Tiwari Purnima, Gupta Madhavi M, Jain Shyama Lata
Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences Nagpur, Nagpur, India.
Department of Obstetrics & Gynaecology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India.
J Perinat Med. 2021 Sep 30;50(6):753-762. doi: 10.1515/jpm-2021-0179. Print 2022 Jul 26.
Placental examination in a case of stillbirth can provide insight into causative/associated factors with fetal demise. The aim of this study was to compare placental and umbilical cord pathologies in singleton stillbirth and livebirth placentas, and to find prevalence of various associated maternal and fetal clinical factors.
This case-control study was conducted at a tertiary-care center in India over a period of 20 months. About 250 women who delivered stillborn fetus ≥28 weeks' gestation and 250 maternal-age-matched controls were recruited. Sociodemographic and clinical details were noted and placental gross and microscopic examination was done. Placental findings were compared between stillbirth and livebirth (overall), preterm stillbirth and preterm livebirth as well as term stillbirth and term livebirth in six categories - placenta gross, cord gross, membranes gross, maternal vascular malperfusion, fetal vascular malperfusion and inflammatory response. Prevalence of 11 maternal and fetal factors were studied in all categories of placental findings in both livebirth and stillbirth.
Placental findings in all six categories were significantly associated with stillbirths (p<0.05). The placental findings associated with stillbirth with highest odds included placental hypoplasia (OR 9.77, 95% CI 5.46-17.46), necrotizing chorioamnionitis (OR 9.30, 95% CI 1.17-73.96) and avascular villi (OR 8.45, 95% CI 3.53-20.25). More than half of the women with stillbirths had medical disorders (n=130, 52.0%) and the most prevalent was hypertensive disorder (n=45, 18.0%).
Changes in placenta are associated with development of stillbirth. Therefore, antenatal investigations to identify placental dysfunction should be investigated to determine whether these reduce stillbirth. Also, placental examination in a case of stillbirth can detect/diagnose many maternal/fetal conditions and thereby can help in preventing future stillbirths.
对死产病例进行胎盘检查有助于深入了解胎儿死亡的病因/相关因素。本研究旨在比较单胎死产和活产胎盘的胎盘及脐带病理情况，并找出各种相关母体和胎儿临床因素的患病率。
本病例对照研究在印度一家三级医疗中心进行，为期20个月。招募了约250名孕周≥28周的死产胎儿产妇以及250名年龄匹配的产妇作为对照。记录社会人口统计学和临床细节，并进行胎盘大体及显微镜检查。比较死产和活产（总体）、早产死产和早产活产以及足月死产和足月活产之间的胎盘检查结果，分为六个类别——胎盘大体、脐带大体、胎膜大体、母体血管灌注不良、胎儿血管灌注不良和炎症反应。研究了活产和死产中所有胎盘检查结果类别中11种母体和胎儿因素的患病率。
所有六个类别的胎盘检查结果均与死产显著相关（p<0.05）。与死产关联度最高的胎盘检查结果包括胎盘发育不全（比值比9.77，95%置信区间5.46 - 17.46）、坏死性绒毛膜羊膜炎（比值比9.30，95%置信区间1.17 - 73.96）和无血管绒毛（比值比8.45，95%置信区间3.53 - 20.25）。超过一半的死产产妇患有疾病（n = 130，52.0%），最常见的是高血压疾病（n = 45，18.0%）。
胎盘变化与死产的发生有关。因此，应研究产前检查以识别胎盘功能障碍，以确定这些检查是否能降低死产率。此外，对死产病例进行胎盘检查可检测/诊断多种母体/胎儿疾病，从而有助于预防未来的死产。
