Stanek Jerzy, Biesiada Jacek
J Perinat Med. 2014 Jul;42(4):457-71. doi: 10.1515/jpm-2013-0219.
To study the relation of retention of dead fetus resulting in its maceration and gestational age at delivery to placental diagnosis.
Some 75 clinicoplacental phenotypes have been retrospectively analyzed in 520 consecutive stillbirths, 329 macerated and 191 nonmacerated, and at three gestational age interval cohorts (330 second trimester, 102 preterm third trimester, and 88 term). Chi-square and clustering methods (Ward dendrograms and multidimensional scaling) were used for statistical analysis.
Maternal diabetes mellitus, induction of labor, fetal growth restriction, various umbilical cord abnormalities, and placental clusters of sclerotic/hemosiderotic chorionic villi were more common in macerated stillbirths, while clinicoplacental signs and symptoms of ascending infection and placental abruption, i.e., retroplacental hematoma, premature rupture of membranes, and acute chorioamnionitis in nonmacerated stillbirths. Placental abnormalities were less common in the second trimester, other than the acute chorioamnionitis. Patterns of chronic hypoxic placental injury were common in preterm third trimester, while signs of in-utero hypoxia (abnormal cardiotocography, meconium, and histological erythroblastosis of fetal blood) in term pregnancy. In addition to classical statistics, the clustering analyses added new information to placental investigation of cause of stillbirth.
Macerated third trimester stillbirths have multifactorial etiology more likely than the second trimester stillbirths and the likely stasis-induced fetal thrombotic vasculopathy secondary to occult umbilical cord compromise should be sought in placental investigation in such cases. Nonmacerated stillbirths are associated with ascending infection and placental abruption.
研究死胎潴留导致其浸软与分娩孕周和胎盘诊断之间的关系。
对520例连续死产病例进行回顾性分析，其中329例为浸软死胎，191例为非浸软死胎，并按三个孕周区间队列进行分析（孕中期330例、早产晚期102例、足月88例）。采用卡方检验和聚类方法（Ward树状图和多维标度法）进行统计分析。
产妇糖尿病、引产、胎儿生长受限、各种脐带异常以及胎盘硬化/含铁血黄素沉着绒毛簇在浸软死胎中更为常见，而非浸软死胎中则有上行感染和胎盘早剥的临床胎盘体征和症状，即胎盘后血肿、胎膜早破和急性绒毛膜羊膜炎。除急性绒毛膜羊膜炎外，孕中期胎盘异常较少见。慢性缺氧性胎盘损伤模式在早产晚期较为常见，而足月妊娠时有宫内缺氧迹象（异常胎心监护、胎粪和胎儿血液组织学红细胞增多症）。除经典统计方法外，聚类分析为死产原因的胎盘调查增添了新信息。
孕晚期浸软死胎的病因多为多因素，比孕中期死胎更常见，在这类病例的胎盘调查中应寻找可能因隐匿性脐带受压继发的淤滞性胎儿血栓性血管病。非浸软死胎与上行感染和胎盘早剥有关。
