先天性心脏病胎儿胎盘病理特征分析

发布时间：2018-06-13 00:04

本文选题：超声心动图 + 胎儿　；参考：《中华医学超声杂志(电子版)》2016年08期

【摘要】：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。
[Abstract]:Objective to investigate the pathological features of fetal placental lesions in congenital heart disease. Methods from August 2010 to April 2014, echocardiography from Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences was selected from the database of fetal heart disease, maternal and fetal medical consultation center, Fetal Heart Disease Medical consultation Center. 20 infants (heart disease group, All of them were induced by cardiac malformation. Prenatal ultrasound and postpartum examination were all normal, but due to premature rupture of membranes, oligohydramnios, gestational diabetes mellitus, preeclampsia, fetal distress, threatened labor, Thirty-four fetuses with arrhythmia induced labor (control group) were analyzed by prenatal ultrasound and placental pathological examination. Results in the congenital heart disease group, 17 cases were placenta in the second trimester of pregnancy, 3 cases were the placenta in the third trimester of pregnancy, and 34 cases in the control group. Postpartum placental pathological examination showed 20 cases of fetal placental lesions in the heart group (18 / 18), with severe choriositis of 77.8% 14 / 18, focal calcification of 44.44% (818) and thrombus formation 16.7% (3 / 18). (1 case with placental infarction 2 cases with placental umbilical cord had no significant change. Placental lesions in 10 fetuses with fatal congenital heart disease were more serious than those with non-fatal cardiac malformations (n = 10) 34 / 34 fetuses in the control group showed placental lesions. The results of placental pathological examination showed that placenta pathological changes were more severe in heart disease group than that in control group. The pathological examination of placenta in mild chorionitis group and control group showed that placenta lesion was more severe in heart disease group than in control group, with 27 / 34% focal calcification, 97.1% 33 / 34% cellulose deposition, and 26.5p / 34% severe chorionitis respectively. The results of placental pathological examination in heart group and control group showed that the degree of placental lesion in heart disease group was more severe than that in control group. The pathological features and sonographic findings of fetal placental lesions were different between the two groups. Conclusion severe placental chorionitis, focal calcification and thrombosis affect maternal and fetal blood circulation and nutrient exchange in congenital heart disease group, which may be related to the occurrence of congenital heart disease.
【作者单位】：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研究北京市重点实验室;首都医科大学附属北京安贞医院病理科;
【分类号】：R445.1;R714.5

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