{"title":"Creta胎盘:与浅胎盘植入相关的一系列病变。","authors":"Jerzy Stanek","doi":"10.1155/2020/4230451","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>On placental histology, placenta creta (PC) ranges from clinical placenta percreta through placenta increta and accreta (clinical and occult) to myometrial fibers with intervening decidua. This retrospective study aimed to investigate the clinicopathologic correlations of these lesions.</p><p><strong>Methods: </strong>A total of 169 recent consecutive cases with PC (group 1) were compared with 1661 cases without PC examined during the same period (group 2). The frequencies of 25 independent clinical and 40 placental phenotypes were statistically compared between the groups using chi-square test or analysis of variance where appropriate.</p><p><strong>Results: </strong>Group 1 placentas, as compared with group 2 placentas, were statistically significantly (<i>p</i> < 0.05) associated with caesarean sections (11.2% vs. 7.5%), antepartum hemorrhage (17.7% vs 11.6.%), gestational hypertension (11.2% vs 4.3%), preeclampsia (11.8% vs 2.6%), complicated third stage of labor (18.9% vs 6.4%), villous infarction (14.2% vs 8.9%), chronic hypoxic patterns of placental injury, particularly the uterine pattern (14.8%, vs 9.6%), massive perivillous fibrin deposition (9.5% vs 5.3%), chorionic disc chorionic microcysts (21.9% vs 15.9%), clusters of maternal floor multinucleate trophoblasts (27.8% vs 21.2%), excessive trophoblasts of chorionic disc (24.3% vs 17.3%), segmental fetal vascular malperfusion (27.8% vs 19.9%), and fetal vascular ectasia (26.2% vs 15.2%).</p><p><strong>Conclusion: </strong>Because of the association of PC with gestational hypertensive diseases, acute and chronic placental hypoxic lesions, increased extravillous trophoblasts in the chorionic disc, chorionic microcysts, and maternal floor trophoblastic giant cells, PC should be regarded as a lesion of abnormal placental implantation and abnormal trophoblast invasion rather than decidual deficiency only.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"4230451"},"PeriodicalIF":1.6000,"publicationDate":"2020-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4230451","citationCount":"2","resultStr":"{\"title\":\"Placenta Creta: A Spectrum of Lesions Associated with Shallow Placental Implantation.\",\"authors\":\"Jerzy Stanek\",\"doi\":\"10.1155/2020/4230451\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>On placental histology, placenta creta (PC) ranges from clinical placenta percreta through placenta increta and accreta (clinical and occult) to myometrial fibers with intervening decidua. This retrospective study aimed to investigate the clinicopathologic correlations of these lesions.</p><p><strong>Methods: </strong>A total of 169 recent consecutive cases with PC (group 1) were compared with 1661 cases without PC examined during the same period (group 2). The frequencies of 25 independent clinical and 40 placental phenotypes were statistically compared between the groups using chi-square test or analysis of variance where appropriate.</p><p><strong>Results: </strong>Group 1 placentas, as compared with group 2 placentas, were statistically significantly (<i>p</i> < 0.05) associated with caesarean sections (11.2% vs. 7.5%), antepartum hemorrhage (17.7% vs 11.6.%), gestational hypertension (11.2% vs 4.3%), preeclampsia (11.8% vs 2.6%), complicated third stage of labor (18.9% vs 6.4%), villous infarction (14.2% vs 8.9%), chronic hypoxic patterns of placental injury, particularly the uterine pattern (14.8%, vs 9.6%), massive perivillous fibrin deposition (9.5% vs 5.3%), chorionic disc chorionic microcysts (21.9% vs 15.9%), clusters of maternal floor multinucleate trophoblasts (27.8% vs 21.2%), excessive trophoblasts of chorionic disc (24.3% vs 17.3%), segmental fetal vascular malperfusion (27.8% vs 19.9%), and fetal vascular ectasia (26.2% vs 15.2%).</p><p><strong>Conclusion: </strong>Because of the association of PC with gestational hypertensive diseases, acute and chronic placental hypoxic lesions, increased extravillous trophoblasts in the chorionic disc, chorionic microcysts, and maternal floor trophoblastic giant cells, PC should be regarded as a lesion of abnormal placental implantation and abnormal trophoblast invasion rather than decidual deficiency only.</p>\",\"PeriodicalId\":19439,\"journal\":{\"name\":\"Obstetrics and Gynecology International\",\"volume\":\"2020 \",\"pages\":\"4230451\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2020-11-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1155/2020/4230451\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Obstetrics and Gynecology International\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/2020/4230451\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2020/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Obstetrics and Gynecology International","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2020/4230451","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2020/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 2
摘要
背景:在胎盘组织学上,creta (PC)的范围从临床的percreta到临床的increta和增生的胎盘(临床的和隐匿的),再到子宫肌纤维并其间有蜕膜。本回顾性研究旨在探讨这些病变的临床病理相关性。方法:将近期连续发生PC的169例患者(第一组)与同期未发生PC的1661例患者(第二组)进行比较,采用卡方检验或方差分析对两组间25种独立临床表型和40种胎盘表型的频率进行统计学比较。结果:与2组胎盘相比,1组胎盘与剖宫产(11.2% vs. 7.5%)、产前出血(17.7% vs. 11.6%)、妊娠高血压(11.2% vs. 4.3%)、先兆子痫(11.8% vs. 2.6%)、分娩第三期并发症(18.9% vs. 6.4%)、绒毛梗死(14.2% vs. 8.9%)、胎盘损伤的慢性缺氧模式,特别是子宫模式(14.8% vs. 9.6%)的相关性有统计学意义(p < 0.05)。大量绒毛周围纤维蛋白沉积(9.5%比5.3%),绒毛膜盘绒毛膜微囊(21.9%比15.9%),母体底多核滋养细胞聚集(27.8%比21.2%),绒毛膜盘滋养细胞过多(24.3%比17.3%),节段性胎儿血管灌注不良(27.8%比19.9%),胎儿血管扩张(26.2%比15.2%)。结论:由于PC与妊娠期高血压疾病、急、慢性胎盘缺氧病变、绒毛膜盘外滋养细胞增多、绒毛膜微囊、母体底滋养细胞巨细胞增多有关,PC应视为胎盘着床异常和滋养细胞侵袭的病变,而不仅仅是蜕膜缺乏。
Placenta Creta: A Spectrum of Lesions Associated with Shallow Placental Implantation.
Background: On placental histology, placenta creta (PC) ranges from clinical placenta percreta through placenta increta and accreta (clinical and occult) to myometrial fibers with intervening decidua. This retrospective study aimed to investigate the clinicopathologic correlations of these lesions.
Methods: A total of 169 recent consecutive cases with PC (group 1) were compared with 1661 cases without PC examined during the same period (group 2). The frequencies of 25 independent clinical and 40 placental phenotypes were statistically compared between the groups using chi-square test or analysis of variance where appropriate.
Results: Group 1 placentas, as compared with group 2 placentas, were statistically significantly (p < 0.05) associated with caesarean sections (11.2% vs. 7.5%), antepartum hemorrhage (17.7% vs 11.6.%), gestational hypertension (11.2% vs 4.3%), preeclampsia (11.8% vs 2.6%), complicated third stage of labor (18.9% vs 6.4%), villous infarction (14.2% vs 8.9%), chronic hypoxic patterns of placental injury, particularly the uterine pattern (14.8%, vs 9.6%), massive perivillous fibrin deposition (9.5% vs 5.3%), chorionic disc chorionic microcysts (21.9% vs 15.9%), clusters of maternal floor multinucleate trophoblasts (27.8% vs 21.2%), excessive trophoblasts of chorionic disc (24.3% vs 17.3%), segmental fetal vascular malperfusion (27.8% vs 19.9%), and fetal vascular ectasia (26.2% vs 15.2%).
Conclusion: Because of the association of PC with gestational hypertensive diseases, acute and chronic placental hypoxic lesions, increased extravillous trophoblasts in the chorionic disc, chorionic microcysts, and maternal floor trophoblastic giant cells, PC should be regarded as a lesion of abnormal placental implantation and abnormal trophoblast invasion rather than decidual deficiency only.
期刊介绍:
Obstetrics and Gynecology International is a peer-reviewed, Open Access journal that aims to provide a forum for scientists and clinical professionals working in obstetrics and gynecology. The journal publishes original research articles, review articles, and clinical studies related to obstetrics, maternal-fetal medicine, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine and infertility, reproductive endocrinology, and sexual medicine.