个正常胎盘作为对照。CA组支气管肺发育不良（BPD）和动脉导管未闭（PDA）的发生率高于对照组。CA组发生早产儿视网膜病变（ROP）、脑室内出血（IVH）和PDA的风险高于血管病变组。
在低胎龄时，CA而非血管病变的胎盘病变对围产期结局有负面影响。组织学血管病变的临床意义仍存在疑问。子宫胎盘循环功能障碍后可能会出现与胎盘变化无关的其他病理生理机制。
