Kovo Michal, Bar Jacob, Schreiber Letizia, Shargorodsky Marina
Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Pathology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Am Soc Hypertens. 2017 Nov;11(11):724-729. doi: 10.1016/j.jash.2017.09.001. Epub 2017 Sep 6.
We examined the impact of chronic hypertension (HTN), gestational HTN, and preeclampsia on placental maternal and fetal vascular circulation. Of the 1047 women who gave birth and underwent a placental histopathologic examination between 2007 and 2013 at Wolfson Medical Center, 140 women were included in the present study: 34 women with preeclampsia, 25 women with chronic HTN, 28 women with gestational HTN, and 53 women without hypertensive disorder, matched by age, gravidity, parity, and mode of delivery.Placental lesions related to maternal vascular malperfusion (MVM) differed significantly across groups (P < .0001) and were highest in subjects with chronic HTN and preeclampsia (72% and 65%, respectively) and lowest in women without hypertensive disorder (26%). Placental fetal vascular malperfusion rate did not differ significantly between groups (P = .767). In the logistic regression analysis, chronic HTN emerged as a significant predictor of placental MVM and increased the risk of this outcome more than sixfold (odds ratio 6.614, 95% confidence interval 2.047-21.37, P = .002). Preeclampsia emerged as a significant predictor of MVM and more than tripled the risk of this outcome (odds ratio 3.468, 95% confidence interval 1.083-11.103, P = .036). Gestational HTN was not significantly associated with increased MVM rate. We demonstrated that chronic HTN and preeclampsia were associated with an increased rate of vascular placental maternal malperfusion and emerged as significant independent predictors of this outcome.
我们研究了慢性高血压（HTN）、妊娠期高血压及先兆子痫对胎盘母体和胎儿血管循环的影响。在2007年至2013年间于沃尔夫森医疗中心分娩并接受胎盘组织病理学检查的1047名女性中，本研究纳入了140名女性：34名先兆子痫患者、25名慢性HTN患者、28名妊娠期高血压患者以及53名无高血压疾病的女性，这些女性在年龄、妊娠次数、产次和分娩方式方面相匹配。与母体血管灌注不良（MVM）相关的胎盘病变在各组间存在显著差异（P <.0001），在慢性HTN和先兆子痫患者中最高（分别为72%和65%），在无高血压疾病的女性中最低（26%）。各组间胎盘胎儿血管灌注不良率无显著差异（P =.767）。在逻辑回归分析中，慢性HTN是胎盘MVM的显著预测因素，使该结果的风险增加了六倍多（比值比6.614，95%置信区间2.047 - 21.37，P =.002）。先兆子痫是MVM的显著预测因素，使该结果的风险增加了两倍多（比值比3.468，95%置信区间1.083 - 11.103，P =.036）。妊娠期高血压与MVM率增加无显著关联。我们证明，慢性HTN和先兆子痫与胎盘母体血管灌注不良率增加相关，并成为该结果的显著独立预测因素。
