Lv Dan, Li Xu-Fang, Chen Shi-Yao, Leakana Praseth, Han Jia-Qi, Xian Jun-Rong, Li Fan-Fan, He Meng-Zhou, Fan Yao, Xu He-Ze, Liu Li, Li Wei, Lin Xing-Guang, Ye Fang, Deng Dong-Rui
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Curr Med Sci. 2025 May 28. doi: 10.1007/s11596-025-00062-y.
Great obstetrical syndrome (GOS) represents a group of pregnancy-related diseases that result in inadequate placentation. Most GOS cases end in preterm, either spontaneously or indicatively, and the use of antenatal corticosteroids (ACS) is inevitably discussed. The placenta is an important, transient fetal-derived organ and is the embodiment of maternal or fetal well-being. However, few studies provide histological evidence of the placenta in GOS. This study aims to address these issues.
A total of 831 pregnant women were prospectively recruited. Placenta tissue was collected immediately and fixed with 4% paraformaldehyde solution for future H&E analysis. A novel checklist was devised to evaluate maternal vascular malperfusion sections on the basis of the commonly accepted Amsterdam placental workshop group consensus statement.
A total of 131 patients were classified as having GOS. Comparisons between those with and without GOS revealed significant differences, including higher levels of distal villous hypoplasia, increased syncytial knots, accelerated villous maturation, and higher total scores in GOS. We found significant negative associations between GOS and neonatal weight, neonatal height, head circumference, placental surface area, placental volume, and placenta gross examination score. GOS neonates were 1.25 times more likely to have hyperbilirubinemia. Regarding the effect of ACS, a significant reduction in birthweight, height, and head circumference was observed, along with an increased risk of hyperbilirubinemia.
This study provides histological evidence of the GOS that supports the defective deep placentation hypothesis. Our research also contributes to benefit-risk consultation in the GOS, such as in cases of PE and FGR, where a balance between fetal lung maturation and short-term neonatal outcomes is crucial.
严重产科综合征（GOS）代表一组与妊娠相关的疾病，这些疾病会导致胎盘形成不足。大多数GOS病例以早产告终，无论是自发早产还是医源性早产，因此不可避免地会讨论产前使用糖皮质激素（ACS）的问题。胎盘是一个重要的、短暂的胎儿来源器官，是母体或胎儿健康的体现。然而，很少有研究提供GOS中胎盘的组织学证据。本研究旨在解决这些问题。
前瞻性招募了831名孕妇。胎盘组织立即采集，并用4%多聚甲醛溶液固定，以备将来进行苏木精-伊红（H&E）分析。根据普遍接受的阿姆斯特丹胎盘研讨会小组共识声明，设计了一种新颖的检查表来评估母体血管灌注不良切片。
共有131例患者被归类为患有GOS。GOS患者与非GOS患者之间的比较显示出显著差异，包括远端绒毛发育不全水平更高、合体结节增加、绒毛成熟加速以及GOS中的总分更高。我们发现GOS与新生儿体重、新生儿身高、头围、胎盘表面积、胎盘体积和胎盘大体检查评分之间存在显著负相关。GOS新生儿患高胆红素血症的可能性高1.25倍。关于ACS的影响，观察到出生体重、身高和头围显著降低，同时高胆红素血症风险增加。
本研究提供了GOS的组织学证据，支持胎盘植入缺陷假说。我们的研究还为GOS中的获益-风险咨询做出了贡献，例如在子痫前期和胎儿生长受限的病例中，胎儿肺成熟与短期新生儿结局之间的平衡至关重要。
