Jaiman Sunil, Romero Roberto, Pacora Percy, Jung Eunjung, Bhatti Gaurav, Yeo Lami, Kim Yeon Mee, Kim Bomi, Kim Chong Jai, Kim Jung-Sun, Qureshi Faisal, Jacques Suzanne M, Erez Offer, Gomez-Lopez Nardhy, Hsu Chaur-Dong
Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA.
Department of Pathology, Hutzel Women's Hospital, Wayne State University School of Medicine, Detroit, MI, USA.
J Perinat Med. 2020 Apr 1. doi: 10.1515/jpm-2020-0030.
Objective The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. Methods This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women's Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks' gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37-42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Results Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. Conclusion This study demonstrates that placentas of women with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.
目的 本研究旨在确定胎儿死亡中绒毛成熟障碍的发生率，并明确胎儿死亡中的其他胎盘组织病理学病变。方法 这是一项对2004年1月至2016年1月期间在美国密歇根州底特律市胡策尔妇女医院发生的胎儿死亡进行的回顾性观察队列研究。病例包括妊娠20周后死亡的胎儿。排除有先天性异常和多胎妊娠的胎儿死亡。对照组包括无医学/产科并发症、分娩单胎、足月（37 - 42周）新生儿且5分钟阿氏评分≥7分、出生体重在第10百分位数和第90百分位数之间的孕妇。结果 92%（132/143）的胎儿死亡胎盘显示有胎盘组织学病变。胎儿死亡与以下情况相关：（1）绒毛成熟障碍的发生率更高[44.0%（64/143）对1.0%（4/405），P < 0.0001，患病率比为44.6；绒毛成熟延迟，22%（31/143）；绒毛成熟加速，20%（28/143）；成熟停滞，4%（5/143）]；（2）母体血管灌注不良病变的发生率更高[75.5%（108/143）对35.7%（337/944），P < 0.0001，患病率比为2.1]以及胎儿血管灌注不良病变的发生率更高[88.1%（126/143）对19.7%（186/944），P < 0.0001，患病率比为4.5]；（3）提示缺氧的胎盘组织学模式的发生率更高[59.0%（85/143）对9.3%（82/942），P < 0.0001，患病率比为6.8]；以及（4）慢性炎症病变的发生率更高[53.1%（76/143）对29.9%（282/944），P < 0.001，患病率比为1.8]。结论 本研究表明，与正常妊娠妇女的胎盘相比，胎儿死亡妇女的胎盘出现绒毛成熟障碍的可能性高44倍。这表明绒毛成熟障碍性胎盘病变的负担很重。
