球状胎盘伴梗死1例

Globular placenta with infarction:A case report

胎盘的异常形态如帆状胎盘、球状胎盘、轮状胎盘在临床上常见却一直并未引起足够的重视,因为多数的胎盘形态异常较少对临床结局产生影响,但是球状胎盘作为异常形态胎盘的一种,发生率低,对妊娠结局的影响却是巨大的。球状胎盘在孕早期超声下表现为体积小、胎盘厚,孕后期可能出现一系列参数的变化或妊娠并发症。有学者发现,胎盘厚度与子痫前期、胎儿生长受限、新生儿出生低Apgar评分及脐血pH值异常相关[1-2]。本文报道1例孕早期发现球状胎盘,孕后期逐渐出现胎儿生长受限和脐血流异常,经过严密监测和积极治疗最终获得较好临床结局的案例,为提高对球状胎盘的认识提供依据。

Globular placenta is a rare type of abnormal placental morphology.It shows small placental volume and placental thickening on imaging,and the placental edge is round and blunt.Some studies have pointed out that it may be due to the invasion of superficial villi into maternal tissue and insufficient transformation of spiral arterioles.It leads to placental ischemia,and early poor perfusion causes abnormal placenta morphology,which is manifested as fibrin deposition around the villi under the microscope.Because the effective exchange area of the globular placenta is smaller than that of the normal placenta,its influence on the fetus gradually appears with the increase of gestational age.Studies have observed that placental volume and placental thickness are associated with fetal growth restriction during pregnancy.Growth-restricted fetuses are at increased risk for perinatal diseases such as intraventricular hemorrhage,periventricular leukomalacia,respiratory distress syndrome,necrotizing enterocolitis,etc.Hemodynamic parameters will reflect the problem of placental perfusion,such as the peak systolic/diastolic blood flow of the uterine artery and umbilical artery,etc.During pregnancy,these two ultrasound indicators and placental morphology should be monitored to detect the disease at an early stage and in the early stage of disease progression.The use of drug intervention may improve perinatal outcomes,but the current clinical evidence is insufficient.Most physicians use empirical treatment,that is,to improve placental circulation and increase perfusion,but there is currently no obvious effective drug.There is no consensus on the doses of drugs such as aspirin and heparin,and the reported obstetric outcomes vary from study to study.In order to better treat these diseases,provide more adequate clinical data,and lay the foundation for further research in the later period,this report describes a young woman who was treated in our hospital.This report describes a young woman who presented to our hospital with a thickening of the placenta on mid-trimester ultrasonography,aggressive use of drug therapy and close follow-up when the fetus did not lag behind,and who developed fetal lag in the third trimester and was accompanied by The fetus was hemodynamically abnormal,and a live birth was obtained after timely termination of the pregnancy,but early necrotizing enteritis developed.Finally,we combined the literature review to understand the pathological mechanism,clinical characteristics,disease prognosis and corresponding treatment methods of the disease.