探讨形状异常单胎胎盘的病理学特点及对母胎妊娠结局的影响

Exploring the Pathological Characteristics of Abnormally Shaped Singleton Placenta and Its Impact on Maternal-fetal Pregnancy Outcome

目的研究形状异常的单胎胎盘病理学特点,并探讨其对母胎妊娠结局的影响。方法回顾性选取2017年1月—2021年12月重庆医科大学附属第二医院病理科送检的120例形状异常胎盘的孕妇进行分析,总结其病理学特点,并分析对母胎妊娠结局产生的影响。结果120例单胎胎盘最终显示的胎儿不良结局包括40例早产儿,21例胎儿宫内生长受限,17例胎儿宫内窘迫,1例由于轮廓胎盘合并脐带过度扭转而宫死胎中;母亲不良结局包括前置胎盘7例,胎盘早剥3例,胎盘粘连10例,胎膜早破45例。有窗胎盘、膜状胎盘、环状胎盘、双叶胎盘、轮廓胎盘、有缘胎盘、副叶胎盘的大体特点各有差异。形状异常胎盘的镜下改变体现在功能性形态学方面,以母胎灌注不足表现为主,具体表现为绒毛梗死、远端绒毛发育不良、绒毛成熟过度。结论形状异常的单胎胎盘大体表现存在差异,母胎灌注功能缺乏,会增加早产儿、胎儿宫内生长受限、胎儿宫内窘迫、宫死胎中、前置胎盘、胎盘早剥、胎盘粘连、胎膜早破等不良结局。

Objective To study the pathological characteristics of single fetal placenta with abnormal shape and to explore its impact on maternal-fetal pregnancy outcome.Methods Retrospective analysis was conducted on 120 pregnant women with abnormal placentas submitted by the Pathology Department of the Second Affiliated Hospital of Chongqing Medical University from January 2017 to December 2021 to summarize their pathological characteristics and analyze the impact on the maternal and fetal pregnancy outcomes.Results The 120 cases of single placenta eventually showed adverse fetal outcomes including 40 preterm births,21 cases of intrauterine growth restriction,17 cases of intrauterine distress,and 1 case of intrauterine death due to the combination of contoured placenta with excessive cord torsion.The adverse maternal outcomes included 7 cases of placenta praevia,3 cases of placenta abruptio,10cases of placental adhesion and 45 cases of premature rupture of membranes.The general characteristics of windowed placenta,membranous placenta,annular placenta,bilobed placenta,contoured placenta,marginal placenta and parietal placenta were different.The microscopic changes of the abnormally shaped placenta were reflected in functional morphology,which was dominated by maternal-fetal underperfusion manifested by chorionic infarction,distal chorionic dysplasia,and chorionic hypermaturation.Conclusion There are differences in the general presentation of single fetal placenta with abnormal shape,and the lack of maternal-fetal perfusion increases the adverse outcomes such as preterm birth,intrauterine growth restriction,intrauterine distress,intrauterine death,placenta praevia,placental abruption,placental adhesion,and premature rupture of membranes.