Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
PLoS One. 2012;7(6):e39259. doi: 10.1371/journal.pone.0039259. Epub 2012 Jun 19.
Decreased fetal movements (DFM) are associated with fetal growth restriction and stillbirth, presumably linked through an underlying placental dysfunction. Yet, the role of placental pathology has received limited attention in DFM studies. Our main objective was to explore whether maternal perceptions of DFM were associated with placental pathology in pregnancies recruited from a low-risk total population.
METHODS/PRINCIPAL FINDINGS: Placentas from 129 DFM and 191 non-DFM pregnancies were examined according to standardized macro- and microscopic protocols. DFM was defined as any maternal complaint of DFM leading to a hospital examination. Morphological findings were timed and graded according to their estimated onset and clinical importance, and classified in line with a newly constructed Norwegian classification system for reporting placental pathology. With our population-based approach we were unable to link DFM to an overall measure of all forms of placental pathology (OR 1.3, 95% CI 0.8-2.2, p = 0.249). However, placental pathology leading to imminent delivery could be a competing risk for DFM, making separate subgroup analyses more appropriate. Our study suggests a link between DFM and macroscopic placental pathology related to maternal, uteroplacental vessels, i.e. infarctions, placental lesions (intraplacental hematomas) and abruptions. Although not statistically significant separately, a compound measure showed a significant association with DFM (OR 2.4, 95%CI 1.1-5.0, p = 0.023). This association was strengthened when we accounted for relevant temporal aspects. More subtle microscopic materno-placental ischemic changes outside the areas of localized pathology showed no association with DFM (OR 0.5, 95%CI 0.2-1.4, p = 0.203). There was a strong association between placental pathology and neonatal complications (OR 2.9, 95% CI 1.6-5.1, p<0.001).
In our population-based study we were generally unable to link maternally perceived DFM to placental pathology. Some associations were seen for subgroups.
胎儿运动减少（DFM）与胎儿生长受限和死胎有关，据推测，这与胎盘功能障碍有关。然而，胎盘病理学在 DFM 研究中受到的关注有限。我们的主要目的是探讨在从低风险人群中招募的妊娠中，母体对 DFM 的感知是否与胎盘病理学有关。
方法/主要发现：根据标准化的宏观和微观方案检查了 129 例 DFM 和 191 例非 DFM 妊娠的胎盘。DFM 定义为任何导致医院检查的母体对 DFM 的抱怨。形态学发现根据其估计的发病时间和临床重要性进行计时和分级，并按照新构建的挪威胎盘病理学报告分类系统进行分类。通过我们的基于人群的方法，我们无法将 DFM 与所有形式的胎盘病理学的总体衡量标准联系起来（OR 1.3，95%CI 0.8-2.2，p=0.249）。然而，即将分娩的胎盘病理学可能是 DFM 的竞争风险，因此更适合进行单独的亚组分析。我们的研究表明，DFM 与与母体、子宫胎盘血管相关的宏观胎盘病理学之间存在联系，即梗塞、胎盘病变（胎盘内血肿）和胎盘早剥。虽然单独来看没有统计学意义，但复合测量指标与 DFM 有显著关联（OR 2.4，95%CI 1.1-5.0，p=0.023）。当我们考虑到相关的时间方面时，这种关联得到了加强。在局部病变区域之外的细微母体胎盘缺血性变化与 DFM 无关（OR 0.5，95%CI 0.2-1.4，p=0.203）。胎盘病理学与新生儿并发症之间存在很强的关联（OR 2.9，95%CI 1.6-5.1，p<0.001）。
在我们的基于人群的研究中，我们通常无法将母体感知的 DFM 与胎盘病理学联系起来。对于一些亚组，我们观察到了一些关联。
