Altshuler G
Department of Pathology, Children's Hospital of Oklahoma, Oklahoma City 73104, USA.
Pediatr Pathol Lab Med. 1996 Mar-Apr;16(2):207-33.
This article on the placenta includes considerations of chorioamnionitis, villitis, preeclampsia, and other low placental blood flow states and aspects of the circulating lupus anticoagulant syndrome. The author explains that, although gross and microscopic placental findings document placental features at one point in time, they also reflect ongoing pathophysiologic changes. Pathogenetic relationships between placental pathology, fetal hypoxia, intrauterine growth retardation, and cerebral palsy are discussed. The reader will learn that low placental blood flow states and chorioamnionitis are important means by which endothelins may eventually participate in the production of placental and fetal vasoconstriction and critical hypoperfusion. The author explains means by which reduced umbilical, placental, and fetal blood flow can result from chronic fetal exposure to meconium, meconium-induced vasoactivity, and ultimate vascular necrosis. Clinically important complications therein may include anoxic-ischemic neuronal necrosis in the brain, necrotizing enterocolitis, and ischemic lesions in the fetal heart, lungs, kidneys, and liver. The article includes a review of nucleated red blood cells that most often signify chronic fetal hypoxia rather than infrequent acute intrapartum asphyxia. The reader will also find information on chorangiosis (placental villous capillary hypervascularity), an important sign of placental malperfusion and very long-standing fetal hypoxia.
这篇关于胎盘的文章涵盖了绒毛膜羊膜炎、绒毛炎、先兆子痫以及其他胎盘低血流状态，还有循环性狼疮抗凝物综合征的相关内容。作者解释道，尽管大体和显微镜下的胎盘检查结果记录了某一时刻的胎盘特征，但它们也反映了正在进行的病理生理变化。文中讨论了胎盘病理、胎儿缺氧、宫内生长受限和脑瘫之间的发病机制关系。读者将了解到，胎盘低血流状态和绒毛膜羊膜炎是内皮素最终可能参与胎盘和胎儿血管收缩及严重灌注不足产生的重要途径。作者解释了慢性胎儿暴露于胎粪、胎粪诱导的血管活性以及最终的血管坏死如何导致脐、胎盘和胎儿血流减少。其中临床上重要的并发症可能包括脑内缺氧缺血性神经元坏死、坏死性小肠结肠炎以及胎儿心脏、肺、肾和肝脏的缺血性病变。文章还回顾了有核红细胞，其最常表示慢性胎儿缺氧而非罕见的急性分娩时窒息。读者还将找到关于绒毛血管增多症（胎盘绒毛毛细血管血管增生）的信息，这是胎盘灌注不良和长期胎儿缺氧的一个重要迹象。
