Perinatal prognosis of pregnancies complicated by placental chronic villitis or intervillositis of unknown etiology and combined lesions: About a series of 178 cases
Perinatal prognosis of pregnancies complicated by placental chronic villitis or intervillositis of unknown etiology and combined lesions: About a series of 178 cases
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DOI：
10.1016/j.placenta.2016.04.017
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发表时间：
2016-08-01
期刊：
影响因子：
3.8
通讯作者：
Le Vaillant, Claudine
中科院分区：
文献类型：
--
作者：
Nowak, Christel;Joubert, Madeleine;Le Vaillant, Claudine
简介：这项工作的目的是评估和比较围产期妊娠并发胎盘慢性绒毛间炎（CIUE）或绒毛炎（CVUE）的病因不明，并combinedlesions.Methods的结果：回顾性研究的所有情况下，显着的CVUE和CLUE发生在12年期间在一所大学的三级医院中心。结果：178例胎盘受累，其中CVUE 78例，CIUE 24例，绒毛间炎合并绒毛炎76例，复发12例。在73%的病例中发现胎儿生长障碍，我们注意到9.5%的病例流产。IUGR的发生率在CLUE的情况下明显更高，胎儿死亡风险高5倍。这些并发症似乎与更弥漫的炎性浸润有关（p < 0.05）。CVUE与42%的重度IUGR和近三分之一病例的脐动脉多普勒严重改变的显著发病率相关。剖腹产是重要的（54.8%）。61%的新生儿住院，11.4%的新生儿复苏。在合并病变的情况下，胎儿结局似乎相对接近CVUE。CVUE可能以更严重的形式复发，或作为对胎儿风险增加的CLUE。Clinicoanatomic correlations noted.Discussion：观察复发CVUE对CIUE或合并病变和类似的表型特征的浸润表明，他们可能是两个不同的阶段，同一疾病。CVUE仍被视为严重疾病。绒毛间炎的小病变的联合并不改变预后。组织学病变的严重程度和最初的产科事故可能是歧视性的，以确定患者的严重复发的风险。Harmonized classification will be required.Conclusions：本研究证实了较高的发病率CIUE相比，CVUE，但显示了监测怀孕后的CVUE，这仍然是在严重和复发性并发症的风险的必要性。(C)2016爱思唯尔有限公司版权所有
Introduction: The objective of this work was to evaluate and compare perinatal outcomes of pregnancies complicated by placental chronic intervillositis (CIUE) or villitis (CVUE) of unknown etiology and combined lesions.Methods: Retrospective study of all cases of significant CVUE and CLUE occurring during a 12-year period in a university tertiary hospital center. Multiple pregnancies, infectious and medical termination of pregnancies (TOP) without intra-uterine growth restriction (IUGR) were excluded.Results: 178 placentas were affected (78 cases of CVUE, 24 cases of CIUE and 76 cases of combined lesions involving both villitis and intervillositis) including 12 cases of recurrence. A disorder of fetal growth was found in 73% of cases and we noted 9.5% of cases of abortion. The rate of IUGR appeared to be significantly higher in case of CLUE with a fetal death risk five times higher. These complications seems to be related to more diffuse inflammatory infiltrates (p < 0.05). CVUE was associated with a significant morbidity with 42% of severe IUGR and severe alterations of umbilical artery Doppler in nearly one third of cases. Caesarean section was important (54.8%). Sixty-one percent of newborns were hospitalized and 11.4% in neonatal reanimation. In case of combined lesions, fetal outcomes appeared relatively close to those of CVUE. CVUE could recur in more severe forms or as CLUE with an increased risk for the fetus. Clinicoanatomic correlations were noted.Discussion: Observation of recurrence of CVUE on CIUE or combined lesions and similar phenotypic characteristics of the infiltrates suggest that they could be two different stages of a same disease. CVUE remains a disease to be considered as serious. Association of small lesions of intervillositis does not change the prognosis. The severity of histological lesions and the initial obstetrical accident could be discriminatory to identify patients at risk of serious recurrence. Harmonized classification will be required.Conclusions: This study confirms the higher morbidity of CIUE compared to CVUE but shows the necessity of monitoring pregnancies following an episode of CVUE, which are still at risk of serious and recurrent complications. (C) 2016 Elsevier Ltd. All rights reserved.