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胎盘分级与围产期结局的关联：一项系统评价与荟萃分析

The Association of Placental Grading with Perinatal Outcomes: A Systematic Review and Meta-Analysis.

作者信息

Siargkas Antonios, Pachi Christina, Nigdelis Meletios P, Stavros Sofoklis, Domali Ekaterini, Mamopoulos Apostolos, Tsakiridis Ioannis, Dagklis Themistoklis

机构信息

Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Agiou Dimitriou, 54124 Thessaloniki, Greece.

Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center (UKS), 66421 Homburg, Germany.

出版信息

Diagnostics (Basel). 2025 May 15;15(10):1264. doi: 10.3390/diagnostics15101264.

DOI:10.3390/diagnostics15101264
PMID:40428256
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12109751/
Abstract

: Premature placental calcification (PPC) has been implicated in adverse perinatal outcomes, yet its clinical significance remains controversial. This meta-analysis aimed to quantitatively synthesize current data on the association between PPC, defined as grade 3 placental calcification before 36 weeks of gestation and adverse perinatal outcomes. Data Sources: A systematic search was conducted in MEDLINE, Scopus and The Cochrane Library from inception until 11 March 2025, to identify eligible studies. Study Eligibility Criteria: Observational studies including singleton pregnancies with PPC diagnosed via ultrasonography between 28 and 36 weeks of gestation and comparing them with pregnancies with Grannum grade 0, 1, or 2 placentas were considered eligible. : Study quality was assessed using the Newcastle-Ottawa Scale, and the risk of bias was evaluated with the Quality In Prognosis Studies tool. The primary outcomes were small-for-gestational-age (SGA) neonates and preeclampsia. Heterogeneity was assessed using Cochran's Q test and the I statistic. Meta-analyses were conducted using a random-effects model, with outcomes reported as relative risk (RR) or mean difference (MD) with 95% confidence intervals (CIs). : In total, nine cohort studies were included. PPC was associated with an increased risk of SGA (RR, 1.99; 95% CI, 1.46-2.70), preeclampsia (RR, 5.27; 95% CI, 2.24-12.40), fetal growth restriction (RR, 2.31; 95% CI, 1.30-4.09), preterm delivery (RR, 2.11; 95% CI, 1.00-4.45), suspected fetal hypoxia (RR, 1.71; 95% CI, 1.13-2.56), low 5 min Apgar score (RR, 2.28; 95% CI, 1.50-3.44) and neonatal intensive care unit admission (RR, 1.80; 95% CI, 1.02-3.18). No significant associations were found with fetal or neonatal death (RR, 2.75; 95% CI, 0.87-8.71), cesarean delivery (RR, 1.26; 95% CI, 0.90-1.78), gestational diabetes mellitus (RR, 1.17; 95% CI, 0.81-1.70), neonatal resuscitation (RR, 1.04; 95% CI, 0.92-1.16), birthweight (MD, -187.46 g; 95% CI, -413.14 to +38.21), or gestational age at birth (MD, -0.62 weeks; 95% CI, -1.36 to +0.11). A sensitivity analysis excluding high-risk-of-bias studies yielded consistent results. : PPC is associated with several adverse perinatal outcomes, including SGA and preeclampsia. While the clinical significance of placental grading has remained limited in recent years, this study has shown that PPC may serve as an early indicator of placental insufficiency, warranting enhanced fetal surveillance and risk assessment in affected pregnancies. Further research is needed to refine its prognostic utility and integration into obstetric practice.

摘要

早产胎盘钙化（PPC）与不良围产期结局有关，但其临床意义仍存在争议。本荟萃分析旨在定量综合目前关于PPC（定义为妊娠36周前3级胎盘钙化）与不良围产期结局之间关联的数据。数据来源：对MEDLINE、Scopus和Cochrane图书馆从创刊至2025年3月11日进行系统检索，以识别符合条件的研究。研究纳入标准：观察性研究，包括单胎妊娠，在妊娠28至36周期间经超声诊断为PPC，并将其与Grannum 0级、1级或2级胎盘的妊娠进行比较，被认为符合条件。研究质量使用纽卡斯尔-渥太华量表进行评估，偏倚风险使用预后研究质量工具进行评估。主要结局为小于胎龄（SGA）新生儿和子痫前期。使用Cochran's Q检验和I统计量评估异质性。荟萃分析使用随机效应模型进行，结果报告为相对风险（RR）或平均差（MD）及95%置信区间（CI）。总共纳入了9项队列研究。PPC与SGA风险增加（RR，1.99；95%CI，1.46 - 2.70）、子痫前期（RR，5.27；95%CI，2.24 - 12.40）、胎儿生长受限（RR，2.31；95%CI，1.30 - 4.09）、早产（RR，2.11；95%CI，1.00 - 4.45）、疑似胎儿缺氧（RR，1.71；95%CI，1.13 - 2.56）、5分钟阿氏评分低（RR，2.28；95%CI，1.50 - 3.44）和新生儿重症监护病房收治（RR，1.80；95%CI，1.02 - 3.18）相关。未发现与胎儿或新生儿死亡（RR，2.75；95%CI，0.87 - 8.71）、剖宫产（RR，1.26；95%CI，0.90 - 1.78）、妊娠期糖尿病（RR，1.17；95%CI，0.81 - 1.70）、新生儿复苏（RR，1.04；95%CI，0.92 - 1.16）、出生体重（MD， - 187.46 g；95%CI， - 413.14至 + 38.21）或出生孕周（MD， - 0.62周；95%CI， - 1.36至 + 0.11）有显著关联。排除高偏倚风险研究的敏感性分析得出了一致的结果。PPC与多种不良围产期结局相关，包括SGA和子痫前期。虽然近年来胎盘分级的临床意义仍然有限，但本研究表明PPC可能是胎盘功能不全的早期指标，并需要在受影响的妊娠中加强胎儿监测和风险评估。需要进一步研究以完善其预后效用并将其纳入产科实践。

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