{"title":"胎盘分级对妊娠结局的影响：一项回顾性队列研究","authors":"Antonios Siargkas, Ioannis Tsakiridis, Georgios Michos, Anastasios Liberis, Sofoklis Stavros, Menelaos Kyriakakis, Ekaterini Domali, Apostolos Mamopoulos, Themistoklis Dagklis","doi":"10.3390/healthcare13060601","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Placental grading remains underutilized in clinical practice despite its potential prognostic value. This study aimed to elucidate the relationship between premature placental calcification (PPC) and relevant perinatal outcomes in a large cohort.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study involving 3088 singleton pregnancies that underwent routine third-trimester ultrasound examinations (30<sup>+0</sup> to 35<sup>+6</sup> gestational weeks) at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, between January 2018 and December 2023. Placental calcification was graded using the Grannum system, categorizing placentas into Grades 0-1 (control), Grade 2, and Grade 3. Primary outcomes assessed were small for gestational age neonates (SGA) and preeclampsia. Secondary outcomes included gestational hypertension, fetal growth restriction (FGR), stillbirth, gestational age at birth, and birthweight centile. Multiple logistic regression was employed to adjust for confounders, i.e., maternal age, BMI, smoking, conception via assisted reproductive technology, and uterine artery pulsatility index.</p><p><strong>Results: </strong>In total, 544 pregnancies (17.6%) had Grade 2 placentas, and 41 pregnancies (1.3%) had Grade 3 placentas. Compared to the control group, Grade 2 placentas were associated with increased odds of SGA (adjusted odds ratio [aOR] 1.80; 95% confidence intervals [CI]: 1.43-2.25) and FGR (aOR 1.81; 95% CI: 1.35-2.42). Grade 3 placentas showed even higher odds of SGA (aOR 3.09; 95% CI: 1.55-6.17) and FGR (aOR 3.26; 95% CI: 1.53-6.95). No significant associations were found between placental grading and preeclampsia or stillbirth. Additionally, PPC was linked to lower birthweight percentiles and earlier gestational age at birth.</p><p><strong>Conclusions: </strong>Premature placental calcification (before 36<sup>+0</sup> weeks), particularly Grade 3, is significantly associated with adverse perinatal outcomes such as SGA and FGR. Incorporating placental grading into routine prenatal care may enhance risk stratification and guide clinical decision making beyond traditional assessment methods.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 6","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942256/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of Placental Grading on Pregnancy Outcomes: A Retrospective Cohort Study.\",\"authors\":\"Antonios Siargkas, Ioannis Tsakiridis, Georgios Michos, Anastasios Liberis, Sofoklis Stavros, Menelaos Kyriakakis, Ekaterini Domali, Apostolos Mamopoulos, Themistoklis Dagklis\",\"doi\":\"10.3390/healthcare13060601\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Placental grading remains underutilized in clinical practice despite its potential prognostic value. This study aimed to elucidate the relationship between premature placental calcification (PPC) and relevant perinatal outcomes in a large cohort.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study involving 3088 singleton pregnancies that underwent routine third-trimester ultrasound examinations (30<sup>+0</sup> to 35<sup>+6</sup> gestational weeks) at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, between January 2018 and December 2023. Placental calcification was graded using the Grannum system, categorizing placentas into Grades 0-1 (control), Grade 2, and Grade 3. Primary outcomes assessed were small for gestational age neonates (SGA) and preeclampsia. Secondary outcomes included gestational hypertension, fetal growth restriction (FGR), stillbirth, gestational age at birth, and birthweight centile. Multiple logistic regression was employed to adjust for confounders, i.e., maternal age, BMI, smoking, conception via assisted reproductive technology, and uterine artery pulsatility index.</p><p><strong>Results: </strong>In total, 544 pregnancies (17.6%) had Grade 2 placentas, and 41 pregnancies (1.3%) had Grade 3 placentas. Compared to the control group, Grade 2 placentas were associated with increased odds of SGA (adjusted odds ratio [aOR] 1.80; 95% confidence intervals [CI]: 1.43-2.25) and FGR (aOR 1.81; 95% CI: 1.35-2.42). Grade 3 placentas showed even higher odds of SGA (aOR 3.09; 95% CI: 1.55-6.17) and FGR (aOR 3.26; 95% CI: 1.53-6.95). No significant associations were found between placental grading and preeclampsia or stillbirth. Additionally, PPC was linked to lower birthweight percentiles and earlier gestational age at birth.</p><p><strong>Conclusions: </strong>Premature placental calcification (before 36<sup>+0</sup> weeks), particularly Grade 3, is significantly associated with adverse perinatal outcomes such as SGA and FGR. Incorporating placental grading into routine prenatal care may enhance risk stratification and guide clinical decision making beyond traditional assessment methods.</p>\",\"PeriodicalId\":12977,\"journal\":{\"name\":\"Healthcare\",\"volume\":\"13 6\",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-03-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942256/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Healthcare\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3390/healthcare13060601\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Healthcare","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/healthcare13060601","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Impact of Placental Grading on Pregnancy Outcomes: A Retrospective Cohort Study.
Background: Placental grading remains underutilized in clinical practice despite its potential prognostic value. This study aimed to elucidate the relationship between premature placental calcification (PPC) and relevant perinatal outcomes in a large cohort.
Methods: We conducted a retrospective cohort study involving 3088 singleton pregnancies that underwent routine third-trimester ultrasound examinations (30+0 to 35+6 gestational weeks) at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, between January 2018 and December 2023. Placental calcification was graded using the Grannum system, categorizing placentas into Grades 0-1 (control), Grade 2, and Grade 3. Primary outcomes assessed were small for gestational age neonates (SGA) and preeclampsia. Secondary outcomes included gestational hypertension, fetal growth restriction (FGR), stillbirth, gestational age at birth, and birthweight centile. Multiple logistic regression was employed to adjust for confounders, i.e., maternal age, BMI, smoking, conception via assisted reproductive technology, and uterine artery pulsatility index.
Results: In total, 544 pregnancies (17.6%) had Grade 2 placentas, and 41 pregnancies (1.3%) had Grade 3 placentas. Compared to the control group, Grade 2 placentas were associated with increased odds of SGA (adjusted odds ratio [aOR] 1.80; 95% confidence intervals [CI]: 1.43-2.25) and FGR (aOR 1.81; 95% CI: 1.35-2.42). Grade 3 placentas showed even higher odds of SGA (aOR 3.09; 95% CI: 1.55-6.17) and FGR (aOR 3.26; 95% CI: 1.53-6.95). No significant associations were found between placental grading and preeclampsia or stillbirth. Additionally, PPC was linked to lower birthweight percentiles and earlier gestational age at birth.
Conclusions: Premature placental calcification (before 36+0 weeks), particularly Grade 3, is significantly associated with adverse perinatal outcomes such as SGA and FGR. Incorporating placental grading into routine prenatal care may enhance risk stratification and guide clinical decision making beyond traditional assessment methods.
期刊介绍：
Healthcare (ISSN 2227-9032) is an international, peer-reviewed, open access journal (free for readers), which publishes original theoretical and empirical work in the interdisciplinary area of all aspects of medicine and health care research. Healthcare publishes Original Research Articles, Reviews, Case Reports, Research Notes and Short Communications. We encourage researchers to publish their experimental and theoretical results in as much detail as possible. For theoretical papers, full details of proofs must be provided so that the results can be checked; for experimental papers, full experimental details must be provided so that the results can be reproduced. Additionally, electronic files or software regarding the full details of the calculations, experimental procedure, etc., can be deposited along with the publication as “Supplementary Material”.
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