Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death
Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death
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DOI：
10.1002/uog.16019
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发表时间：
2016-11-01
影响因子：
7.1
通讯作者：
Sebire, N. J.
中科院分区：
文献类型：
--
作者：
Man, J.;Hutchinson, J. C.;Sebire, N. J.
目的胎盘异常是死产死亡的常见原因，仅次于不明原因死亡，尽管胎盘疾病导致的比例差异很大。在临床实践中，解释胎盘发现的意义是困难的，因为死产的许多胎盘特征与活产的胎盘特征重叠。我们的目的是客观地检查1000例宫内死亡后尸检中胎盘的分类结果，以评估胎盘组织学检查在确定死亡原因中的作用。方法：作为评估宫内死亡尸检结果的几个方面的大型研究的一部分，我们使用了一个专门的数据库来整理2005年至2013年在英国伦敦的两个三级专科中心检查的所有病例的产前和尸检细节。胎盘的组织学结果与最终死亡原因的关系进行了评估。结果在1064例宫内死亡病例中，946例（89%）在尸检时检查了胎盘。其中，307例（32%）的死亡原因是胎盘、脐带或胎膜的异常。大约三分之一的死产（>= 24周）有一些孤立的胎盘组织学异常，许多不确定的意义，显著高于妊娠中期宫内胎儿死亡的比例（P < 0.0001）。死亡原因是上升感染，176/946例（19%），在妊娠22周达到高峰，与其他种族相比，黑人母亲的上升感染明显更多（P < 0.0001）。母体血管灌注不良是死产中最大的胎盘异常类型，在妊娠晚期早期患病率最高。18例（2%）有特异性组织学异常，包括慢性组织细胞绒毛间炎和大量绒毛周围纤维蛋白沉积。结论胎盘病理是宫内死亡的主要原因。胎盘组织学检查是尸检过程中唯一最有用的组成部分。少数病例与特定的胎盘病理有关，通常具有高复发率，只能通过胎盘的显微镜检查来诊断。许多死亡仍然无法解释，尽管胎盘组织学病变可能存在，这是不确定的意义。严格、系统的胎盘病理学研究和分类方法可以更好地理解胎盘发现的意义，并降低不明原因的宫内死亡发生率。版权所有2016isuog由John Wiley & Sons Ltd出版。
Objectives Placental abnormalities are a common cause of death in stillbirth, ranking second only to unexplained deaths, though there is wide variation in the proportion attributed to placental disease. In clinical practice, interpretation of the significance of placental findings is difficult, since many placental features in stillbirths overlap with those in live births. Our aim was to examine objectively classified placental findings from a series of >1000 autopsies following intrauterine death in order to evaluate the role of placental histological examination in determining the cause of death.Methods As part of a larger study evaluating several aspects of autopsy findings in intrauterine death, a dedicated database was used to collate antenatal and postmortem examination details for all cases examined between 2005 and 2013 at two tertiary specialist centers in London, UK. Histological findings for placentas were evaluated in relation to the final cause of death.Results Among 1064 intrauterine deaths, 946 (89%) cases had the placenta submitted for examination as part of the autopsy. Of these, 307 (32%) cases had the cause of death assigned to abnormalities of the placenta, cord or membranes. Around one third of stillbirths (>= 24 weeks) had some isolated placental histological abnormality identified, many of uncertain significance, a significantly greater proportion than in cases of second-trimester intrauterine fetal demise (P < 0.0001). The cause of death was ascending infection in 176/946 (19%) cases, peaking at 22 weeks' gestation, with significantly more black mothers having ascending infection compared with other ethnicities (P < 0.0001). Maternal vascular malperfusion was the largest category of placental abnormalities in stillbirth, with peak prevalence in the early third trimester. There were 18 (2%) cases with specific histological abnormalities, including chronic histiocytic intervillositis and massive perivillous fibrin deposition.Conclusions Placental pathologies represent the largest category of cause of intrauterine death. Placental histological examination is the single most useful component of the autopsy process in this clinical setting. A minority of cases are associated with specific placental pathologies, often with high recurrence rates, that can be diagnosed only on microscopic examination of the placenta. Many deaths remain unexplained, although placental histological lesions may be present which are of uncertain significance. A rigorous, systematic approach to placental pathology research and classification may yield better understanding of the significance of placental findings and reduce the rate of unexplained intrauterine deaths. Copyright (C) 2016 ISUOG. Published by John Wiley & Sons Ltd.