Stanek Jerzy
Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
J Obstet Gynaecol Res. 2015 Mar;41(3):358-69. doi: 10.1111/jog.12539. Epub 2014 Oct 10.
This retrospective analysis is aimed to study clinical and placental associations of placental acute, chronic, and acute-on-chronic (overlap) hypoxic lesions.
Frequencies of 32 clinical (maternal and fetal) and 47 placental (gross and microscopic) phenotypes were compared by the Yates χ(2) with the Holm-Bonferroni correction among consecutive placentas from 2831 ≥ 16-week gestations: 778 placentas with chronic hypoxic lesion(s) (diffuse patterns of hypoxic placental injury, chorangiosis, excessive extravillous trophoblasts, microscopic chorionic pseudocysts, clusters of decidual multinucleate trophoblasts), 481 placentas with acute hypoxic lesion(s) (infarction, intravillous hemorrhage, deep meconium penetration, membrane laminar necrosis), 585 placentas with hypoxic overlap lesion(s) (coexisting at least one lesion from each of the above groups), and 987 placentas without placental hypoxic lesions, adjusted for gestational age.
The control group was dominated by premature rupture of membranes, inflammatory pattern of placental injury, and poor prenatal care. The fetal and placental hypoxic patterns were associated not only with increased frequency of clinical hypoxia-associated conditions, but also abnormal umbilical cord coiling, intervillous thrombi, retroplacental hematomas, and placental features of fetal thrombotic vasculopathy, particularly in association with hypoxic overlap lesions.
Placental hypoxic overlap lesions are associated with clinical complications of pregnancy and predispose to thrombotic lesions, some most likely stasis-induced.
本回顾性分析旨在研究胎盘急性、慢性和急性-on-慢性（重叠）缺氧性病变的临床及胎盘相关性。
在2831例孕周≥16周的连续胎盘病例中，采用Yates χ(2)检验并经Holm-Bonferroni校正，比较32种临床（母体和胎儿）及47种胎盘（大体和显微镜下）表型的频率：778例有慢性缺氧性病变的胎盘（缺氧性胎盘损伤的弥漫性模式、绒毛膜血管病、过多的绒毛外滋养层细胞、显微镜下绒毛膜假囊肿、蜕膜多核滋养层细胞簇），481例有急性缺氧性病变的胎盘（梗死、绒毛内出血、深胎粪侵入、膜层状坏死），585例有缺氧性重叠病变的胎盘（同时存在上述每组中至少一种病变），以及987例无胎盘缺氧性病变的胎盘，并对孕周进行了校正。
对照组以胎膜早破、胎盘损伤的炎症模式和产前护理不佳为主。胎儿和胎盘缺氧模式不仅与临床缺氧相关病症的频率增加有关，还与异常的脐带缠绕、绒毛间血栓、胎盘后血肿以及胎儿血栓性血管病的胎盘特征有关，特别是与缺氧性重叠病变相关。
胎盘缺氧性重叠病变与妊娠临床并发症相关，并易引发血栓性病变，其中一些很可能是由淤血引起的。
