Guo Xiaojun, Wang Yixiao, Yu Hong
Department of Obstetrics and Gynecology, Southeast University Affiliated Zhongda Hospital, Nanjing, China.
Front Pediatr. 2023 Jun 15;11:1201991. doi: 10.3389/fped.2023.1201991. eCollection 2023.
To evaluate the relationship between maternal vascular malperfusion and acute intrauterine infection/inflammation with neonatal outcomes.
This was a retrospective study of women with singleton pregnancies who completed placenta pathological examination. The aim was to study the distribution of acute intrauterine infection/inflammation and maternal placental vascular malperfusion among groups with preterm birth and/or rupture of membranes. The relationship between two subtypes of placental pathology and neonatal gestational age, birth weight Z-score, neonatal respiratory distress syndrome, and intraventricular hemorrhage was further explored.
990 pregnant women were divided into four groups, including 651 term, 339 preterm, 113 women with premature rupture of membranes, and 79 with preterm premature rupture of membranes. The incidence of respiratory distress syndrome and intraventricular hemorrhage in four groups were (0.7%, 0.0%, 31.9%, 31.6%, < 0.001) and (0.9%, 0.9%, 20.0%, 17.7%, < 0.001), respectively. The incidence of maternal vascular malperfusion and acute intrauterine infection/inflammation were (82.0%, 77.0%, 75.8%, 72.1%, = 0.06) and (21.9%, 26.5%, 23.1%, 44.3%, P = 0.010), respectively. Acute intrauterine infection/inflammation was associated with shorter gestational age (adjusted difference -4.7 weeks, < 0.001) and decreased weight (adjusted Z score -2.6, < 0.001) than those with no lesions in preterm birth. When two subtype placenta lesions co-occurrence, shorter gestational age (adjusted difference -3.0 weeks, < 0.001) and decreased weight (adjusted Z score -1.8, < 0.001) were observed in preterm. Consistent findings were observed in preterm births with or without premature rupture of membranes. In addition, acute infection/inflammation and maternal placenta malperfusion alone or in combination were associated with an increased risk of neonatal respiratory distress syndrome (adjusted odds ratio (aOR) 0.8, 1.5, 1.8), but the difference was not statistically significant.
Maternal vascular malperfusion and acute intrauterine infection/inflammation alone or co-occurrence are associated with adverse neonatal outcomes, which may provide new ideas for clinical diagnosis and treatment.
评估母体血管灌注不良与急性宫内感染/炎症和新生儿结局之间的关系。
这是一项对完成胎盘病理检查的单胎妊娠女性进行的回顾性研究。目的是研究早产和/或胎膜破裂组中急性宫内感染/炎症和母体胎盘血管灌注不良的分布情况。进一步探讨胎盘病理的两种亚型与新生儿胎龄、出生体重Z评分、新生儿呼吸窘迫综合征和脑室内出血之间的关系。
990名孕妇分为四组，包括651名足月产孕妇、339名早产孕妇、113名胎膜早破孕妇和79名早产胎膜早破孕妇。四组中呼吸窘迫综合征和脑室内出血的发生率分别为（0.7%，0.0%，31.9%，31.6%，P<0.001）和（0.9%，0.9%，20.0%，17.7%，P<0.001）。母体血管灌注不良和急性宫内感染/炎症的发生率分别为（82.0%，77.0%，75.8%，72.1%，P=0.06）和（21.9%，26.5%，23.1%，44.3%，P=0.010）。与早产时无病变的孕妇相比，急性宫内感染/炎症与较短的孕周（校正差异-4.7周，P<0.001）和体重减轻（校正Z评分-2.6，P<0.001）相关。当两种亚型的胎盘病变同时出现时，早产时观察到较短的孕周（校正差异-3.0周，P<0.001）和体重减轻（校正Z评分-1.8，P<0.001）。在有或没有胎膜早破的早产中观察到一致的结果。此外，单独或联合出现的急性感染/炎症和母体胎盘灌注不良与新生儿呼吸窘迫综合征的风险增加相关（校正比值比（aOR）分别为0.8、1.5、1.8），但差异无统计学意义。
母体血管灌注不良和急性宫内感染/炎症单独或同时出现与不良新生儿结局相关，这可能为临床诊断和治疗提供新思路。
