Vardi Leehe, Paterson Helen, Hung Noelyn Anne
Department of Women's Health, Dunedin Public Hospital, Dunedin, New Zealand.
Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.
BMJ Case Rep. 2017 Jan 10;2017:bcr2016217886. doi: 10.1136/bcr-2016-217886.
Chronic histiocytic intervillositis (CHI) is a rare placental lesion associated with adverse obstetric outcomes and high recurrence rate. We report a case of six consecutive pregnancies in one woman, where CHI was detected following an intrauterine death in the fifth pregnancy, after being missed in four earlier losses. The successful sixth pregnancy was treated with a combination of immunosuppressive and antithrombotic agents. While low-molecular-weight heparin (LMWH) and aspirin had been shown to improve pregnancy outcome in recurrent pregnancy loss, there was limited evidence of improved outcome in CHI. It has been suggested that CHI may result from a maternal immunological process and there have been a few reports of the use of corticosteroids because of this possibility, though without convincing evidence of efficacy. We too tried a corticosteroid, in combination with LMWH and aspirin. Comparative histopathological analysis of the placentae supported post-treatment effectiveness of our intervention strategy.
慢性组织细胞性绒毛间炎（CHI）是一种罕见的胎盘病变，与不良产科结局及高复发率相关。我们报告一例女性连续六次妊娠的病例，该女性在第五次妊娠发生宫内死亡后检测出CHI，而在前四次流产中均未检出。第六次妊娠成功，采用了免疫抑制和抗血栓药物联合治疗。虽然低分子量肝素（LMWH）和阿司匹林已被证明可改善复发性流产的妊娠结局，但在CHI中改善结局的证据有限。有人认为CHI可能源于母体免疫过程，基于这种可能性有一些使用皮质类固醇的报道，不过尚无令人信服的疗效证据。我们也尝试了一种皮质类固醇，联合LMWH和阿司匹林。胎盘的对比组织病理学分析支持了我们干预策略的治疗后有效性。
