Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Pathology, Haukeland University Hospital, Bergen, Norway.
BMC Pregnancy Childbirth. 2024 Mar 14;24(1):201. doi: 10.1186/s12884-024-06392-4.
To evaluate placental pathology in term and post-term births, investigate differences in clinical characteristics, and assess the risk of adverse neonatal outcome.
This prospective observational study included 315 singleton births with gestational age (GA) > 36 weeks + 6 days meeting the local criteria for referral to placental histopathologic examination. We applied the Amsterdam criteria to classify the placentas. Births were categorized according to GA; early-term (37 weeks + 0 days to 38 weeks + 6 days), term (39 weeks + 0 days to 40 weeks + 6 days), late-term (41 weeks + 0 days to 41 weeks + 6 days), and post-term births (≥ 42 weeks + 0 days). The groups were compared regarding placental pathology findings and clinical characteristics. Adverse neonatal outcomes were defined as 5-minute Apgar score < 7, umbilical cord artery pH < 7.0, admission to the neonatal intensive care unit or intrauterine death. A composite adverse outcome included one or more adverse outcomes. The associations between placental pathology, adverse neonatal outcomes, maternal and pregnancy characteristics were evaluated by logistic regression analysis.
Late-term and post-term births exhibited significantly higher rates of histologic chorioamnionitis (HCA), fetal inflammatory response, clinical chorioamnionitis (CCA) and transfer to neonatal intensive care unit (NICU) compared to early-term and term births. HCA and maternal smoking in pregnancy were associated with adverse outcomes in an adjusted analysis. Nulliparity, CCA, emergency section and increasing GA were all significantly associated with HCA.
HCA was more prevalent in late and post-term births and was the only factor, along with maternal smoking, that was associated with adverse neonatal outcomes. Since nulliparity, CCA and GA beyond term are associated with HCA, this should alert the clinician and elicit continuous intrapartum monitoring for timely intervention.
评估足月和过期产儿的胎盘病理情况，探讨其临床特征差异，并评估不良新生儿结局的风险。
本前瞻性观察性研究纳入了 315 例符合当地转诊胎盘组织病理学检查标准的孕龄（GA）＞36 周+6 天的单胎分娩。我们应用阿姆斯特丹标准对胎盘进行分类。根据 GA 将分娩分为早产（37 周+0 天至 38 周+6 天）、足月（39 周+0 天至 40 周+6 天）、晚期足月（41 周+0 天至 41 周+6 天）和过期产（≥42 周+0 天）。比较各组胎盘病理发现和临床特征。不良新生儿结局定义为 5 分钟 Apgar 评分＜7 分、脐动脉 pH＜7.0、新生儿重症监护病房入院或宫内死亡。复合不良结局包括 1 项或多项不良结局。通过逻辑回归分析评估胎盘病理、不良新生儿结局、产妇和妊娠特征之间的关系。
与早产和足月分娩相比，晚期足月和过期产的组织学绒毛膜羊膜炎（HCA）、胎儿炎症反应、临床绒毛膜羊膜炎（CCA）和转新生儿重症监护病房（NICU）的发生率显著更高。HCA 和妊娠期间母亲吸烟与调整后的不良结局相关。初产妇、CCA、急诊剖宫产术和 GA 增加均与 HCA 显著相关。
HCA 在晚期和过期产中更为普遍，是唯一与不良新生儿结局相关的因素，除了母亲吸烟以外。由于初产妇、CCA 和超过足月的 GA 与 HCA 相关，这应该提醒临床医生，并进行持续的产时监测以进行及时干预。
