Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands.
Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:45-56. doi: 10.1016/j.ejogrb.2021.04.042. Epub 2021 May 4.
An antepartum screening method to determine normal and abnormal placental function is desirable in the prevention of maternal and fetal pregnancy complications. Placental appearance can easily be obtained and evaluated using 2D ultrasonography, but surprisingly little is known about the change in placental appearance during gestation. Aim of this systematic review was to describe the antepartum placental appearance in placenta syndrome (PS) pregnancies, and to compare this to the appearance in healthy pregnancies.
A systematic review investigating placental thickness, -lakes and/or -calcifications by ultrasound examination in both uncomplicated (reference group) and PS pregnancies in relation to gestational age was performed. English literature was searched using PubMed (NCBI), EMBASE (Ovid) and the Cochrane Library, from database inception until September 2020. Data on placental thickness was presented as a continuous variable or as the proportion of abnormal placental thickness. Data on placental lakes and -calcifications was presented as prevalence (%). There was no restriction applied on the definition of placental lakes or -calcifications. Due to heterogeneity, pooling of the results was not performed.
A total of 28 studies were included describing 1719 PS cases; consisting of 370 (21 %) cases with preeclampsia or pregnancy induced hypertension, 1341 (78 %) cases with fetal growth restriction (FGR) or small for gestational age (SGA), and 8 (1%) cases with combined clinical expressions. In addition, the reference group comprised 3315 pregnant women. Placental thickness showed an increase between the first and second trimester, which was higher in PS- compared to uncomplicated pregnancies. Placental lakes were frequently observed in FGR and SGA pregnancies, especially in the second trimester. Grade 3 calcifications were most prominent in the PS pregnancies, specifically in the late second and third trimester. Moreover, in the reference group, no grade 3 calcifications were reported before 35 weeks of gestation.
Placental appearance in PS-pregnancies shows higher placental thickness and greater presence of placental lakes and -calcifications compared to uncomplicated pregnancies. Standardized definitions of (ab-)normal placental appearance and longitudinal research in both healthy and complicated pregnancies are needed to improve personalized obstetric care.
为了预防母婴妊娠并发症，理想情况下需要一种能够对正常和异常胎盘功能进行产前筛查的方法。二维超声检查可轻松获得并评估胎盘外观，但令人惊讶的是，人们对妊娠期间胎盘外观的变化知之甚少。本系统综述的目的是描述胎盘综合征（PS）妊娠中的产前胎盘外观，并将其与健康妊娠中的胎盘外观进行比较。
通过超声检查对未合并 PS（参考组）和 PS 妊娠的胎盘厚度、胎盘小凹和/或胎盘钙化进行系统评价，以评估与胎龄的关系。使用 PubMed（NCBI）、EMBASE（Ovid）和 Cochrane Library 进行英文文献检索，检索范围从数据库建立到 2020 年 9 月。胎盘厚度数据以连续变量或异常胎盘厚度的比例呈现。胎盘小凹和胎盘钙化的数据以患病率（%）呈现。未对胎盘小凹或胎盘钙化的定义进行限制。由于存在异质性，因此未对结果进行汇总。
共纳入 28 项研究，共描述了 1719 例 PS 病例；其中 370 例（21%）为子痫前期或妊娠高血压，1341 例（78%）为胎儿生长受限或小于胎龄儿（SGA），8 例（1%）为合并临床表现。此外，参考组包括 3315 名孕妇。胎盘厚度在第一和第二孕期之间增加，PS 妊娠中的胎盘厚度高于未合并 PS 的妊娠。胎盘小凹在胎儿生长受限和 SGA 妊娠中较为常见，尤其是在第二孕期。3 级钙化在 PS 妊娠中最为突出，特别是在第二和第三孕期晚期。此外，在参考组中，在 35 周妊娠前未报告 3 级钙化。
与未合并 PS 的妊娠相比，PS 妊娠中的胎盘外观表现为胎盘厚度增加、胎盘小凹和胎盘钙化更为常见。需要对正常和异常胎盘外观进行标准化定义，并对健康和复杂妊娠进行纵向研究，以改善个体化产科护理。
