Catov Janet M, Scifres Christina M, Caritis Steve N, Bertolet Marnie, Larkin Jacob, Parks W Tony
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Am J Obstet Gynecol. 2017 Apr;216(4):411.e1-411.e14. doi: 10.1016/j.ajog.2016.12.022. Epub 2017 Jan 5.
Preterm birth has staggering health implications, and yet the causes of most cases are still unknown. Placental features have been understudied as an etiology for preterm birth, and the association between placental pathologic lesions and neonatal outcomes are incompletely understood.
We sought to characterize births according to placental pathology and relate these to adverse neonatal outcomes.
We studied 20,091 births (15,710 term and 4381 preterm) with placental evaluations. Births were classified according to the presence or absence of placental lesions consistent with malperfusion (vasculopathy, infarct, advanced villous maturation, perivillous fibrin, fibrin deposition) and intrauterine inflammation/infection (chorioamnionitis, funisitis, vasculitis). Outcomes were gestational week of delivery, birthweight z-score, neonatal respiratory distress syndrome, and intraventricular hemorrhage.
Among all preterm births, evidence of placental malperfusion was identified more often than inflammation/infection (50.6% vs 27.3%, P < .0001). Placental malperfusion was associated with reduced fetal growth (adjusted birthweight z-score, -0.83, P < .0001) and lesions of inflammation/infection were associated with earlier delivery (adjusted difference -2.08 weeks, P < .0001) than those with no lesions. When both placental lesions were present, earlier delivery (adjusted difference -2.28 weeks, P < .0001) and reduced fetal growth (adjusted birthweight z-score difference, -0.24, P = .001) were observed more often than when neither lesion was present. Findings were similar when restricted to cases of spontaneous preterm birth. Intraventricular hemorrhage was higher in preterm births with malperfusion lesions than cases with no lesions (7.6% vs 3.4%; odds ratio, 1.98; confidence interval, 1.18-3.32), accounting for gestational age and other covariates.
Placental pathology provides important insight into subtypes of preterm birth with adverse neonatal outcomes. Co-occurrence of malperfusion and inflammation/infection, especially among spontaneous preterm births, may be a novel pattern of placental injury linked to severe adverse outcomes.
早产对健康有严重影响，但大多数病例的病因仍不清楚。胎盘特征作为早产的病因尚未得到充分研究，胎盘病理病变与新生儿结局之间的关联也尚未完全了解。
我们试图根据胎盘病理特征对分娩进行分类，并将其与不良新生儿结局相关联。
我们对20,091例分娩（15,710例足月分娩和4381例早产）进行了胎盘评估。根据是否存在与灌注不良（血管病变、梗死、绒毛成熟过度、绒毛周围纤维蛋白、纤维蛋白沉积）和宫内炎症/感染（绒毛膜羊膜炎、脐带炎、血管炎）一致的胎盘病变对分娩进行分类。结局指标包括分娩孕周、出生体重Z评分、新生儿呼吸窘迫综合征和脑室内出血。
在所有早产中，胎盘灌注不良的证据比炎症/感染更为常见（50.6%对27.3%，P <.0001）。与无病变者相比，胎盘灌注不良与胎儿生长受限有关（校正出生体重Z评分，-0.83，P <.0001），炎症/感染病变与更早分娩有关（校正差异-2.08周，P <.0001）。当两种胎盘病变都存在时，与两种病变都不存在时相比，更常观察到更早分娩（校正差异-2.28周，P <.0001）和胎儿生长受限（校正出生体重Z评分差异，-0.24，P =.001）。在自发性早产病例中，结果相似。有灌注不良病变的早产中脑室内出血高于无病变者（7.6%对3.4%；比值比，1.98；置信区间，1.18 - 3.32），并对孕周和其他协变量进行了校正。
胎盘病理为具有不良新生儿结局的早产亚型提供了重要见解。灌注不良和炎症/感染同时存在，尤其是在自发性早产中，可能是一种与严重不良结局相关的新型胎盘损伤模式。
