Altshuler G
Department of Pathology, Children's Hospital of Oklahoma, Oklahoma City 73126.
Semin Diagn Pathol. 1993 Aug;10(3):204-21.
This report focuses on the relationship of placental pathology to unfavorable pregnancy outcome. Relevant literature is cited and data from the author's investigations are reported and tabulated. The reader will find detailed information on placental lesions that have not been completely investigated or discussed previously. Particular considerations include placental meconium staining, edema, acute and chronic intrauterine infections, placental fetal vasculopathy with fetal nucleated red blood cells, and chorangiosis or other placental dysmaturity. These pathologic changes often signify the pathogenesis of cerebral palsy and other developmental disorders. Almost 90% of neurodevelopmental disorders are initiated before the intrapartum period. Prenatal asphyxia or severe chronic fetal hypoxia are probably present therein. Most investigations of these afflictions are invalid because they do not include placental study with well-designed epidemiologic methods. The pathologic placental findings that are most strongly associated with perinatal asphyxia include chronic ischemic changes, fetal nucleated red blood cells, intravillous hemorrhage, fetal fibrin vascular intimal cushions, meconium staining, and placental intervillous fibrin. Chorioamnionitis is a pathologic entity rather than a clinical syndrome as defined by obstetricians. When it causes severe prematurity, chorioamnionitis is also associated with cerebral palsy.
本报告重点关注胎盘病理学与不良妊娠结局之间的关系。文中引用了相关文献，并报告和列表展示了作者调查的数据。读者将找到关于此前尚未得到充分研究或讨论的胎盘病变的详细信息。特别需要考虑的因素包括胎盘胎粪染色、水肿、急慢性宫内感染、伴有胎儿有核红细胞的胎盘胎儿血管病变，以及绒毛膜血管病或其他胎盘发育不成熟。这些病理变化往往预示着脑瘫和其他发育障碍的发病机制。几乎90%的神经发育障碍在分娩期前就已开始。其中可能存在产前窒息或严重的慢性胎儿缺氧。对这些疾病的大多数研究都是无效的，因为它们没有采用精心设计的流行病学方法进行胎盘研究。与围产期窒息最密切相关的胎盘病理表现包括慢性缺血性改变、胎儿有核红细胞、绒毛内出血、胎儿纤维蛋白血管内膜垫、胎粪染色和胎盘绒毛间隙纤维蛋白。绒毛膜羊膜炎是一种病理实体，而非产科医生所定义的临床综合征。当它导致严重早产时，绒毛膜羊膜炎也与脑瘫有关。
