Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU de Brest, Hôpital La Cavale Blanche, 29609 Brest Cedex, France; EA 3878, GETBO, Université Bretagne Loire, 29200 Brest, France.
EA 3878, GETBO, Université Bretagne Loire, 29200 Brest, France; Service de Gynécologie et d'Obstétrique, CHU de Brest, Hôpital Morvan, 29200 Brest, France.
Pregnancy Hypertens. 2021 Mar;23:59-65. doi: 10.1016/j.preghy.2020.11.004. Epub 2020 Nov 25.
We aimed at describing placental abruption in our county and at evaluating factors associated with poor fetal outcome.
In this case-control study, women with placental abruption were identified from two databases of Brest University Hospital between January 2013 and December 2018.
Placental histological findings, course of pregnancies, maternal and fetal characteristics were described and compared between cases (placental abruption with stillbirth or neonatal death) and controls.
We identified 135 placental abruption, of whom 24.4% were complicated with stillbirth and 6.5% with neonatal death. Forty percent of women were smokers and 14.1% had a history of vasculoplacental disorder. Pregnancies were complicated with 42.2% of pre-eclampsia and 43% of intrauterine growth restriction. Cases were associated with more autoimmune diseases in mother (20.0% versus 3.2%, P = 0.003), more aspirin or heparin use during pregnancy (20.0% versus 6.3%, P = 0.03), less pre-eclampsia (25.0% versus 49.5%, P = 0.01) and more deliveries ≤ 34 weeks of gestation (80.0% versus 43.2%, P = 0.0001) than controls. Placentas from cases showed more placental indentation ≥ 30% (42.5% versus 5.3%, P < 0.0001) and less histological chronic inflammation, especially less chronic chorioamniotitis (2.5% versus 24.2%, P = 0.002) than controls. In multivariate analysis, factors negatively associated with poor fetal outcome were placental histological chronic inflammation (P = 0.01) and macroscopic infarcts (P = 0.01).
Poor fetal outcome is negatively associated with certain placental histological chronic lesions, but not with pre-eclampsia, what suggests various pathophysiological processes among placental abruption.
我们旨在描述我县胎盘早剥的情况，并评估与不良胎儿结局相关的因素。
在这项病例对照研究中，我们从 2013 年 1 月至 2018 年 12 月布雷斯特大学医院的两个数据库中确定了胎盘早剥的患者。
描述和比较胎盘早剥患者（死胎或新生儿死亡）和对照组的胎盘组织学发现、妊娠过程、母亲和胎儿特征。
我们共发现 135 例胎盘早剥，其中 24.4%并发死胎，6.5%并发新生儿死亡。40%的女性为吸烟者，14.1%有血管胎盘疾病病史。妊娠合并子痫前期的发生率为 42.2%，宫内生长受限的发生率为 43%。与对照组相比，病例组母亲更易发生自身免疫性疾病（20.0% vs 3.2%，P=0.003），更易在孕期使用阿司匹林或肝素（20.0% vs 6.3%，P=0.03），子痫前期发生率更低（25.0% vs 49.5%，P=0.01），分娩孕周更早（≤34 周）的比例更高（80.0% vs 43.2%，P=0.0001）。与对照组相比，病例组胎盘更易出现≥30%的胎盘凹陷（42.5% vs 5.3%，P<0.0001），且组织学慢性炎症更少见，尤其是慢性绒毛膜羊膜炎更少见（2.5% vs 24.2%，P=0.002）。多变量分析显示，与不良胎儿结局相关的因素为胎盘组织学慢性炎症（P=0.01）和大体梗死（P=0.01）。
不良胎儿结局与某些胎盘组织学慢性病变呈负相关，与子痫前期无关，这提示胎盘早剥存在不同的病理生理过程。
