van Hoeven K H, Anyaegbunam A, Hochster H, Whitty J E, Distant J, Crawford C, Factor S M
Department of Pathology, Bronx Municipal Hospital Center, New York, USA.
Pediatr Pathol Lab Med. 1996 Sep-Oct;16(5):731-44.
The purpose of this study was to determine the importance of varying histologic stages of inflammation in the placental membranes and cord. Acute inflammation was histologically staged in fetal membranes and umbilical cord sections from 2899 placentas received from consecutive singleton deliveries. Then clinical data were collected for a subset of randomly selected placentas with stage 1 through stage 4 membrane inflammation (n = 212) and without significant inflammation (stage 0, n = 216). Statistical analyses revealed that increasing stage of membrane inflammation was associated with an increasing rate of funisitis, perinatal death, and preterm birth (P < .05). Inflammation permeating the entire trophoblastic layer of the chorion (stage 1) was associated with clinical symptoms of intrauterine infection and thus was an important pathologic finding. Acute necrotizing chorioamnionitis was very strongly associated with perinatal death and preterm birth. Acute funisitis was a more specific but less sensitive marker for perinatal complications than inflammation in the membranes. With increasing stage of funisitis, there was an increased incidence of clinical symptoms of intrauterine infection, preterm birth, and perinatal death. Almost three-fourths of the cases with histologic evidence of membrane inflammation were clinically silent. In conclusion, increasing histologic stages of inflammation of the membranes and cord are associated with an increased rate of perinatal morbidity and mortality. Stage I membrane inflammation provides a clinically acceptable minimum threshold for the reporting of pathologic changes.
本研究的目的是确定胎盘胎膜和脐带中不同组织学炎症阶段的重要性。对连续单胎分娩的2899份胎盘的胎膜和脐带切片进行组织学急性炎症分期。然后收集了随机选择的1至4期胎膜炎症胎盘（n = 212）和无明显炎症（0期，n = 216）的临床数据。统计分析显示，胎膜炎症分期增加与脐带炎、围产期死亡和早产发生率增加相关（P <.05）。绒毛膜整个滋养层弥漫性炎症（1期）与宫内感染临床症状相关，因此是一项重要的病理发现。急性坏死性绒毛膜羊膜炎与围产期死亡和早产密切相关。与胎膜炎症相比，急性脐带炎是围产期并发症更具特异性但敏感性较低的标志物。随着脐带炎分期增加，宫内感染临床症状、早产和围产期死亡的发生率增加。几乎四分之三有胎膜炎症组织学证据的病例临床上无症状。总之，胎膜和脐带炎症组织学分期增加与围产期发病率和死亡率增加相关。1期胎膜炎症为病理变化报告提供了临床上可接受的最低阈值。
