胎儿生长受限并羊水过少与妊娠结局及胎盘病理的关联性研究

Study on the relationship between fetal growth restriction and oligohydramnios with pregnancy outcome and placental pathology

目的研究胎儿生长受限并羊水过少孕妇妊娠结局及胎盘病理的关联性。方法随机选取2018年1月-2020年6月在惠州市第一妇幼保健院分娩的胎儿生长受限(fetal growth restriction,FGR)病例177例,将FGR合并羊水过少者列入实验组(n=57),未合并羊水过少者列入对照组(n=120),比较两组孕妇的分娩方式、羊水性状、24 h产后出血量、发现FGR到分娩的持续时间,新生儿出生体质量、Apgar评分、脐动脉血气分析、围产儿并发症、是否转入新生儿重症监护室(NICU),脐带、胎盘的重量和病理结果等指标。结果实验组剖宫产率84.21%,其中急诊剖宫产率56.00%,高于对照组;实验组羊水浑浊、新生儿入住NICU的发生率高于对照组;实验组发现FGR至胎儿娩出的持续时间短于对照组,以上差异均具有统计学意义(P<0.05);实验组脐带异常的发生率高于对照组,胎盘重量小于对照组,但上述差异均无统计学意义(P> 0.05)。实验组胎盘母体血管灌注不良及胎儿血管灌注不良的发生率高于对照组,特别是胎盘绒毛过度成熟、胎儿血栓性血管病的比例明显升高,差异均具有统计学意义(P<0.05)。结论母体血管灌注不良、炎症以及胎儿血管灌注不足是FGR并羊水过少的病理组织学特征性表现,三者可能协同作用,导致胎盘功能不足,严重影响母胎妊娠结局,甚至危害新生儿远期预后。

Objective To study the correlation between placental pathology and pregnancy outcome in women with fetal growth restriction and oligohydramnios.Methods A total of 177 cases of fetal growth restriction(FGR) were randomly selected from January2018 to June 2020 in Huizhou First Maternity and Child Health Hospital, and included FGR with oligohydramnios into the experimental group(n= 57). Those without oligohydramnios were included in the control group(n= 120). The two groups of pregnant women were compared with their delivery methods, amniotic fluid state, 24-hour postpartum hemorrhage, the duration from the discovery of FGR to delivery, and the neonatal birth weight,Apgar score, umbilical artery blood gas analysis, perinatal complications, whether to transfer to NICU, umbilical cord, placenta weight and pathological results, etc., were statistically analyzed by the method of correlation analysis.The rate of cesarean section in the experimental group was 84. 21%, and the rate of emergency cesarean section in the experimental group was 56%, which was signify.Results Cantly higher than that in the control group(P< 0. 05), the differences were statistically significant(P< 0. 05);The incidence of amniotic fluid turbidity and NICU admission in the experimental group was significantly higher than that in the control group, and the differences were statistically significant(P< 0. 05);in the experimental group, it was found that the duration from FGR to fetal delivery was significantly shorter than that in the control group. It was statistically significant(P< 0. 05);the experimental group had more complications such as neonatal pneumonia, neonatal respiratory distress syndrome, myocardial damage, and bronchial dysplasia than the control group, but the difference was not statistically significant(P> 0. 05);The incidence of abnormal umbilical cord in the experimental group was significantly higher than that in the control group, and the placental weight was less than that in the control group, but the difference was not statistically significant(P>0. 05). In the experimental group, there were 27 cases of over-maturation of placental villi, increased villous syncytial nodules, and poor vascular perfusion, such as decidual vasculopathy, there were 22 cases of malperfusion of fetal blood vessels, such as thrombotic angiopathy, occlusion of dry blood vessels and deposition of fibrin in blood vessels, there were 12 cases of acute Chorioamnionitis,acute choriovasculitis, acute umbilical vein inflammation, non-specific inflammation, and 2 cases of choriovasculopathy, the incidence of placental malperfusion and fetal malperfusion in the experimental group was significantly higher than that in the control group,especially the rate of over mature placental villi and thrombotic vasculopathy, the difference was statistically significant(P< 0. 05).Conclusion Poor maternal vascular perfusion, inflammation and inadequate fetal vascular perfusion are the pathohistological characteristics of FGR with oligohydramnios, which may synergize and lead to inadequate placental function, which may seriously affect the outcome of maternal-fetal pregnancy, and even endanger the long-term prognosis of the newborn.