胎盘病理学改变对特发性胎儿生长受限新生儿结局的影响

Effect of placental pathological changes on neonatal outcome of idiopathic fetal growth restriction

目的:分析不同胎盘病理学类型对特发性胎儿生长受限(IFGR)新生儿结局的影响。方法:回顾性分析2010年1月至2019年12月在广州医科大学附属第三医院住院分娩的185例单胎IFGR孕产妇的病例资料。根据国际胎盘组制定的2016年Amsterdam标准分类,将IFGR划分为胎盘正常组和胎盘病变组。比较两组间胎盘大体指标、分娩方式及新生儿结局;同时分析不同胎盘病理学类型对新生儿结局的影响。结果:胎盘病变组的胎盘重量(P=0.064)、新生儿体重/胎盘重量(P=0.017)均低于胎盘正常组;两组的分娩方式比较,差异无统计学意义。与胎盘正常组比较,胎盘病变组导致IFGR的新生儿呼吸窘迫综合征发生率升高(P=0.007),新生儿住院天数延长(P=0.000),新生儿体重下降(P=0.000),差异均有统计学意义。将胎盘病变组根据Amsterdam标准进一步分类。新生儿呼吸窘迫综合征的发生率:母体血管合并胎儿血管灌流不良组>母体血管灌流不良组>胎儿血管灌流不良组,差异有统计学意义(χ^(2)=17.201,P=0.000);新生儿体重:母体血管合并胎儿血管灌流不良组<母体血管灌流不良组<胎儿血管灌流不良组,差异有统计学意义(F=6.924,P=0.001)。结论:胎盘病变是引起IFGR不良新生儿结局的主要原因;对比胎儿血管灌流不良,母体血管灌流不良引起的IFGR新生儿结局更差。当两种情况同时存在时,IFGR的新生儿结局进一步恶化。

Objective:To analyze the effect of different placental pathological types on neonatal outcome of idiopathic fetal growth restriction(IFGR).Methods:A retrospective analysis was performed on 185 singleton pregnancies with IFGR who were admitted to the third Affiliated Hospital of Guangzhou Medical University during January 2010 to December 2019.According to the Amsterdam standard classification developed by the International Placenta Group in 2016,IFGR was divided into normal placenta group and placental lesion group.The placenta gross indexes,delivery mode and neonatal outcomes between the two groups were compared.At the same time,the influence of different placental pathological types on neonatal outcome was analyzed.Result:Placental weight(P=0.064)and neonatal weight/placental weight(P=0.017)were decreased in the placental lesion group.There was no significant difference in delivery pattern between the two groups.The incidence of neonatal respiratory distress syndrome(P=0.007),neonatal hospitalization(P=0.000)and neonatal weight loss(P=0.000)were increased in the placental lesion group.The placental lesions were further classified according to Amsterdam criteria.Analysis of the incidence of neonatal respiratory distress syndrome,found that maternal vessels with fetal vascular malperfusion group>maternal vascular malperfusion group>fetal vascular malperfusion group,the difference was statistically significant(χ^(2)=17.201,P=0.000).Analysis of neonatal weight,found that maternal vessels with fetal vascular malperfusion group<maternal vascular malperfusion group<fetal vascular malperfusion group,the difference was statistically significant(F=6.924,P=0.001).Conclusions:Placental disease is the main cause of IFGR adverse neonatal outcome.Compared with fetal vascular malperfusion,maternal vascular malperfusion caused by IFGR neonatal outcome is worse.When the two conditions exist at the same time,the neonatal outcome of IFGR further worsens.