先天性心脏病胎儿胎盘病理特征分析

目的探讨先天性心脏病胎儿胎盘病变的病理特征。 方法选取2010年8月至2014年4月首都医科大学附属北京安贞医院超声心动图二部胎儿心脏病母胎医学会诊中心胎儿心脏病母胎医学数据库样本库中先天性心脏病胎儿20例（心脏病组，均为心脏畸形引产胎儿），另选取产前超声及产后检查均正常，但因胎膜早破、羊水过少、妊娠期糖尿病、子痫前期、胎儿窘迫、先兆临产、孕妇心律失常引产的胎儿34例（对照组），对两组胎儿产前超声及产后胎盘病理检查结果进行分析。 结果先天性心脏病组胎儿中17例为妊娠中期胎盘，3例为妊娠晚期胎盘；对照组34例均为妊娠晚期胎盘。产后胎盘病理检查显示：（1）心脏病组20例胎儿胎盘病变18例（18/20），以重度绒毛膜炎（77.8%，14/18）、灶状钙化（44.4%，8/18）和血栓形成（16.7%，3/18）为主，1例胎盘梗死，2例胎盘脐带未见显著变化。（2）心脏病组10例致死性先天性心脏病胎儿的胎盘病变重于10例非致死性心脏畸形胎儿。（3）对照组34例（34/34）胎儿均显示胎盘病变，以轻度绒毛膜炎（61.8%，21/34）、灶状钙化（79.4%，27/34）、纤维素样物沉着为主（97.1%，33/34），部分为重度绒毛膜炎（26.5%，9/34）。（4）心脏病组与对照组胎儿胎盘病理检查结果对照显示，心脏病组胎儿的胎盘病变程度重于对照组胎儿；两组胎儿胎盘病变的病理特征不同，超声表现亦不同。 结论先天性心脏病组胎儿胎盘重度绒毛膜炎、灶状钙化和血栓形成影响母胎血液循环及营养物质交换，可能与先天性心脏病的发生有相关性。

Analysis of the pathological characteristics of placenta of fetal with congenital heart disease

ObjectiveTo investigate the pathological characteristics of placenta pathological changes of fetal with congenital heart disease. MethodsFrom August 2010 to April 2014 in the Department of Ultrasound in Beijing Anzhen Hospital and Fetal Heart Disease Maternal Fetal Medicine Research Important Laboratories, 20 cases induced by congenital heart disease (heart disease group, all of the fetuses due to cardiac malformations induced labor), and 34 cases which prenatal ultrasound and postpartum examination were normal, but induced by premature rupture of fetal membranes, hypamnion, gestational diabetes mellitus, preeclampsia, intrauterine asphyxia, threatened abortion, pregnant women of arrhythmia (control group). An analysis of fetal prenatal ultrasound and postpartum placental pathology were performed between the 2 groups. ResultsIn the placenta of congenital heart disease group, 17 cases were in the second trimester of pregnancy, 3 cases were in the late stage of pregnancy. In the placenta of control group, 34 cases were all in the later stage of pregnancy. Postpartum placental pathological examination showed: (1) There were 18 cases with placental lesions in the heart disease group (18/20), with severe chorionic villositis (77.8%, 14/18), focal calcification (44.4%, 8/18) and thrombosis (16.7%, 3/18) as the main, one case of placenta infarction, two cases of non significant changes were found in placenta or umbilical cord. (2) Ten cases of placenta lesions of fetal with lethal congenital heart disease was more serious than the other 10 cases of placenta lesions of fetal with non lethal congenital heart malformation in heart disease group. (3) All the 34 cases with placental lesions were found in the control group (34/34), with mild chorionic villositis (61.8%, 21/34), focal calcification (79.4%, 27/34) and cellulose like substance (97.1%, 33/34) as the main, with severe chorionic villositis (26.5%, 9/34) as a part. (4) The comparable results of pathologic examination in heart disease group and control group showed that fetal placenta lesions in the heart disease group were more serious than that in the control group. Both the pathological characteristics of placenta lesions in the two groups and the ultrasound performances were different. ConclusionsSevere placental chorionic inflammation, focal calcification and thrombosis of placenta in congenital heart disease group affect the maternal fetal blood circulation and exchange of nutrients, which may associated with the incidence of congenital heart disease.