Departments of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Reprod Sci. 2021 Feb;28(2):351-360. doi: 10.1007/s43032-020-00287-3. Epub 2020 Aug 18.
Placenta-associated pregnancy complications (fetal growth restriction and preeclampsia) are traditionally classified as "early" and "late" due to their different pathophysiology, histopathology, and pregnancy outcomes. As placental abruption (PA) represents another placenta-associated complication, we aimed to study if this categorization can be applied to PA as well. Pregnancy and placental reports of all pregnancies complicated by PA between November 2008 and January 2019 were reviewed. Maternal background, pregnancy outcomes, and placental histopathology were compared between cases of PA < 34 weeks (early PA group) vs. > 34 weeks (late PA group). Placental lesions were classified according to the "Amsterdam" criteria. The primary outcome was severe neonatal morbidity (≥ 1 severe neonatal complications: seizures, IVH, HIE, PVL, blood transfusion, NEC, or death). Included were 305 cases of PA, 71 (23.3%) in the early group and 234 (76.7%) in the late group. The early PA group was characterized by higher rates of vaginal bleeding upon presentation (p = 0.003), DIC (p = 0.018), and severe neonatal morbidity (p < 0.001). The late PA group was characterized by a higher rate of urgent Cesarean deliveries (p < 0.001). The early PA group was characterized by higher rates of placental maternal vascular malperfusion (MVM) lesions (p < 0.001), maternal inflammatory response (MIR) lesions (p < 0.001), placental hemorrhage (p < 0.001), and a lower feto-placental ratio (p < 0.001). Using regression analysis, we found that severe neonatal morbidity was independently associated with early abruption (aOR = 5.3, 95% CI = 3.9-7.6), placental MVM (aOR = 1.5, 95% CI = 1.2-1.9), placental MIR (aOR = 1.9, 95% CI = 1.4-2.3), and inversely associated with antenatal corticosteroids (aOR = 0.9, 95% CI = 0.6-0.98). "Early" and "late" PA significantly differ in their presentation, placental pathology, and pregnancy outcomes.
胎盘相关的妊娠并发症（胎儿生长受限和子痫前期）由于其不同的病理生理学、组织病理学和妊娠结局而传统上分为“早期”和“晚期”。由于胎盘早剥（PA）代表另一种与胎盘相关的并发症，我们旨在研究这种分类是否也适用于 PA。对 2008 年 11 月至 2019 年 1 月期间因 PA 而复杂化的所有妊娠的妊娠和胎盘报告进行了回顾。比较了 34 周前（早期 PA 组）与 34 周后（晚期 PA 组） PA 病例的母体背景、妊娠结局和胎盘组织病理学。根据“阿姆斯特丹”标准对胎盘病变进行分类。主要结局是严重新生儿发病率（≥1 种严重新生儿并发症：癫痫发作、IVH、HIE、PVL、输血、NEC 或死亡）。共纳入 305 例 PA 病例，其中 71 例（23.3%）为早期组，234 例（76.7%）为晚期组。早期 PA 组的特点是在就诊时出现阴道出血的比例较高（p=0.003）、DIC（p=0.018）和严重的新生儿发病率（p<0.001）。晚期 PA 组的特点是紧急剖宫产的比例较高（p<0.001）。早期 PA 组的胎盘母体血管灌注不良（MVM）病变（p<0.001）、母体炎症反应（MIR）病变（p<0.001）、胎盘出血（p<0.001）和胎-胎盘比（p<0.001）较高。通过回归分析，我们发现严重新生儿发病率与早期胎盘早剥（优势比[aOR]5.3，95%置信区间[CI]3.9-7.6）、胎盘 MVM（aOR 1.5，95%CI 1.2-1.9）、胎盘 MIR（aOR 1.9，95%CI 1.4-2.3）独立相关，与产前皮质类固醇（aOR 0.9，95%CI 0.6-0.98）呈负相关。“早期”和“晚期”PA 在表现、胎盘病理学和妊娠结局方面存在显著差异。
