Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, M5G 1Z5 Canada.
Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, M5G 1Z5 Canada.
Placenta. 2018 Apr;64:1-6. doi: 10.1016/j.placenta.2018.02.002. Epub 2018 Feb 6.
Chronic histiocytic intervillositis (CHI) of the placenta although rare, has a high recurrence rate, is associated with serious adverse pregnancy outcomes and has no available treatment. This study aims to determine clinical, biochemical and radiological factors associated with CHI, to guide management of subsequent pregnancies.
This retrospective observational study included consecutive cases with a histopathologic diagnosis of CHI after 18 weeks of gestation, between 2001 and 2014, and no controls. Clinical (maternal, fetal and delivery outcomes), biochemical (first- and second-trimester biomarkers for fetal aneuploidy and serum alkaline phosphatase) and radiological (second- and third-trimester fetal, placental and Doppler ultrasound) factors associated with a histopathological diagnosis of CHI were identified and results presented as percentages. Outcomes of subsequent pregnancies were described.
Of 231 identified cases of 'intervillositis', 33 were confirmed to have CHI, of which only 4/33 (12.1%) had prior uncomplicated term deliveries. During pregnancy, 10/18 (55.5%) had abnormal first-trimester screening, 4/16 (25%) had abnormal second-trimester screening, 6/19 (31.6%) had at least one elevated alkaline phosphatase level, and 15/20 (75%) had at least one abnormal feature on mid-trimester placental ultrasound. In subsequent pregnancies that were closely followed with a combination of biochemical and radiologic tests, there were no cases of fetal loss, and lower incidence of fetal growth restriction and preterm birth.
No clinical, biochemical or radiological finding is consistently associated with CHI and adverse outcomes thereof. Whether the incorporation of these tests in individualized care-plans could improve outcomes in subsequent pregnancies needs to be studied further.
慢性组织细胞性绒毛膜炎（CHI）虽然罕见，但复发率高，与严重的不良妊娠结局相关，且尚无有效治疗方法。本研究旨在确定与 CHI 相关的临床、生化和影像学因素，以指导后续妊娠的管理。
本回顾性观察性研究纳入了 2001 年至 2014 年间连续的 18 孕周后经组织病理学诊断为 CHI 的病例，且无对照组。确定与 CHI 组织病理学诊断相关的临床（母体、胎儿和分娩结局）、生化（胎儿非整倍体的早、中孕期标志物和血清碱性磷酸酶）和影像学（胎儿、胎盘和多普勒超声的中、晚孕期）因素，并以百分比表示结果。描述了后续妊娠的结局。
在 231 例“绒毛膜炎”中，有 33 例被确认为 CHI，其中仅 4/33（12.1%）有先前无并发症的足月分娩史。在妊娠期间，18 例中有 10 例（55.5%）早孕期筛查异常，16 例中有 4 例（25%）中孕期筛查异常，19 例中有 6 例（31.6%）至少有 1 次碱性磷酸酶水平升高，20 例中有 15 例（75%）中孕期胎盘超声至少有 1 项异常。在随后的妊娠中，密切结合生化和影像学检查进行监测，无胎儿丢失，胎儿生长受限和早产的发生率较低。
没有单一的临床、生化或影像学发现与 CHI 及其不良结局相关。这些检查是否纳入个体化的护理计划中能够改善后续妊娠的结局，需要进一步研究。
