小于胎龄儿的高危因素及产妇胎盘病理特征

High Risk Factors for Small for Gestational Age Infant and the Pathological Characteristics of Placenta in Postpartum Women

目的探讨小于胎龄儿(SGA)的高危因素及产妇胎盘病理特征。方法回顾性分析2013年1月至2020年12月郑州市妇幼保健院出生的151例足月SGA。选取同期体重>2500 g的200例适于胎龄儿(AGA)作为对照。对比两组临床资料及病理结果。结果两组产妇年龄、生产时孕周、分娩方式差异有统计学意义(P<0.05);两组怀孕次数和生产次数差异无统计学意义(P>0.05)。两组胎膜早破、羊水、胎盘粘连、妊娠高血压、子痫前期情况差异有统计学意义(P<0.05);妊娠糖尿病和贫血情况差异无统计学意义(P>0.05)。与AGA组相比,SGA组胎盘后血肿和绒毛梗死易见,脐带附着异常、脐带螺旋过多及脐带过细例数较多(P<0.05);与AGA组比较,SGA组合体结节增多,易出现绒毛纤维素沉积物及钙化、绒毛间隙狭窄或消失、干绒毛硬化、终末绒毛血管扩张及直细血管绒毛、底蜕膜炎症及绒毛膜炎症(P<0.05),但两组绒毛间血栓和绒毛炎症反应发生情况差异无统计学意义(P>0.05)。结论产妇孕周短、胎膜早破、羊水异常、胎盘粘连和子痫前期是SGA发生的高危因素,SGA产妇胎盘更容易伴随病理改变。

Objective To explore high risk factors for small for gestational age infant(SGA)and the pathological characteristics of placenta in postpartum women.Methods Retrospective analysis of 151 full-term SGA cases born in Zhengzhou Maternal and Child Health Hospital from January 2013 to December 2020,and 200 normal full-term infants of appropriate for gestational age infant(AGA)weighing over 2500 g during the same period were selected as controls.The clinical data and pathological results between the two groups were compared.Results There was statistically difference in age,gestational age at birth,and delivery method between the two groups(P<0.05).There was no statistically difference in the number of pregnancies and births between the two groups(P>0.05).There was statistically difference in the situation of premature rupture of membranes,amniotic fluid,placental adhesions,gestational hypertension,and preeclampsia between the two groups(P<0.05).There was no statistically difference between diabetes and anemia during pregnancy(P>0.05).Compared with the AGA group,the SGA group had higher incidence of posterior placental hematoma and villous infarction,as well as more cases of abnormal umbilical cord attachment,excessive umbilical cord spiral,and thin umbilical cord(P<0.05).Compared with the AGA group,the number of nodules in the SGA group increased,and it was prone to the deposition and calcification of villous cellulose,narrowing or disappearance of villous spaces,dry villous sclerosis,dilation of terminal villous vessels,and inflammation of straight microvascular villi,decidua basalis,and chorionic villi(P<0.05).However,there was no statistically difference in the occurrence of villous thrombosis and villous inflammation between the two groups(P>0.05).Conclusion Short gestational age,premature rupture of membranes,abnormal amniotic fluid,placental adhesions,and preeclampsia are high-risk factors for SGA,and the placenta of SGA mothers is more prone to pathological changes.