妊娠高血压综合征子宫胎盘的病理变化及对围生儿的影响

Clinical study on pathological changes of placenta of mother with edema-proteinuria-hypertension syndrome and the effect on perinate

目的 了解妊娠高血压综合征 (简称妊高征 )患者子宫胎盘的病理改变对围生儿的影响。 方法 对 6 2例妊高征者及 86例无合并症者胎盘进行病理检查 ,并进行新生儿头颅 B超、脑电图 (EEG)、脑干听觉诱发电位测定 (ABR)等检查。 结果 妊高征母亲胎盘绒毛纤维素性坏死>2 5 %、合体细胞结节增多 >70 %、末梢绒毛血管增多充血、胎盘及蜕膜细胞浸润、胎盘部分梗死、子宫螺旋动脉血管壁增厚、管腔狭窄、脐动脉周围充血或出血的发生率均明显高于对照组 (P<0 .0 1) ;妊高征组新生儿头颅 B超、 EEG、 ABR检查异常者多于对照组 ,差异有显著性 (P<0 .0 5 ) ;中、重度妊高征组者早产及低体重儿发生率远较对照组高 ,差异有显著性 (P<0 .0 5 )。 结论 妊高征患者子宫胎盘病理以细胞的浸润、绒毛毛细血管减少、狭窄、梗死、血管合体膜的增厚、螺旋动脉管腔狭窄、管壁增厚及闭塞改变为相对特异性改变 ,可导致新生儿头颅 B超、 EEG、 ABR的异常 ,提示我们应高度重视围生保健工作。

Objective To understand the effects of pathological changes of uterus and placenta of patients with edema proteinuria hypertension syndrome(EPH)on perinates. Methods The placenta of mothers with EPH were examed pathologically.Ultrasonography B examination of brain and ABR,EEG examination were taken on neonates. Results In the EPH group,fibrous nectrosis of villus in uterus and placenta was >25 %;Increase of syncytium cell nodule was >70 %.The occurrence of increase of terminal villus vessels and congestion,placental and decidual cell inflammation,partial infarction of placenta,thicker spiral arterial vessels of uterus and narrow cavity,peripheral congestion,and hemorrhage umbilical artery were all obviously higher than that of the control group (P<0 05).The occurrence of villous space stenosis among mothers with moderate EPH was higher than that of the severe and slight groups;The difference was significant (P<0 05).In the EPH group,more abnormalities were found in the brain ultrasonography B examination,and the EEG and ABR examinations;The difference was significant (P<0 05).The occurrence of premature birth and low birth weight in EPH group was obviously higher than that of the control group;The difference was significant (P<0 05). Conclusion The pathological changes of uterus and placenta effected the exchange of blood and nutrition between fetus and mothers,resulted in perinates intrauterine chronic hypoxia,and even resulted in brain damages that caused function and structure changes in nerve system,and also influenced the prognosis of perinates.It suggested that perinatal health care and nerve system examinations such as the ultrasonography B of brain,EEG and ABR,which can help to discover abnormalities promptly,should be taken early.We should emphasis more on this, and its good for the perinates.