Weiner E, Miremberg H, Grinstein E, Mizrachi Y, Schreiber L, Bar J, Kovo M
Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel.
Department of Pathology, The Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel.
J Perinatol. 2016 Dec;36(12):1073-1078. doi: 10.1038/jp.2016.140. Epub 2016 Sep 1.
To compare the clinical characteristics and placental histopathology between pregnancies complicated by placenta previa and controls.
Between 2009 and 2015, cesarean deliveries (CDs) of 119 pregnancies with placenta previa were identified from which maternal outcomes, neonatal outcomes and placental pathology were reviewed. Results were compared with CDs matched for maternal age and pregnancy complications (control group, n=119). Placental lesions were classified into maternal and fetal vascular supply lesions and inflammatory response. Composite neonatal outcome was defined as one or more of early neonatal complications. Small-for-gestational age (SGA) was defined as birth weight ⩽10th percentile.
Placentas from the previa group had higher rates of weights <10th percentile (P<0.001) and of maternal and fetal vascular supply lesions (P<0.001, for both). Higher rate of SGA (P=0.003) and worse composite neonatal outcome (P<0.001) were also observed in the previa group as compared with controls. After controlling for potential confounding bias using multivariable logistic regression models, placenta previa remained statistically significantly associated with placental maternal (adjusted odds ratio (aOR) 2.48, 95% confidence interval (CI) 1.2-4.9, P=0.009) and fetal (aOR 7.05, 95% CI 2.4-20.2, P<0.001) vascular supply lesions, SGA (aOR 10, 95% CI 2.3-44.2, P=0.002) and adverse neonatal outcome (aOR 6.87, 95% CI 2.9-11.8, P<0.001).
More placental vascular supply lesions, higher rate of SGA and worse neonatal outcome characterized pregnancies with placenta previa in the current study. These findings may suggest that abnormal placentation is accompanied by suboptimal implantation that interferes with fetal growth.
比较前置胎盘妊娠与对照组的临床特征及胎盘组织病理学。
2009年至2015年间，从119例前置胎盘妊娠的剖宫产病例中确定产妇结局、新生儿结局及胎盘病理学情况。将结果与年龄及妊娠并发症相匹配的剖宫产病例（对照组，n = 119）进行比较。胎盘病变分为母体和胎儿血管供应病变以及炎症反应。综合新生儿结局定义为一种或多种早期新生儿并发症。小于胎龄儿（SGA）定义为出生体重≤第10百分位数。
前置胎盘组胎盘重量<第10百分位数的发生率更高（P<0.001），母体和胎儿血管供应病变的发生率也更高（两者均P<0.001）。与对照组相比，前置胎盘组SGA发生率更高（P = 0.003），综合新生儿结局更差（P<0.001）。使用多变量逻辑回归模型控制潜在混杂偏倚后，前置胎盘仍与胎盘母体血管供应病变（调整优势比（aOR）2.48，95%置信区间（CI）1.2 - 4.9，P = 0.009）、胎儿血管供应病变（aOR 7.05，95%CI 2.4 - 20.2，P<0.001）、SGA（aOR 10，95%CI 2.3 - 44.2，P = 0.002）及不良新生儿结局（aOR 6.87，95%CI 2.9 - 11.8，P<0.001）在统计学上显著相关。
本研究中，前置胎盘妊娠的特点是胎盘血管供应病变更多、SGA发生率更高及新生儿结局更差。这些发现可能提示胎盘形成异常伴有影响胎儿生长的次优着床。
