150例胎儿生长受限患者胎盘及脐带病理分析
|
摘要
目的探讨150例胎儿生长受限(FGR)患者胎盘及脐带的病理改变,为临床预防治疗FGR提供借鉴。方法对大连市妇女儿童医疗中心近5年150例无妊娠合并症,胎儿剖宫产,无异常,晚期妊娠胎儿生长受限FGR胎盘及脐带进行病理学大体及显微镜下分析。结果 150例FGR,胎盘病变为主有33例(22%),主要包括胎盘形状异常,大面积梗死等,其中17例合并有脐带病变。脐带病变为主有67例(44.67%),主要包括脐带长度异常、脐带真结、脐血管瘤等。肉眼及显微镜下检查均无明显病因的有50例(33.33%)。结论 FGR患者胎盘病理检查约66.67%会出现不同程度的胎盘及脐带的发育,结构异常,导致循环障碍等病理改变,这些病变可以引起胎儿营养供给不足导致FGR形成。在FGR的发生中脐带的病理改变较胎盘更常见,脐带的异常在FGR发生中占44.67%。50例(33.33%)的FGR病因不明确,其发病机制可能与滋养细胞凋亡增加有关,有待于进一步研究。
Objective To investigate the pathological changes of placenta and umbilical cord in 150 patients with fetal growth restriction(FGR),and to provide reference for clinical prevention and treatment of FGR. Methods In Dalian Medical Center for Women and Children, 150 cases of FGR placenta and umbilical cord were examined by pathological examination and microscope analysis in the last 5 years without complications of pregnancy, caesarean section of fetus, no abnormality, and fetal growth restriction of full-term pregnancy. Results 150 cases of FGR, there were 33 cases(22%) of placental lesions, including abnormal placenta shape and large area infarction, among which 17 cases were complicated with umbilical cord diseases. There were 67 cases(44.67%) of umbilical cord lesion, including abnormal umbilical cord length, umbilical cord true knot, umbilical hemangioma and so on. There were 50 cases(33.33%) with no obvious etiology under the naked eye and microscope. Conclusion Placental pathological examination in patients with FGR. About 66.67% of them had abnormal development of placenta and umbilical cord, circulatory disturbance and other pathological changes. These pathological changes could lead to the formation of FGR due to insufficient nutrition supply of fetus. The pathological changes of umbilical cord were more common in FGR than in placenta. Abnormal umbilical cord accounted for 44.67% of FGR. 50 cases(33.33%) of FGR had unclear etiology, the pathogenesis of which might be related to the increase of trophoblastic apoptosis, which should be further studied.
Objective To investigate the pathological changes of placenta and umbilical cord in 150 patients with fetal growth restriction(FGR),and to provide reference for clinical prevention and treatment of FGR. Methods In Dalian Medical Center for Women and Children, 150 cases of FGR placenta and umbilical cord were examined by pathological examination and microscope analysis in the last 5 years without complications of pregnancy, caesarean section of fetus, no abnormality, and fetal growth restriction of full-term pregnancy. Results 150 cases of FGR, there were 33 cases(22%) of placental lesions, including abnormal placenta shape and large area infarction, among which 17 cases were complicated with umbilical cord diseases. There were 67 cases(44.67%) of umbilical cord lesion, including abnormal umbilical cord length, umbilical cord true knot, umbilical hemangioma and so on. There were 50 cases(33.33%) with no obvious etiology under the naked eye and microscope. Conclusion Placental pathological examination in patients with FGR. About 66.67% of them had abnormal development of placenta and umbilical cord, circulatory disturbance and other pathological changes. These pathological changes could lead to the formation of FGR due to insufficient nutrition supply of fetus. The pathological changes of umbilical cord were more common in FGR than in placenta. Abnormal umbilical cord accounted for 44.67% of FGR. 50 cases(33.33%) of FGR had unclear etiology, the pathogenesis of which might be related to the increase of trophoblastic apoptosis, which should be further studied.
引文
[1] Malacova E, Regan A, Nassar N, et al. Risk of still-birth, preterm delivery, and fetal growth restric-tion following exposure in a previous birth:system-atic review and meta-analysis[J]. BJOG, 2018,125(2):183-192.
[2]乐杰.妇产科学[M].北京:人民卫生出版社,2008:135-136.
[3]郑文新.妇产科病理学[M].北京:科学出版社,2013:828-829.
[4]陈乐真.妇产科诊断病理学[M].北京:人民军医出版社,2010:527-528.
[5] Temming LA, Dicke JM, Stout MJ, et al. Early Second-Trimester Fetal Growth Restriction and Adverse Peri-natal Outcomes[J]. Obstet Gynecol, 2017,130(4):865-869.
[6] Nardozza LM, Caetano AC, Zamarian AC, et al. Fetalgrowth restriction:current knowledge[J]. Arch Gyne-col Obstet, 2017,295(5):1061-1077.
[7] Sawant LD, Venkat S. Comparative Analysis of Normalversus Fetal Growth Restriction in Pregnancy:TheSignificance of Maternal Body Mass Index, Nutrition-al Status, Anemia, and Ultrasonography Screening[J].Int J Reprod Med, 2013,2013:671954.
[8] Blatt K, Moore E, Chen A, et al. Association of re-ported trimester-specific smoking cessation with fe-tal growth restriction[J]. Obstet Gynecol, 2015,125(6):1452-1459.
[9] Nguyen TPH, Yong HEJ, Chollangi T, et al. Altereddownstream target gene expression of the placentalVitamin D receptor in human idiopathic fetal growthrestriction[J]. Cell Cycle, 2018,17(2):182-190.
[10] Yamamoto R, Ishii K, Shimada M, et al. Significanceof maternal screening for toxoplasmosis, rubella,cytomegalovirus and herpes simplex virus infectionin cases of fetal growth restriction[J]. J ObstetGynaecol Res, 2013,39(3):653-657.
[11] Gaccioli F, Aye ILMH, Sovio U, et al. Screening forfetal growth restriction using fetal biometry com-bined with maternal biomarkers[J]. Am J Obstet Gyne-col, 2018,218(2S):S725-S737.
[12] Wolf H, Arabin B, Lees CC, et al. Longitudinalstudy of computerized cardiotocography in early fe-tal growth restriction[J]. Ultrasound Obstet Gyne-col, 2017,50(1):71-78.
[13]刘伯宁.胎儿宫内发育迟缓的胎盘病理变化[J].中国实用妇科与产科杂志,2002,18(1):19-20.
[14] Whitehead CL, Walker SP, Lappas M, et a1. Circulat-ing RNA coding genes regulating apoptosis in mater-nal blood in severe early onset fetal growth re-striction and pre-eclampsia[J]. J Perinatol, 2013,33(8):600-604.
[2]乐杰.妇产科学[M].北京:人民卫生出版社,2008:135-136.
[3]郑文新.妇产科病理学[M].北京:科学出版社,2013:828-829.
[4]陈乐真.妇产科诊断病理学[M].北京:人民军医出版社,2010:527-528.
[5] Temming LA, Dicke JM, Stout MJ, et al. Early Second-Trimester Fetal Growth Restriction and Adverse Peri-natal Outcomes[J]. Obstet Gynecol, 2017,130(4):865-869.
[6] Nardozza LM, Caetano AC, Zamarian AC, et al. Fetalgrowth restriction:current knowledge[J]. Arch Gyne-col Obstet, 2017,295(5):1061-1077.
[7] Sawant LD, Venkat S. Comparative Analysis of Normalversus Fetal Growth Restriction in Pregnancy:TheSignificance of Maternal Body Mass Index, Nutrition-al Status, Anemia, and Ultrasonography Screening[J].Int J Reprod Med, 2013,2013:671954.
[8] Blatt K, Moore E, Chen A, et al. Association of re-ported trimester-specific smoking cessation with fe-tal growth restriction[J]. Obstet Gynecol, 2015,125(6):1452-1459.
[9] Nguyen TPH, Yong HEJ, Chollangi T, et al. Altereddownstream target gene expression of the placentalVitamin D receptor in human idiopathic fetal growthrestriction[J]. Cell Cycle, 2018,17(2):182-190.
[10] Yamamoto R, Ishii K, Shimada M, et al. Significanceof maternal screening for toxoplasmosis, rubella,cytomegalovirus and herpes simplex virus infectionin cases of fetal growth restriction[J]. J ObstetGynaecol Res, 2013,39(3):653-657.
[11] Gaccioli F, Aye ILMH, Sovio U, et al. Screening forfetal growth restriction using fetal biometry com-bined with maternal biomarkers[J]. Am J Obstet Gyne-col, 2018,218(2S):S725-S737.
[12] Wolf H, Arabin B, Lees CC, et al. Longitudinalstudy of computerized cardiotocography in early fe-tal growth restriction[J]. Ultrasound Obstet Gyne-col, 2017,50(1):71-78.
[13]刘伯宁.胎儿宫内发育迟缓的胎盘病理变化[J].中国实用妇科与产科杂志,2002,18(1):19-20.
[14] Whitehead CL, Walker SP, Lappas M, et a1. Circulat-ing RNA coding genes regulating apoptosis in mater-nal blood in severe early onset fetal growth re-striction and pre-eclampsia[J]. J Perinatol, 2013,33(8):600-604.