Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India.
Pediatr Dev Pathol. 2024 Jan-Feb;27(1):59-66. doi: 10.1177/10935266231194161. Epub 2023 Oct 6.
Chronic placental inflammatory lesions (CPIL) include chronic deciduitis (CD), villitis of unknown etiology (VUE), and chronic chorioamnionitis (CCA). The frequency of these lesions and their relationship with various clinicopathological parameters in preterm birth (PTB) is presented.
Preterm placentas from April 2018 to December 2020 were reviewed for presence of CPIL. PTB was classified as spontaneous, indicated, or mixed phenotype. The association of CPIL with clinical parameters like gestational age, birth weight, obstetric complications, and placental parameters like placental dimensions, weight, vascular malperfusion, acute inflammatory lesions, and basal plate myometrial fibers were analyzed.
The study included 538 preterm placentas with 54.3% from indicated PTB. CD was more common (28.4%) than VUE (17.8%) and CCA (12.6%). CD showed significant association with VUE and CCA (both = .0001) and VUE with CCA ( = .0001). CD was more common in indicated PTB (33.8%, = .002) and associated with lower birth weight (1591 g vs 1705 g, = .003), lower placental weight (270.7 g vs 296.9 g, = .004), length (14.2 cm vs 14.8 cm, = .006), breadth (11.7 cm vs 12.2 cm, = .007), maternal vascular malperfusion ( = .004), and basal plate myometrial fibers ( = .02). High-grade and multifocal low-grade VUE was associated with reduced placental length (13.9 cm vs 14.6 cm, = .02)and breadth (11.5 cm vs 12.1 cm, = .01). CCA did not show any other association.
CPIL are common in PTB and their coexistence suggested a common pathogenic mechanism. Placental examination is the only definite way to identify as they lack clinical signs and symptoms. The smaller placental size associated with these lesions may suggest alter mechanisms for adverse pregnancy outcomes.
慢性胎盘炎症病变（CPIL）包括慢性蜕膜炎（CD）、原因不明的绒毛膜炎（VUE）和慢性绒毛膜羊膜炎（CCA）。本研究介绍了这些病变在早产（PTB）中的频率及其与各种临床病理参数的关系。
对 2018 年 4 月至 2020 年 12 月的早产胎盘进行 CPIL 检查。将 PTB 分为自发性、指征性或混合表型。分析 CPIL 与临床参数（如胎龄、出生体重、产科并发症）以及胎盘参数（如胎盘尺寸、重量、血管灌注不良、急性炎症病变、基底膜平滑肌纤维）之间的关系。
本研究纳入了 538 例早产胎盘，其中 54.3%为指征性 PTB。CD（28.4%）比 VUE（17.8%）和 CCA（12.6%）更为常见。CD 与 VUE 和 CCA 显著相关（均为 = .0001），而 VUE 与 CCA 相关（ = .0001）。CD 在指征性 PTB 中更为常见（33.8%， = .002），与较低的出生体重（1591 g 比 1705 g， = .003）、较低的胎盘重量（270.7 g 比 296.9 g， = .004）、长度（14.2 cm 比 14.8 cm， = .006）、宽度（11.7 cm 比 12.2 cm， = .007）、母胎血管灌注不良（ = .004）和基底膜平滑肌纤维（ = .02）相关。高级别和多灶性低级别 VUE 与胎盘长度（13.9 cm 比 14.6 cm， = .02）和宽度（11.5 cm 比 12.1 cm， = .01）缩短有关。CCA 未显示其他相关性。
CPIL 在 PTB 中很常见，它们的共存提示存在共同的发病机制。由于这些病变缺乏临床症状和体征，只有通过胎盘检查才能明确诊断。与这些病变相关的较小胎盘大小可能提示不良妊娠结局的发生机制不同。
