From the Department of Pathology, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, Massachusetts.
Arch Pathol Lab Med. 2020 Oct 1;144(10):1254-1261. doi: 10.5858/arpa.2019-0481-OA.
CONTEXT.—: The percentage of pregnant women with advanced maternal age (AMA) has increased during the past several decades due to various socioeconomic factors and advances in assisted reproduction. These pregnancies are associated with adverse maternal and fetal outcomes. However, the underlying placental pathology has not been well described.
OBJECTIVE.—: To investigate the placental histopathology associated with AMA pregnancies.
DESIGN.—: Placental pathology from 168 AMA women 35 years or older at delivery was reviewed. The cases were subdivided into 2 age subgroups, ages 35 to 39 and 40 or older, as well as a "pure AMA" subgroup where the only indication for placental examination was AMA. A group of 60 consecutive non-AMA placentas was also identified and used as comparison. The spectrum of histologic features in each case was catalogued.
RESULTS.—: Of the overall AMA cases, meconium deposition was seen in 55% (93 of 168), chorangiosis in 40% (68 of 168), and acute chorioamnionitis in 36% (60 of 168). Fetal vascular malperfusion was also seen with high frequency (30%; 50 of 168). Two histologic alterations found to be significantly different between the 35 to 39 and greater than 40 age subgroups were fetal vascular malperfusion (11% [7 of 65] versus 42% [43 of 103]; P = .001) and delayed villous maturation (1.5% [1 of 65] versus 13% [13 of 103]; P = .02). The pure AMA subgroup showed no statistically significant differences compared with the overall AMA group. Chronic deciduitis was the only statistically significant difference between the overall AMA group and the non-AMA comparison group (14% [23 of 168] versus 30% [18 of 60]; P = .02).
CONCLUSIONS.—: Our findings, particularly the high frequency of fetal vascular malperfusion, suggest that AMA should be an independent indication for placental pathologic examination.
由于各种社会经济因素和辅助生殖技术的进步，过去几十年中，高龄产妇（AMA）的比例有所增加。这些妊娠与不良的母婴结局相关。然而，其潜在的胎盘病理学尚未得到很好的描述。
研究与 AMA 妊娠相关的胎盘组织病理学。
回顾了 168 名年龄在 35 岁或以上分娩的 AMA 孕妇的胎盘病理。将病例分为 2 个年龄亚组，35 至 39 岁和 40 岁或以上，以及一个“纯 AMA”亚组，其中进行胎盘检查的唯一指征是 AMA。还确定了 60 例连续的非 AMA 胎盘作为对照。对每个病例的组织学特征进行了分类。
在所有 AMA 病例中，胎粪沉积占 55%（168 例中的 93 例），绒毛膜炎占 40%（168 例中的 68 例），急性绒毛膜羊膜炎占 36%（168 例中的 60 例）。也经常发现胎儿血管灌注不良（30%；168 例中的 50 例）。在 35 至 39 岁和大于 40 岁年龄亚组之间发现有两个组织学改变明显不同，即胎儿血管灌注不良（11%[7/65]与 42%[43/103]；P=.001）和绒毛成熟延迟（1.5%[1/65]与 13%[13/103]；P=.02）。纯 AMA 亚组与总体 AMA 组相比无统计学差异。慢性蜕膜炎是总体 AMA 组与非 AMA 对照组之间唯一具有统计学差异的病变（14%[23/168]与 30%[18/60]；P=.02）。
我们的研究结果，特别是胎儿血管灌注不良的高频率，表明 AMA 应该是胎盘病理检查的独立指征。
