Perinatology Research Branch , Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, Detroit, MI, USA.
Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
J Perinat Med. 2022 Mar 4;50(5):553-566. doi: 10.1515/jpm-2021-0681. Print 2022 Jun 27.
To determine whether placental vascular pathology and impaired placental exchange due to maturational defects are involved in the etiology of spontaneous preterm labor and delivery in cases without histologic acute chorioamnionitis.
This was a retrospective, observational study. Cases included pregnancies that resulted in spontaneous preterm labor and delivery (<37 weeks), whereas uncomplicated pregnancies that delivered fetuses at term (≥37-42 weeks of gestation) were selected as controls. Placental histological diagnoses were classified into three groups: lesions of maternal vascular malperfusion, lesions of fetal vascular malperfusion, and placental microvasculopathy, and the frequency of each type of lesion in cases and controls was compared. Moreover, we specifically searched for villous maturational abnormalities in cases and controls. Doppler velocimetry of the umbilical and uterine arteries were performed in a subset of patients.
There were 184 cases and 2471 controls, of which 95 and 1178 had Doppler studies, respectively. The frequency of lesions of maternal vascular malperfusion was greater in the placentas of patients with preterm labor than in the control group [14.1% (26/184) vs. 8.8% (217/2471) (p=0.023)]. Disorders of villous maturation were more frequent in the group with preterm labor than in the control group: 41.1% (39/95) [delayed villous maturation in 31.6% (30/95) vs. 2.5% (13/519) in controls and accelerated villous maturation in 9.5% (9/95) vs. none in controls].
Maturational defects of placental villi were associated with approximately 41% of cases of unexplained spontaneous preterm labor and delivery without acute inflammatory lesions of the placenta and with delivery of appropriate-for-gestational-age fetuses.
确定无组织学急性绒毛膜羊膜炎的自发性早产和分娩病例中，胎盘血管病变和胎盘交换受损是否与成熟缺陷有关。
这是一项回顾性观察性研究。病例包括自发性早产和分娩（<37 周）的妊娠，而选择无并发症并在足月（≥37-42 孕周）分娩的妊娠作为对照。胎盘组织学诊断分为三组：母体血管灌注不良病变、胎儿血管灌注不良病变和胎盘微血管病变，并比较病例和对照组中每种病变的发生率。此外，我们还专门在病例和对照组中寻找绒毛成熟异常。对部分患者进行了脐动脉和子宫动脉多普勒血流速度检测。
共有 184 例病例和 2471 例对照，其中 95 例和 1178 例进行了多普勒研究。早产患者胎盘的母体血管灌注不良病变发生率高于对照组[14.1%（26/184）比 8.8%（217/2471）（p=0.023）]。早产组绒毛成熟障碍的发生率高于对照组：41.1%（39/95）[绒毛成熟延迟 31.6%（30/95）比对照组 2.5%（13/519），绒毛成熟加速 9.5%（9/95）比对照组无]。
胎盘绒毛成熟缺陷与约 41%的无明显炎症的不明原因自发性早产和分娩有关，且分娩的胎儿为适合胎龄儿。
