Novac Maria Violeta, Niculescu Mihaela, Manolea Maria Magdalena, Dijmărescu Anda Lorena, Iliescu Dominic Gabriel, Novac Marius Bogdan, Rotaru Luciana Teodora, Stoenescu Manuela Florica, Tabacu Maria Carmen, Tudorache Ştefania, Busuioc Cristina Jana, Gheonea Ioana Andreea
Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy of Craiova, Romania;
Rom J Morphol Embryol. 2018;59(3):715-720.
Placental lesions and placental ischemia are typical elements of intrauterine growth restriction (IUGR). The aim of this study is to analyze histological and immunohistochemical (IHC) changes in the placentas of IUGR fetuses.
In this prospective study, 126 placentas from small for gestational age (SGA) pregnancies (newborns with birth weight <10th percentile) that formed the study group and 31 placentas from pregnancies without SGA representing control group, were included. Placentas were examined according to standard protocol. Histopathological and IHC examinations of placentas were performed for analysis.
A certain type of lesion of placental injury is increased in placentas from SGA pregnancies. These placental lesions were placental infarction (over 5%), increased syncytial knots, intervillous fibrinoid deposition, villous thrombohematoma. Other common placental lesions were probably related to fetal adaptation to placental ischemia or represent a placental change characteristic of pregnancy evolution.
It seems that although IUGR∕SGA fetuses are more commonly associated with histological placental abnormalities, it cannot be established whether these abnormalities certainly contribute to IUGR, as there are no specific placental lesions in SGA placentas. Pseudo-angiomatous aspect, associated with increased syncytial knots, was specific for vascular hypoxia. Especially the magnitude of modifications of the placental structure beyond the qualitative modifications, which also lead to functional changes, are involved in this pathology of pregnancy, the onset of lesions being triggered at the level of stem villi.
胎盘病变和胎盘缺血是宫内生长受限（IUGR）的典型特征。本研究旨在分析IUGR胎儿胎盘的组织学和免疫组化（IHC）变化。
在这项前瞻性研究中，纳入了126例来自小于胎龄（SGA）妊娠（出生体重<第10百分位数的新生儿）的胎盘作为研究组，以及31例来自无SGA妊娠的胎盘作为对照组。胎盘按照标准方案进行检查。对胎盘进行组织病理学和IHC检查以进行分析。
SGA妊娠胎盘的某种类型的胎盘损伤病变增加。这些胎盘病变包括胎盘梗死（超过5%）、合体结节增加、绒毛间纤维素样沉积、绒毛血栓血肿。其他常见的胎盘病变可能与胎儿对胎盘缺血的适应有关，或代表妊娠进展的胎盘变化特征。
似乎尽管IUGR/SGA胎儿更常与胎盘组织学异常相关，但由于SGA胎盘中没有特定的胎盘病变，无法确定这些异常是否肯定导致IUGR。与合体结节增加相关的假血管瘤样表现是血管缺氧的特异性表现。特别是胎盘结构改变的程度超过了定性改变，这也导致了功能变化，参与了这种妊娠病理过程，病变的起始发生在主干绒毛水平。
