Beebe L A, Cowan L D, Altshuler G
Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Obstet Gynecol. 1996 May;87(5 Pt 1):771-8. doi: 10.1016/0029-7844(95)00483-1.
To investigate the epidemiologic and pathogenetic significance of placental features and neonatal outcome in a high-risk population.
One pathologist examined 1252 placentas from clinically selected at-risk singleton pregnancies. Placental pathology features were analyzed relative to gestational age and status of the newborn, including fetal growth restriction (FGR), low 1-minute Apgar score, infection, liver disorder, anomalies, and death in the immediate postnatal period.
The most frequent placental pathologic features were ischemic change, meconium staining, and chorioamnionitis. Only 8% of placentas were considered normal. The number of features per placenta increased with gestational age. Among preterm infants, chorioamnionitis occurred most frequently with low 1-minute Apgar score (40%), clinically apparent infection (43%), liver disorder (43%), and anomalies (42%), compared with healthy newborns (15%). Chorioamnionitis at term was most frequent among infants with low 1-minute Apgar score (26%), infection (30%), and liver disorder (23%), compared with healthy newborns (16%). Meconium and ischemic changes were most frequent in placentas from healthy newborns, compared with affected newborns, regardless of gestational age. Multivariable analyses revealed an independent association between chorioamnionitis and low 1-minute Apgar score (P < .05), and both chorioamnionitis and villitis were associated with newborn infection (P < .05).
The frequency of many major pathologic placental features, especially ischemic changes and meconium, in the absence of immediately detectable abnormality is relatively high. Thus, continued follow-up is needed to determine their long-term clinical significance. In addition, associations of ischemic changes and infarction with FGR in term infants suggest that need for comprehensive investigations of the effects of histopathologically apparent low placental blood flow.
探讨高危人群中胎盘特征及新生儿结局的流行病学和发病机制意义。
一名病理学家检查了从临床选择的高危单胎妊娠中获取的1252份胎盘。分析胎盘病理特征与胎龄及新生儿状况的关系，包括胎儿生长受限（FGR）、1分钟Apgar评分低、感染、肝脏疾病、畸形以及出生后即刻死亡。
最常见的胎盘病理特征为缺血性改变、胎粪污染和绒毛膜羊膜炎。只有8%的胎盘被认为是正常的。每个胎盘的特征数量随胎龄增加。在早产儿中，绒毛膜羊膜炎最常伴有1分钟Apgar评分低（40%）、临床明显感染（43%）、肝脏疾病（43%）和畸形（42%），而健康新生儿中这一比例为15%。足月时，绒毛膜羊膜炎在1分钟Apgar评分低（26%）、感染（30%）和肝脏疾病（23%）的婴儿中最为常见，而健康新生儿中这一比例为16%。与患病新生儿相比，无论胎龄如何，健康新生儿的胎盘胎粪污染和缺血性改变最为常见。多变量分析显示绒毛膜羊膜炎与1分钟Apgar评分低之间存在独立关联（P <.05），绒毛膜羊膜炎和绒毛炎均与新生儿感染有关（P <.05）。
许多主要的胎盘病理特征，尤其是缺血性改变和胎粪污染，在无即刻可检测到的异常情况下发生率相对较高。因此，需要持续随访以确定其长期临床意义。此外，足月婴儿缺血性改变和梗死与FGR的关联表明，需要对组织病理学上明显的胎盘低血流影响进行全面研究。
