Placental histopathology in sickle cell disease: A descriptive and hypothesis-generating study
Placental histopathology in sickle cell disease: A descriptive and hypothesis-generating study
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DOI：
10.1016/j.placenta.2020.04.003
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发表时间：
2020-06-01
期刊：
影响因子：
3.8
通讯作者：
D'Souza, Rohan
中科院分区：
文献类型：
--
作者：
Malinowski, Ann Kinga;Dziegielewski, Claudia;D'Souza, Rohan
引言：胎盘发育异常是镰状细胞病（SCD）中许多不良妊娠结局（APO）的统一因素。我们的目的是描述SCD妇女的胎盘组织病理学检查结果及其与APO的关系，并探讨产前超声检查结果和胎盘pathology.Methods之间的关联：回顾性单中心病例系列的所有妊娠妇女SCD（2000年1月至2017年12月），妊娠超过20周的妊娠，和可用的胎盘组织病理学。APO包括宫内胎儿死亡、早期新生儿死亡、早产、小于胎龄儿和妊娠期高血压疾病。在对临床结局和组织病理学结果设盲的情况下，完成了妊娠中期超声图像和分娩近端超声图像的审查。大体和组织病理学检查结果进行了审查，并根据公布的classification.Results的特点：72胎盘，异常存在于69%，与产妇血管灌注不良（MVM）指出，在40%。在61%的总体患者和79%的MVM患者中遇到了APO。无论是SCD基因型，也没有严重的母体贫血组织病理学胎盘功能的影响。妊娠中期超声检查时高阻力子宫动脉波形的存在与APO和胎盘组织病理学异常结果（最明显的是MVM）密切相关。MVM与小于胎龄儿、早产和死产密切相关。讨论：MVM是SCD妇女胎盘的主要病变，与APO密切相关。妊娠中期超声可以识别出一部分有风险的女性。需要进一步研究先进的成像方式，以帮助产前诊断，同时调查潜在的有益治疗。
Introduction: Abnormal placental development is a unifying factor amongst many adverse pregnancy outcomes (APOs) in Sickle Cell Disease (SCD). Our aim was to describe placental histopathologic findings in women with SCD and their relationship with APOs, and to explore the association between antenatal sonographic findings and placental pathology.Methods: Retrospective single-centre case series of all pregnant women with SCD (January 2000-December 2017), pregnancy beyond 20 weeks' gestation, and available placenta histopathology. APOs included intrauterine fetal death, early neonatal death, preterm birth, small for gestational age, and hypertensive disorders of pregnancy. Review of images for mid-pregnancy ultrasound and one proximal to delivery was completed, blinded to clinical outcomes and histopathology results. Gross and histopathologic findings were reviewed and characterized per published classification.Results: Of 72 placentas, abnormalities were present in 69%, with Maternal Vascular Malperfusion (MVM) noted in 40%. APOs were encountered in 61% overall and in 79% of those with MVM. Neither SCD genotype nor severe maternal anemia had an influence on histopathologic placental features. Presence of high-resistance uterine artery waveforms at mid-trimester ultrasound was strongly associated with APOs and with abnormal findings on placental histopathology, most notably MVM. MVM was strongly associated with small for gestational age infants, preterm birth, and stillbirth.Discussion: MVM is the predominant lesion in placentas of women with SCD and is strongly associated with APOs. Mid-trimester ultrasound can identify a subset of women at risk. Future research into advanced imaging modalities to aid in antenatal diagnosis alongside investigations of potentially beneficial therapies is needed.