局限性胎盘嵌合体：磁共振成像评估胎盘大小和功能。

Confined placental mosaicism: placental size and function evaluated on magnetic resonance imaging.

机构信息

Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.

Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

出版信息

Ultrasound Obstet Gynecol. 2023 Jul;62(1):130-136. doi: 10.1002/uog.26174.

DOI:10.1002/uog.26174

PMID:36730148

Abstract

OBJECTIVES

Evidence regarding placental function in pregnancies complicated by confined placental mosaicism (CPM) is conflicting. We aimed to compare placental function between CPM and non-CPM pregnancies prenatally and at birth. A secondary objective was to evaluate the relationship between placental function and chromosomal subtype of CPM.

METHODS

This was a retrospective study of pregnancies with CPM and control pregnancies delivered at a tertiary hospital in Denmark between 2014 and 2017. Placental volume and placental transverse relaxation time (T2*) were estimated on magnetic resonance imaging (MRI), fetal weight and uterine artery pulsatility index (UtA-PI) were estimated on ultrasound and fetoplacental ratio was assessed on MRI and at birth. These estimates of placental function were adjusted for gestational age and compared between groups using the Wilcoxon rank-sum test. Within the group of CPM pregnancies, measures of placental function were compared between those at high risk (chromosome numbers 2, 3, 7, 13 and 16) and those at low risk (chromosome numbers 5, 18 and 45X).

RESULTS

A total of 90 pregnancies were included, of which 12 had CPM and 78 were controls. MRI and ultrasound examinations were performed at a median gestational age of 32.6 weeks (interquartile range, 24.7-35.3 weeks). On MRI assessment, CPM placentae were characterized by a lower placental T2* Z-score (P = 0.004), a lower fetoplacental ratio (P = 0.03) and a higher UtA-PI Z-score (P = 0.03), compared with non-CPM placentae. At birth, the fetoplacental ratio was significantly lower (P = 0.02) and placental weight Z-score was higher (P = 0.01) in CPM pregnancies compared with non-CPM pregnancies. High-risk CPM pregnancies showed a reduced placental T2* Z-score (P = 0.003), lower birth-weight Z-score (P = 0.041), earlier gestational age at delivery (P = 0.019) and higher UtA-PI Z-score (P = 0.028) compared with low-risk CPM pregnancies. Low-risk CPM pregnancies did not differ in any of these parameters from non-CPM pregnancies.

CONCLUSIONS

CPM pregnancies are characterized by an enlarged and dysfunctional placenta. Placental function was highly related to the chromosomal type of CPM; placental dysfunction was seen predominantly in high-risk CPM pregnancies in which chromosomes 2, 3, 7, 13 or 16 were involved. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

摘要

目的

关于胎盘功能在局限型胎盘嵌合体（CPM）合并妊娠中的证据存在争议。我们旨在比较 CPM 和非 CPM 妊娠的产前和出生时的胎盘功能。次要目的是评估胎盘功能与 CPM 的染色体亚型之间的关系。

方法

这是一项在丹麦一家三级医院进行的回顾性研究，纳入了 2014 年至 2017 年间患有 CPM 和对照妊娠的孕妇。通过磁共振成像（MRI）估计胎盘体积和胎盘横向弛豫时间（T2*），通过超声估计胎儿体重和子宫动脉搏动指数（UtA-PI），并通过 MRI 和出生时评估胎-胎盘比。这些胎盘功能的估计值根据胎龄进行了调整，并使用 Wilcoxon 秩和检验比较了各组之间的差异。在 CPM 妊娠组中，比较了高危（染色体数 2、3、7、13 和 16）和低危（染色体数 5、18 和 45X）CPM 妊娠的胎盘功能指标。

结果

共纳入 90 例妊娠，其中 12 例为 CPM，78 例为对照组。MRI 和超声检查在中位妊娠 32.6 周（四分位距 24.7-35.3 周）进行。在 MRI 评估中，与非 CPM 胎盘相比，CPM 胎盘的胎盘 T2Z 分数较低（P=0.004）、胎-胎盘比低（P=0.03）和 UtA-PI Z 分数较高（P=0.03）。在出生时，CPM 妊娠的胎-胎盘比显著较低（P=0.02），胎盘重量 Z 分数较高（P=0.01）。与非 CPM 妊娠相比，高危 CPM 妊娠的胎盘 T2Z 分数较低（P=0.003）、出生体重 Z 分数较低（P=0.041）、分娩时的胎龄较早（P=0.019）和 UtA-PI Z 分数较高（P=0.028）。低危 CPM 妊娠在这些参数上与非 CPM 妊娠无差异。