Department of Pathology, Leiden University Medical Center, the Netherlands; Department of Obstetrics and Gynaecology, Leiden University Medical Center, the Netherlands.
Department of Pathology, Leiden University Medical Center, the Netherlands.
Placenta. 2020 Feb;91:19-23. doi: 10.1016/j.placenta.2020.01.001. Epub 2020 Jan 10.
Chronic intervillositis of unknown etiology (CIUE) is a histopathological lesion of the placenta that is frequently accompanied by unfavourable pregnancy outcomes, e.g. miscarriage, fetal growth restriction (FGR) and intrauterine fetal death. Earlier described case series and cohorts have been based on diverse diagnostic criteria of CIUE. To improve our understanding of clinical outcomes associated with CIUE, we report the obstetric and perinatal outcomes in a cohort based on the recently described diagnostic criteria.
CIUE is defined as an infiltrate occupying 5% or more of the intervillous space with approximately 80% of mononuclear cells positive for CD68 in the absence of an infection. Thirty-eight cases were included. Also previous and subsequent pregnancies were described.
Pregnancies accompanied by CIUE frequently resulted in FGR (51.6%) and pre-term birth (55.3%). Twenty-nine out of 38 pregnancies (76.3%) with CIUE resulted in a living baby. Women with CIUE frequently have had a miscarriage (16/38; 42%). Four-teen subsequent pregnancies in 8 women resulted in 2 miscarriages, 2 terminations of pregnancy for FGR, 1 early neonatal death and 9 living babies (9/14; 64.3%). Histopathologically confirmed CIUE recurred in 5 out of 10 subsequent pregnancies. Two pregnancies with recurrent CIUE were terminated, one pregnancy ended in a late miscarriage and another resulted in term birth complicated by FGR. Recurrent CIUE can also be accompanied by an uncomplicated pregnancy (1/5; 20%).
This study provides additional insight into the clinical phenotype of CIUE and emphasises the need for further research to understand the pathophysiology behind different pregnancy outcomes in CIUE.
病因不明的慢性绒毛膜炎（CIUE）是一种胎盘组织病理学病变，常伴有不良妊娠结局，如流产、胎儿生长受限（FGR）和宫内胎儿死亡。之前描述的病例系列和队列研究基于 CIUE 的不同诊断标准。为了更好地了解与 CIUE 相关的临床结局，我们报告了基于最近描述的诊断标准的队列研究中的产科和围产期结局。
CIUE 定义为绒毛间隙浸润，浸润面积占绒毛间隙的 5%或以上，且无感染时约 80%的单核细胞 CD68 阳性。共纳入 38 例病例。还描述了之前和之后的妊娠情况。
伴有 CIUE 的妊娠常导致 FGR（51.6%）和早产（55.3%）。38 例 CIUE 妊娠中有 29 例（76.3%）分娩出活婴。患有 CIUE 的女性常发生流产（16/38；42%）。8 名女性的 14 次后续妊娠中有 2 次流产、2 次因 FGR 终止妊娠、1 例新生儿早期死亡和 9 例活婴（9/14；64.3%）。10 次后续妊娠中有 5 次组织学证实的 CIUE 复发。2 次复发 CIUE 妊娠终止，1 次妊娠晚期流产，另 1 次妊娠足月但伴有 FGR。复发的 CIUE 也可伴有无并发症的妊娠（5/5；20%）。
本研究进一步了解了 CIUE 的临床表型，并强调需要进一步研究以了解 CIUE 不同妊娠结局背后的病理生理学。
