Placental Vascular Pathology Findings and Pathways to Preterm Delivery
Placental Vascular Pathology Findings and Pathways to Preterm Delivery
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DOI：
10.1093/aje/kwp131
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发表时间：
2009-07-15
影响因子：
5
通讯作者：
Chung, H.
中科院分区：
文献类型：
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作者：
Kelly, R.;Holzman, C.;Chung, H.
作者研究了来自密歇根州妊娠队列研究(1998-2004)的1053名亚组妇女(239名早产，814名早产)胎盘血管发现与早产的关系。29个来自显微镜检查的胎盘血管变量被分成5个结构：3个母体结构-阻塞性病变(MV-O)、出血/血管完整性(MV-I)和母体螺旋动脉生理性转换缺失(MV-D)-2个胎儿结构-阻塞性病变(FV-O)和出血/血管完整性(FV-I)。通过将阳性发现的数量相加，并推导出一个二分法变量，以近似每个结构中最高的五分之一(“高”)和最低的四个五分(“不高”)，从而产生特定于结构的分数。在多变量多分类Logistic回归模型中，医学显示35周时早产与每种血管结构的高分显著相关；调整后的优势比为2.4至5.4。35-36周的自然早产与MV-I、MV-D和FV-I三种结构中的任何一种的高分显著相关。35周时自然早产与MV-I、MV-D和FV-I中两个或更多的结构得分显著相关；调整后的优势比为4.1到7.4。这些结果支持各种胎盘血管病变在医学指征和自发早产中的作用。
The authors examined the associations between placental vascular findings and preterm delivery in 1,053 subcohort women (239 preterm, 814 term) from a Michigan pregnancy cohort study (1998-2004). Twenty-nine placental vascular variables from microscopic examinations were grouped into 5 constructs: 3 maternal constructs-obstructive lesions (MV-O), bleeding/vessel integrity (MV-I), and lack of physiologic conversion of maternal spiral arteries (MV-D)-and 2 fetal constructs-obstructive lesions (FV-O) and bleeding/vessel integrity (FV-I). Construct-specific scores were created by adding the number of positive findings and deriving a dichotomous variable to approximate the top quintile ("high") and bottom 4 quintiles ("not high") within each construct. In multivariate polytomous logistic regression models, medically indicated preterm delivery at < 35 weeks was significantly associated with high scores for each of the vascular constructs; adjusted odds ratios ranged from 2.4 to 5.4. Spontaneous preterm delivery at 35-36 weeks was significantly associated with a high score on any 1 of 3 constructs: MV-I, MV-D, and FV-I. Spontaneous preterm delivery at < 35 weeks was significantly associated with a high score on 2 or more of 3 constructs: MV-I, MV-D, and FV-I; adjusted odds ratios ranged from 4.1 to 7.4. These results support a role for various placental vascular lesions in medically indicated and spontaneous preterm delivery.