Stereological investigation of placental morphology in pregnancies complicated by pre-eclampsia with and without intrauterine growth restriction
Stereological investigation of placental morphology in pregnancies complicated by pre-eclampsia with and without intrauterine growth restriction
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DOI：
10.1053/plac.2002.0900
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发表时间：
2003-02-01
期刊：
影响因子：
3.8
通讯作者：
Ong, SS
中科院分区：
文献类型：
--
作者：
Mayhew, TM;Ohadike, C;Ong, SS
本研究的目的是量化伴有和不伴有宫内生长限制的妊娠合并先兆子痫的胎盘形态。特别注意外周（中间+终末）绒毛的尺寸和组成。随机抽取9例对照妊娠、5例先兆子痫、5例宫内生长受限和5例伴有宫内生长受限的先兆子痫患者的胎盘进行定位和体位。用马松三色法染色的福尔马林固定蜡包埋切片进行立体学分析，以量化胎盘成分的体积、外周绒毛和胎儿毛细血管的表面和衍生直径。采用双向方差分析进行组间比较。在所有复杂妊娠中，胎儿体重都有所下降，但只有宫内生长受限伴有明显较小的胎盘。子痫前期与胎盘形态的主要影响无关（除了滋养层厚度），子痫前期没有相互作用的影响。相反，宫内生长受限与胎盘有关，胎盘减少了绒毛间隙和所有类型的绒毛（茎、中间、终末）的体积。外周绒毛生长不良影响到所有组织（滋养细胞、间质、毛细血管），并伴有较小的交换表面积和较厚的滋养上皮。绒毛和毛细血管的平均直径不受影响。由此得出结论，宫内生长受限与胎盘形态的实质改变有关，包括绒毛和胎儿血管的生长不良，而不是子痫前期。这些变化可能会降低胎盘氧扩散传导，导致胎儿缺氧应激。2003爱思唯尔科学有限公司版权所有。
The aim of this study was to quantify placental morphology in pregnancies complicated by pre-eclampsia with and without intrauterine growth restriction. Particular attention is given to the dimensions and composition of peripheral (intermediate+terminal) villi. Placentae from 9 control pregnancies, 5 cases of pre-eclampsia, 5 cases of intrauterine growth restriction and 5 cases of pre-eclampsia with intrauterine growth restriction were randomly sampled for location and position. Formalin-fixed, wax-embedded sections stained by the Masson trichrome method were subjected to stereological analysis in order to quantify the volumes of placental components and the surfaces and derived diameters for peripheral villi and fetal capillaries. Group comparisons were drawn using two-way analysis of variance. Fetal weights were reduced in all complicated pregnancies but only intrauterine growth restriction was accompanied by a significantly smaller placenta. Pre-eclampsia was not associated with main effects on placental morphology and (except for trophoblast thickness) there were no interaction effects involving pre-eclampsia. In contrast, intrauterine growth restriction was associated with a placenta which had reduced volumes of intervillous space and all types of villi (stem, intermediate, terminal). The impoverished growth of peripheral villi affected all tissues (trophoblast, stroma, capillaries) and was accompanied by smaller exchange surface areas and a thicker trophoblastic epithelium. The derived mean diameters of villi and capillaries were not affected. It is concluded that intrauterine growth restriction, but not pre-eclampsia, is associated with substantial changes in placental morphology including impoverished growth of villi and fetal vasculature. These changes are likely to reduce placental oxygen diffusive conductances and contribute to fetal hypoxic stress. (C) 2003 Elsevier Science Ltd. All rights reserved.