Ernst Linda M, Linn Rebecca L, Minturn Lucy, Miller Emily S
1 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
2 Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Pediatr Dev Pathol. 2017 Sep-Oct;20(5):387-393. doi: 10.1177/1093526617698600. Epub 2017 Mar 20.
Background The pathology that underlies morbidly adherent placenta (MAP) is poorly understood. The objective of this study was to describe the placental pathology, especially implantation site pathology, associated with MAP. Methods This was a single institution, retrospective case-control study design examining placentas of patients who delivered between January 2008 and September 2013. MAP cases were defined by the need for clinical intervention at delivery beyond spontaneous placental delivery or simple manual extraction of the placenta. Controls consisted of patients with placentas sent for examination due to a history of maternal malignancy with no clinical suspicion of accreta. Placental pathologic findings of maternal vascular underperfusion (MVU), acute inflammation, chronic inflammation, fetal vascular obstruction, and hemorrhage were recorded and compared using bivariable and multivariable analyses. Results Three categories of pathologic changes were seen more commonly in MAP placentas (N = 101) than control placentas (N = 110): chronic basal inflammation, villous changes of MVU, and retromembranous and subchorionic/intervillous hemorrhage. In multivariable analyses adjusted for confounders, basal chronic villitis (aOR 5.6, 1.73-18.18), plasma cell deciduitis (aOR 2.63, 1.08-6.39), increased syncytial knots (aOR 3.92, 1.57-9.75), villous agglutination (aOR 24.85, 2.78-221.75), increased perivillous fibrin (aOR 5.08, 1.49-17.34), and the presence of subchorionic/intervillous thrombi (aOR 4.01, 1.63-9.86) remained associated with MAP. Conclusions MAP is highly associated with evidence of intraparenchymal placental hemorrhage, villous changes of MVU, and a lymphoplasmacytic infiltrate at the implantation site. The contribution of this basal chronic inflammatory infiltrate to MAP requires further investigation.
背景 对病态粘连胎盘（MAP）的病理基础了解甚少。本研究的目的是描述与MAP相关的胎盘病理，尤其是着床部位病理。方法 这是一项单机构回顾性病例对照研究设计，研究对象为2008年1月至2013年9月期间分娩患者的胎盘。MAP病例定义为分娩时需要临床干预，超出自然胎盘娩出或简单人工剥离胎盘的情况。对照组由因母亲有恶性肿瘤病史而送检胎盘且无临床植入异常怀疑的患者组成。记录母体血管灌注不足（MVU）、急性炎症、慢性炎症、胎儿血管阻塞和出血的胎盘病理结果，并使用双变量和多变量分析进行比较。结果 与对照胎盘（N = 110）相比，MAP胎盘（N = 101）中更常见三类病理变化：慢性基底炎症、MVU的绒毛变化以及膜后和绒毛膜下/绒毛间出血。在对混杂因素进行调整的多变量分析中，基底慢性绒毛炎（校正比值比[aOR] 5.6，1.73 - 18.18）、浆细胞蜕膜炎（aOR 2.63，1.08 - 6.39）、合体结节增加（aOR 3.92，1.57 - 9.75）、绒毛凝集（aOR 24.85，2.78 - 221.75）、绒毛周围纤维蛋白增加（aOR 5.08，1.49 - 17.34）以及绒毛膜下/绒毛间血栓的存在（aOR 4.01，1.63 - 9.86）仍与MAP相关。结论 MAP与实质内胎盘出血、MVU的绒毛变化以及着床部位的淋巴细胞浆细胞浸润密切相关。这种基底慢性炎症浸润对MAP的作用需要进一步研究。
