118例胎盘血池的临床病理特征

Clinicopathological features of 118 cases of placental lakes

目的:分析胎盘血池的临床及病理特征,探讨胎盘血池对母婴妊娠结局的影响及临床意义。方法:回顾性分析在福建省妇幼保健院规律产检并住院分娩的超声诊断胎盘血池患者118例,根据末次彩超检查胎盘血池体积是否>20 cm^3分为小胎盘血池组(体积<20 cm^3;88例)与大胎盘血池组(体积≥20 cm^3;30例),随访其母婴预后、实验室检查及病理结果等指标,比较分析胎盘血池的临床特征,探讨其临床意义。结果:2组患者的孕周、孕产次、分娩前体重指数(body mass index,BMI)、孕期体重增长、血红蛋白(hemoglobin,Hb)及血压等一般资料差异无统计学意义(P>0.05)。整个孕期大胎盘血池组的血池增大明显,差异有统计学意义(P<0.05)。小胎盘血池组在产后出血率、新生儿窒息率、胎盘早剥率及小于胎龄儿率等方面均明显低于大胎盘血池组(均P<0.05),2组在是否发生前置胎盘、早产、分娩方式及新生儿性别等方面差异无统计学意义(P>0.05)。大胎盘血池组发生绒毛纤维素样变或纤维素样沉积者明显高于小胎盘血池组(P<0.05)。结论:胎盘血池的临床及病理特征具有多样性,临床上应加以识别。母体较大的胎盘血池可能通过胎盘慢性缺氧性损伤,对母婴妊娠结局产生不良影响。对于中孕期系统彩超提示胎盘血池者,应引起重视,动态监测胎盘血池大小对评估母婴情况、及时处理、改善预后等具有一定的临床意义。

Objective: To analyze the clinical and pathological features of placental lakes, to explore the effect of placental lakes on maternal and child pregnancy outcomes and clinical significance. Methods: We retrospectively analyzed 118 cases of placental lakes in our hospital. All cases were routinely examined and delivered in our hospital. According to the last color Doppler ultrasound examination, the grouping was based on the volume of the placental lakes(88 cases of less than 20 cm^3 placental lakes, 30 cases of more than 20 cm^3 placental lakes). We followed the prognosis, laboratory examination and pathological results of all cases, and compared the clinical features of the placental lakes to explore the clinical significance of the placental lakes. Results: There were no significant differences in the gestational age, gravidity, parity, body mass index(BMI), weight gain during pregnancy, hemoglobin and blood pressure between the two groups(both P>0.05). The lakes of the large placenta lakes group increased significantly during the whole pregnancy, which was statistically significant(P<0.05). The small placental lakes group was significantly lower than the large placental lakes group in terms of postpartum hemorrhage rate, neonatal asphyxia rate, placental abruption rate and small gestational age group(P<0.05). There was no significant difference in placenta, premature delivery, mode of delivery and gender of the newborn(P>0.05). The villous cellulose-like or cellulose-like deposits in the large placenta lakes group were significantly higher than those in the small placental lakes group(P<0.05). Conclusion: The clinical and pathological features of the placental lakes are diverse and should be identified clinically. The mother’s larger placental lakes may pass the chronic hypoxic injury of the placenta, which may have adverse effects on the pregnancy outcome of the mother and child. For patients with mid-pregnancy system color Doppler reminder of placental lakes, clinicians should pay attention to it. Dynamic examination of placental lakes size has certain clinical significance for assessing mother and child condition, timely treatment and improving prognosis.