Mikhaleva L M, Gracheva N A, Biryukov A E
Research Institute of Human Morphology, Moscow, Russia; City Clinical Hospital Thirty-One, Moscow Healthcare Department, Moscow, Russia.
City Clinical Hospital Thirty-One, Moscow Healthcare Department, Moscow, Russia.
Arkh Patol. 2018;80(2):11-17. doi: 10.17116/patol201880211-17.
Preeclampsia is the most menacing complication of pregnancy and childbirth worldwide and remains one of the leading causes of maternal and perinatal morbidity and mortality. It is characterized by a complex etiopathogenesis with specific clinical and laboratory changes (hypertension, proteinuria and edema), as well as by the morphological pattern of target organ damage and uteroplacental blood vascular lesions. However, the triad of clinical signs of preeclampsia is not encountered in all cases now.
to study the clinical and anatomical aspects of preeclampsia at the present stage.
17 maternal deaths due to preeclampsia were studied at the medical institutions of the Moscow Healthcare Department from 2012 to the first half of 2017 through postmortem examination at City Clinical Hospital Thirty-One, Moscow Healthcare Department.
This analysis showed the atypical course of preeclampsia (without substantial blood pressure elevations, with mild/moderate proteinuria, but almost always with edema). The characteristic feature is a laboratory sign, such as thrombocytopenia and liver enzyme dysfunction. Morphological examination of deceased patients showed that almost half of the cases had brain hemorrhages of different localization and size; in most cases, renal changes corresponded to the pattern of a shock kidney with endotheliosis and frequently with cortical necroses. The liver was characterized by a considerable increase in size with the development of fatty dystrophy, centrolobular necroses and hemorrhages; there were metabolic damage foci in the heart in almost half of the cases, as well as signs of disseminated intravascular coagulation with numerous hemorrhages in the organs and tissues.
Characteristic uteroplacental artery morphological changes in both the surgical and autopsy material render a leading assistance in the diagnosis of preeclampsia/eclampsia.
子痫前期是全球妊娠和分娩最具威胁性的并发症，仍是孕产妇和围产儿发病和死亡的主要原因之一。其特征为病因复杂，伴有特定的临床和实验室变化（高血压、蛋白尿和水肿），以及靶器官损害和子宫胎盘血管病变的形态学模式。然而，现在并非所有病例都会出现子痫前期的三联征临床症状。
研究现阶段子痫前期的临床和解剖学方面。
通过对莫斯科市第31临床医院（莫斯科卫生部）的尸体解剖，研究了2012年至2017年上半年莫斯科卫生部医疗机构中17例因子痫前期导致的孕产妇死亡病例。
该分析显示子痫前期病程不典型（血压无显著升高，有轻度/中度蛋白尿，但几乎总有水肿）。其特征性表现为实验室指标，如血小板减少和肝功能障碍。对死亡患者的形态学检查表明，几乎一半的病例有不同部位和大小的脑出血；大多数情况下，肾脏变化符合休克肾伴血管内皮病变的模式，且常伴有皮质坏死。肝脏表现为体积显著增大，伴有脂肪变性、小叶中心坏死和出血；近一半病例心脏有代谢损伤灶，还有弥散性血管内凝血的迹象，器官和组织有大量出血。
手术和尸检材料中特征性的子宫胎盘动脉形态学变化对子痫前期/子痫的诊断有重要辅助作用。
