Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Prenat Diagn. 2012 Dec;32(13):1263-72. doi: 10.1002/pd.3988. Epub 2012 Oct 24.
The objective of the study was to evaluate the association between placental histological patterns and umbilical artery (UA) Doppler velocimetry in pregnancies complicated by fetal growth restriction (FGR).
A cohort of 126 FGR pregnancies was followed according to a standard protocol. Placental lesions were diagnosed according to consensus nomenclature and standardized criteria.
Pulsatility index was normal in 45 (35.7%) and increased in 44 (34.9%) women. End-diastolic UA Doppler flow was absent in 27 (21.4%) and reversed in 10 (7.9%). Fifty-four women (42.9%) had preeclampsia. In preeclampsia, increasing Doppler abnormalities, from normal to reversed UA end-diastolic flow, were directly associated only with an increased number of placental syncytial knots. In normotensive pregnancies, Doppler abnormalities were associated with increased intervillous fibrin deposits, villous hypoplasia, syncytial knots, placental site giant cells, immature intermediate trophoblast, and with pattern of lesions indicating superficial implantation and maternal vascular underperfusion. In the whole cohort, increase of syncytial knots [odds ratio (OR) = 28.7; 95% confidence interval (CI) = 2.75-298.5], intervillous fibrin deposits (OR = 2.1; 95% CI = 1.04-4.28), placental site giant cells (OR = 3.0; 95% CI = 1.05-8.84), and patterns suggesting maternal underperfusion (OR = 2.9; 95% CI = 1.0-7.1) were independently associated with increased rates of absent/reversed UA end-diastolic flow.
In pregnancies complicated by FGR, abnormalities of UA Doppler velocimetry were associated with placental lesions indicating superficial implantation and maternal vascular underperfusion.
本研究旨在评估胎盘组织学模式与胎儿生长受限（FGR）相关的脐动脉（UA）多普勒血流变化之间的关联。
按照标准方案对 126 例 FGR 妊娠进行了随访。根据共识命名法和标准化标准诊断胎盘病变。
脉动指数正常者 45 例（35.7%），增加者 44 例（34.9%）。27 例（21.4%）UA 舒张末期无血流，10 例（7.9%）血流反向。54 例（42.9%）患者患有子痫前期。在子痫前期中，从正常 UA 舒张末期血流到反向血流的多普勒异常增加仅与胎盘合体细胞结节数量的增加直接相关。在正常血压的妊娠中，多普勒异常与绒毛间纤维蛋白沉积、绒毛发育不良、合体细胞结节、胎盘部位巨细胞、未成熟中间滋养层以及表明浅表植入和母体血管灌注不足的病变模式有关。在整个队列中，合体细胞结节增加[比值比（OR）=28.7；95%置信区间（CI）=2.75-298.5]、绒毛间纤维蛋白沉积（OR=2.1；95%CI=1.04-4.28）、胎盘部位巨细胞（OR=3.0；95%CI=1.05-8.84）和提示母体灌注不足的模式（OR=2.9；95%CI=1.0-7.1）与 UA 舒张末期无/反向血流的增加率独立相关。
在 FGR 合并妊娠中，UA 多普勒血流异常与表明浅表植入和母体血管灌注不足的胎盘病变有关。
