Division of Pathology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
Placenta. 2019 Feb;77:30-38. doi: 10.1016/j.placenta.2019.02.001. Epub 2019 Feb 4.
Postmortem regressive placental changes of stillbirth may obscure the pre-existing placental histomorphology. The objective is to find out whether the use of CD34 immunostain can increase the sensitivity of placental examination in the diagnosis of fetal vascular malperfusion (FVM).
Twenty six independent clinical and 46 placental variables of 46 placentas from stillbirths were statistically compared to those of 92 placentas from livebirths. One histologically most unremarkable section per case was stained using double E-cadherin/CD34 immunostain (ECCD34). Clusters of avascular/hypovascular chorionic villi on hematoxylin and eosin (H&E) staining system and/or CD34 immunostaining, the latter also including endothelial CD34 positive debris in the villous stroma, were regarded as evidence of FVM.
The gestational age and cesarean section rate were statistically significantly lower and the induction of labor and mild erythroblastosis of fetal blood was higher, but the frequencies of clinical and placental features of umbilical cord compromise were not statistically significant between stillbirths and livebirths, respectively. By using H&E stain, 9 (19.6%) of stillbirths and 30 (32.6%) of livebirths showed clusters of avascular villi on H&E. By CD34, the rates of FVM increased to 23 (50%) and 34 (40%), respectively. The increase was statistically significant for stillbirths only (Chi square = 9.4, p = 0.002). By CD34, new clusters of hypovascular chorionic villi or villi with endothelial fragmentation were found in 23 stillbirth cases (50%) as opposed to livebirths (29 cases, 31.5%)(Chi square = 9.4, p = 0.002).
When compared with H&E stain, the CD34 increases sensitivity and/or upgrades FVM in placental examination in stillbirths but not in livebirths.
死产时退行性胎盘变化可能会掩盖先前存在的胎盘组织形态学改变。目的是探讨 CD34 免疫染色是否能提高胎盘检查诊断胎儿血管灌注不良（FVM）的敏感性。
对 46 例死产胎盘的 26 项临床和 46 项胎盘变量与 92 例活产胎盘进行统计学比较。对每个病例中组织学上最无明显变化的部分进行双 E-钙黏蛋白/CD34 免疫染色（ECCD34）染色。苏木精和伊红（H&E）染色系统中无血管/低血管绒毛的簇状和/或 CD34 免疫染色，后者还包括绒毛间质中内皮 CD34 阳性碎片，被认为是 FVM 的证据。
死产儿的胎龄和剖宫产率明显降低，引产和胎儿血轻度母源性红细胞增多症的发生率较高，但死产儿和活产儿的脐带压迫的临床和胎盘特征的发生率均无统计学差异。使用 H&E 染色，9 例（19.6%）死产儿和 30 例（32.6%）活产儿的 H&E 染色显示无血管绒毛簇。通过 CD34，FVM 的发生率分别增加到 23（50%）和 34（40%）。仅死产儿的增加具有统计学意义（卡方=9.4，p=0.002）。通过 CD34，在 23 例死产儿（50%）中发现了新的低血管绒毛簇或有内皮碎片的绒毛，而在活产儿中仅发现 29 例（31.5%）（卡方=9.4，p=0.002）。
与 H&E 染色相比，CD34 增加了死产儿胎盘检查中 FVM 的敏感性和/或升级，但在活产儿中则没有。
