Pásztor Norbert, Sikovanyecz János, Keresztúri Attila, Kozinszky Zoltan, Németh Gábor
a Department of Obstetrics and Gynecology , University of Szeged , Szeged , Hungary.
b Department of Obstetrics and Gynecology , Blekinge Hospital , Karlskrona , Sweden.
J Obstet Gynaecol. 2018 Jan;38(1):74-80. doi: 10.1080/01443615.2017.1349084. Epub 2017 Oct 3.
The aim of the present study was to evaluate the clinical importance of placental weight (PW) and placental weight to foetal weight (PW/FW) ratio according to maternal characteristics, pathological conditions in obstetrics and the causes of foetal death by category in stillbirths. The results of autopsies and placental histopathological examinations for 145 singleton stillbirths were reviewed retrospectively. Pathological features of the placenta were significantly associated with lower PW compared to the group with no pathological placental parameters (230 grams versus 295 grams, p = .045). Foetal growth restriction (FGR) with pre-eclampsia (PE) was accompanied by significantly lower FW, PW and PW/FW compared to FGR cases without PE (1045 grams versus 1405 grams, p = .026, 200 grams versus 390 grams, p = .006 and .19 versus .24, p = .037, respectively), whereas a similar trend was not observed in the non-FGR pregnancies complicated by PE. Oligohydramnios was accompanied by lower foetal weight compared to those who had normal amount of amniotic fluid (650 grams versus 1400 grams, p = .006). Among the clinical factors, only PE and oligohydramnios contributed to disproportionate fetoplacental growth in stillbirth, while none of the categories of stillbirth was related to unequal fetoplacental growth. Impact statement What is already known on this subject: In 27% of stillbirths, pathological features of the placenta or placental vascular bed are recorded. Underlying placental pathology contributes to foetal growth restriction (FGR) in approximately 50%. Although placental weight relative to foetal weight (PW/FW ratio) is an indicator of foetal as well as placental growth, data on PW/FW in stillbirth has not yet been published. What the results of this study add: Causes of death do not show any correlation with PW/FW ratio. Placentas derived from pregnancies complicated by pre-eclampsia (PE) and concomitant FGR are smaller and PW/FW is also diminished. Oligohydramnios is associated with an enhanced risk of restricted placental growth. FGR is not correlated with any categories of causes of death. What the implications are of these findings for clinical practice and/or further research: Sonographic follow-up of placental volume and FW can predict the stillbirth in PE complicated by FGR and oligohydramnios.
本研究的目的是根据母亲特征、产科病理状况以及死产中按类别划分的胎儿死亡原因，评估胎盘重量（PW）和胎盘重量与胎儿重量之比（PW/FW）的临床重要性。回顾性分析了145例单胎死产的尸检结果和胎盘组织病理学检查结果。与无胎盘病理参数的组相比，胎盘的病理特征与较低的PW显著相关（230克对295克，p = 0.045）。与无先兆子痫（PE）的胎儿生长受限（FGR）病例相比，伴有先兆子痫（PE）的FGR病例的FW、PW和PW/FW显著降低（分别为1045克对1405克，p = 0.026；200克对390克，p = 0.006；0.19对0.24，p = 0.037），而在合并PE的非FGR妊娠中未观察到类似趋势。与羊水正常的孕妇相比，羊水过少孕妇的胎儿体重较低（650克对1400克，p = 0.006）。在临床因素中，只有PE和羊水过少导致死产中胎儿胎盘生长不成比例，而死产的任何类别均与胎儿胎盘生长不均无关。影响声明关于该主题已知的信息：在27%的死产中，记录了胎盘或胎盘血管床的病理特征。潜在的胎盘病理在约50%的情况下导致胎儿生长受限（FGR）。尽管胎盘重量相对于胎儿重量（PW/FW比）是胎儿以及胎盘生长的一个指标，但关于死产中PW/FW的数据尚未发表。本研究结果补充的内容：死亡原因与PW/FW比无任何相关性。来自合并先兆子痫（PE）和伴随FGR的妊娠的胎盘较小，PW/FW也降低。羊水过少与胎盘生长受限风险增加有关。FGR与任何类别的死亡原因均无相关性。这些发现对临床实践和/或进一步研究的意义：对胎盘体积和FW进行超声随访可预测合并FGR和羊水过少的PE中的死产情况。
