Li T Y, Zhang Y
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Aug 18;55(4):758-761. doi: 10.19723/j.issn.1671-167X.2023.04.031.
Globular placenta is a rare type of abnormal placental morphology. It shows small placental volume and placental thickening on imaging, and the placental edge is round and blunt. Some studies have pointed out that it may be due to the invasion of superficial villi into maternal tissue and insufficient transformation of spiral arterioles. It leads to placental ischemia, and early poor perfusion causes abnormal placenta morphology, which is manifested as fibrin deposition around the villi under the microscope. Because the effective exchange area of the globular placenta is smaller than that of the normal placenta, its influence on the fetus gradually appears with the increase of gestational age. Studies have observed that placental volume and placental thickness are associated with fetal growth restriction during pregnancy. Growth-restricted fetuses are at increased risk for perinatal diseases such as intraventricular hemorrhage, periventricular leukomalacia, respiratory distress syndrome, necrotizing enterocolitis, etc. Hemodynamic parameters will reflect the problem of placental perfusion, such as the peak systolic/diastolic blood flow of the uterine artery and umbilical artery, etc. During pregnancy, these two ultrasound indicators and placental morphology should be monitored to detect the disease at an early stage and in the early stage of disease progression. The use of drug intervention may improve perinatal outcomes, but the current clinical evidence is insufficient. Most physicians use empirical treatment, that is, to improve placental circulation and increase perfusion, but there is currently no obvious effective drug. There is no consensus on the doses of drugs such as aspirin and heparin, and the reported obstetric outcomes vary from study to study. In order to better treat these diseases, provide more adequate clinical data, and lay the foundation for further research in the later period, this report describes a young woman who was treated in our hospital. This report describes a young woman who presented to our hospital with a thickening of the placenta on mid-trimester ultrasonography, aggressive use of drug therapy and close follow-up when the fetus did not lag behind, and who developed fetal lag in the third trimester and was accompanied by The fetus was hemodynamically abnormal, and a live birth was obtained after timely termination of the pregnancy, but early necrotizing enteritis developed. Finally, we combined the literature review to understand the pathological mechanism, clinical characteristics, disease prognosis and corresponding treatment methods of the disease.
球形胎盘是一种罕见的胎盘形态异常类型。影像学上表现为胎盘体积小且胎盘增厚，胎盘边缘圆钝。一些研究指出，这可能是由于浅表绒毛侵入母体组织以及螺旋小动脉转化不足所致。这会导致胎盘缺血，早期灌注不良导致胎盘形态异常，显微镜下表现为绒毛周围有纤维蛋白沉积。由于球形胎盘的有效交换面积小于正常胎盘，其对胎儿的影响会随着孕周增加而逐渐显现。研究观察到，胎盘体积和胎盘厚度与孕期胎儿生长受限有关。生长受限的胎儿患围产期疾病的风险增加，如脑室内出血、脑室周围白质软化、呼吸窘迫综合征、坏死性小肠结肠炎等。血流动力学参数会反映胎盘灌注问题，如子宫动脉和脐动脉的收缩期/舒张期血流峰值等。孕期应监测这两个超声指标及胎盘形态，以便在疾病早期及疾病进展早期进行检测。药物干预的使用可能改善围产期结局，但目前临床证据不足。大多数医生采用经验性治疗，即改善胎盘循环并增加灌注，但目前尚无明显有效的药物。对于阿司匹林和肝素等药物的剂量尚无共识，且不同研究报道的产科结局各异。为了更好地治疗这些疾病，提供更充分的临床数据，并为后期进一步研究奠定基础，本报告描述了一名在我院接受治疗的年轻女性。本报告描述了一名年轻女性，她在孕中期超声检查时发现胎盘增厚，在胎儿未出现生长迟缓时积极采用药物治疗并密切随访，而在孕晚期出现胎儿生长迟缓并伴有胎儿血流动力学异常，及时终止妊娠后获得活产，但随后出现早期坏死性小肠结肠炎。最后，我们结合文献综述来了解该疾病的病理机制、临床特征、疾病预后及相应的治疗方法。
