Department of Pathology, St. John's Medical College, Bangalore, India, 560076.
Placenta. 2024 Jul;152:9-16. doi: 10.1016/j.placenta.2024.05.124. Epub 2024 May 6.
Placental abnormalities can precipitate preterm birth (PTB), a principal contributor to neonatal morbidity and mortality. This study targets understanding placental variations among different gestational age-based categories of PTB.
A three-year retrospective study conducted a detailed clinicopathological analysis of PTB placentas categorized by gestational age: extremely preterm (EPTB,<28 weeks), very preterm (VPTB, 28 to 31 + 6 weeks), moderate preterm (MPTB, 32 to 33 + 6 weeks), and late preterm (LPTB, 34 to 36 + 6 weeks). Macroscopic parameters sourced from pathology records and microscopic examination assessed for maternal and fetal stromal-vascular lesions, inflammatory and hypoxic lesions and others. Stillbirths/intrauterine demise and multifetal gestation were excluded. Clinical data were gathered from medical records.
A total of 645 preterm placentas were received and 538 were included. The majority were LPTB(46.3 %), while EPTB, VPTB and MPTB accounted for 5.8 %, 28.4 % and 19.5 % respectively. Low birth weight and low Apgar were prevalent in EPTB(p < 0.001), while obstetric complications were higher in other PTB categories. Placental infarction was higher in VPTB and MPTB(p = 0.006). On microscopy, maternal (48.4 %), fetal (29 %) inflammatory response and villous edema (48.4 %) was higher in EPTB(p = 0.04 & p < 0.001 respectively), while maternal stromal-vascular lesions were higher in VPTB and MPTB(67.3 % & 64.8 %, p < 0.001). Delayed villous maturation (17.7 %,p = 0.02), chronic chorioamnionitis (11.3 %,p = 0.02), membrane hypoxia (38.6 %,p = 0.007), and massive fibrin deposition (10.8 %,p < 0.001) featured higher in LPTB.
Acute inflammatory pathology was common in EPTB, strongly suggesting inflammation in triggering parturition. Frequent obstetric complications and maternal stromal-vascular lesions in VPTB and MPTB may underscore maternal vascular compromise in this group. Villous maturation defects, chronic chorioamnionitis, massive fibrin deposition and membrane hypoxia in LPTB, likely contribute to long-term neonatal morbidity.
本研究旨在了解不同胎龄早产（PTB）分类中的胎盘差异。
这是一项为期三年的回顾性研究，对根据胎龄分类的 PTB 胎盘进行了详细的临床病理分析：极早产（EPTB，<28 周）、非常早产（VPTB，28 至 31+6 周）、中度早产（MPTB，32 至 33+6 周）和晚期早产（LPTB，34 至 36+6 周）。从病理记录和显微镜检查中获取宏观参数，评估母体和胎儿基质-血管病变、炎症和缺氧病变等。排除死胎/宫内死亡和多胎妊娠。临床数据来自病历。
共接收了 645 例早产胎盘，其中 538 例被纳入研究。大多数为 LPTB（46.3%），而 EPTB、VPTB 和 MPTB 分别占 5.8%、28.4%和 19.5%。EPTB 中低出生体重和低 Apgar 更为常见（p<0.001），而其他 PTB 类别中产科并发症更高。VPTB 和 MPTB 的胎盘梗死发生率更高（p=0.006）。显微镜下，EPTB 母体（48.4%）、胎儿（29%）炎症反应和绒毛水肿（48.4%）更高（p=0.04 和 p<0.001），而 VPTB 和 MPTB 的母体基质-血管病变更高（67.3%和 64.8%，p<0.001）。绒毛成熟延迟（17.7%，p=0.02）、慢性绒毛膜羊膜炎（11.3%，p=0.02）、膜缺氧（38.6%，p=0.007）和大量纤维蛋白沉积（10.8%，p<0.001）在 LPTB 中更为常见。
EPTB 中常见急性炎症性病理学，强烈提示炎症在引发分娩中起作用。VPTB 和 MPTB 中频繁的产科并发症和母体基质-血管病变可能表明该组存在母体血管损伤。LPTB 中绒毛成熟缺陷、慢性绒毛膜羊膜炎、大量纤维蛋白沉积和膜缺氧可能导致长期新生儿发病率增加。
