胎儿窘迫的胎盘病理学改变及临床意义

目的探讨胎儿窘迫的胎盘病理学变化与新生儿窒息和感染的关系。方法对本院2010年1月至2011年11月327例胎儿窘迫的临床资料和病检结果进行回顾性分析。结果胎盘病变发生率为81.7%,主要病理变化以绒毛膜羊膜炎、间质水肿、绒毛间质纤维化为主。胎儿窘迫发生在分娩期的胎盘绒毛膜羊膜炎、间质水肿发生率明显高于妊娠晚期组(P<0.05)。妊娠晚期组胎盘绒毛间质纤维化和胎盘钙化的发生率显著高于分娩期组(P<0.01,P<0.05)。胎盘感染组的新生儿窒息率和感染率显著高于对照组(18.7%VS 8.3%;10.5%VS 3.1%,P<0.05)。结论胎盘病理学变化与胎儿窘迫发生密切相关,胎盘炎细胞浸润、渗出和纤维化是导致胎儿窘迫的病理学机制之一,也是导致新生儿窒息和感染的发生率增加的重要影响因素。

Pathological changes of the placenta and its significance in fetal distress

Objective To investigate the relationship between the pathological changes of the placenta in fetal distress and neonatal asphyxia and infection.Methods The clinical data of 327 fetal distress patients who received pathological examinations from January 2010 to November 2011 in our hospital were retrospectively analyzed.Results The incidence rate of the placenta pathological changes was 81.7%.Chorioamnionitis,interstitial edema and villus interstitial fibrosis were the most salient pathological changes.The incidence rates of chorioamnionitis and interstitial edema in fetal distress were significantly higher in labor group than in late pregnancy group(P<0.05),and the incidence rates of villus interstitial fibrosis and placental calcification in fetal distress were significantly higher in late pregnancy group than in labor group(P<0.01,P<0.05).The incidence rates of neonatal asphyxia and infections were significantly higher in the placental infection group than in the control group(18.7% VS 8.3%;10.5% VS 3.1%,P<0.05).Conclusion The pathological changes of the placenta are closely related with fetal distress.The changes of the placenta including inflammatory cell infiltration,exudation and interstitial fibrosis may not only an important pathological evidence of fetal distress but also a key factor in pathogenesis of neonatal asphyxia and infection.