Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Pathology, The Edith Wolfson Medical Center, Holon, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Placenta. 2021 Jan 1;103:214-219. doi: 10.1016/j.placenta.2020.10.002. Epub 2020 Nov 5.
We aimed to compare obstetric and neonatal outcomes of deliveries complicated by meconium stained amniotic fluid (MSAF), according to placental histology of continuous vs. acute meconium associated changes.
This was a retrospective cohort study of singleton deliveries complicated by MSAF at a single university-affiliated medical center during 2008-2018. Obstetric and neonatal outcomes were compared between cases with placental acute vs. continuous meconium exposure associated changes (columnar epithelial changes and meconium-laden macrophages, respectively). Regression analysis was used to identify independent associations with adverse neonatal outcomes.
The medical records of 294 deliveries at our institution were reviewed, along with medical records of the neonates and the histopathological reports of their placentas. Ninety-two cases were classified as an acute placental reaction to meconium (acute exposure group) and 200 as continuous placental exposure (continuous exposure group). Patient demographics did not differ between groups. Placentas from the continuous exposure to meconium were associated with a higher rate of placental weight <10th percentile (p = 0.03) while the acute exposure group was associated with a shorter time between rupture of membranes and delivery (p = 0.02). and higher rates of non-reassuring fetal heart rate in labor (p = 0.003), and of adverse neonatal outcome (p = 0.02). In multivariable analysis adverse neonatal outcome was associated with acute histologic exposure to meconium independent of background confounders (aOR = 1.51, 95% CI 1.12-3.67).
Acute histological changes of MSAF were independently associated with adverse neonatal outcomes as compared to continuous histologic MSAF.
我们旨在比较因胎粪污染羊水（MSAF）而导致的分娩时的产科和新生儿结局，根据胎盘组织学表现为连续型或急性型胎粪相关改变。
这是一项回顾性队列研究，纳入了 2008 年至 2018 年期间在单一大学附属医院因 MSAF 而导致分娩复杂化的单胎妊娠病例。比较了胎盘表现为急性型或连续型胎粪暴露相关改变（柱状上皮改变和充满胎粪的巨噬细胞）的病例之间的产科和新生儿结局。采用回归分析来确定与不良新生儿结局相关的独立因素。
共回顾了 294 例我院病例的病历记录，以及新生儿病历记录和胎盘组织病理学报告。92 例病例被归类为急性胎盘对胎粪的反应（急性暴露组），200 例为连续胎盘暴露（连续暴露组）。两组患者的人口统计学特征无差异。与连续型胎粪暴露相关的胎盘更可能出现胎盘重量<第 10 百分位数（p=0.03），而急性暴露组胎膜破裂至分娩的时间更短（p=0.02）。急性暴露组的产时胎心监护结果不典型（p=0.003）和不良新生儿结局（p=0.02）的发生率更高。多变量分析显示，与背景混杂因素独立相关的不良新生儿结局与急性组织学胎粪暴露相关（aOR=1.51，95%CI 1.12-3.67）。
与连续型胎粪污染羊水的组织学表现相比，急性组织学改变与不良新生儿结局独立相关。
