Pathological Changes Of The Placenta And Its Clinical Significance In High Risk Pregnancy

Objective: To analyze the pathological changes of the placenta in high risk pregnancy, assess pathological examination prognostic significance for patients in high risk pregnancy and newborn.Methods:(1) The object of study: The clinical data of 358 high-risk puerperas who deliveried and received pathological examinations from January 2013 to December 2015 in The First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. High-risk factors of puerperas were analyzed, and pregnancy outcomes of different placenta pathology types in high risk pregnancy were discussed, such as puerperal infection,neonatal asphyxia and neonatal infection.(2)Research methods: research indicators:the patient's general information: admission number, name, age, length of stay, pregnancy history, gestational age, risk factors were combined; The obstetric specialist information: placental pathology type, placental pathology inspection report, time of delivery, mode of delivery; newborn: newborn Apgar's score, the incidence rates of neonatal asphyxia and neonatal infection.(3) Statistical methods: Measurement data using ± SD, enumeration data count rate, said rate compared by chi-square test, the results with P < 0.05 as there are significant differences. All the processing of data by SPSS 20.0 statistics software to complete.Results: 1. In 358 cases of high-risk pregnancy who received pathological examinations, to analyze the high-risk factors, found that hypertensive disorders in pregnancy, placenta previa, premature rupture of membranes were the main proportion, ratio of 23.46%, 21.51%, 18.99% respectively. 2.The 358 cases of placental pathologic examination results showed the microscopically histological diversity,The varies of placental pathology type from more to less in proper order were:calcareous infarct, placental villi infarction, fibrindeposition, inflammation of the placenta, cytotrophoblasts hyperplasia nodules increased and villous vessels wall fibrinoid necrosis. 3. Different risk factors had correlation with placental pathologic changes, it was statistically significant(P < 0.05). 4. Cytotrophoblasts hyperplasia nodules increased associated with inflammation of the placenta, placental villi infarction associated with calcifications, fibrin deposition associated with calcifications and illous vessels wall fibrinoid necrosis, illous vessels wall fibrinoid necrosis associated with cytotrophoblasts hyperplasia nodules increased, the differences were statistically significant(P<0.05). 5. Compared with gestational age < 37 weeks group, The incidence of calcifications and fibrin depositions were significantly higher than that of gestational age ? 37,hower, the incidence of inflammation of the placenta in gestational age < 37 group was significantly higher, the two groups had significant difference(P < 0.05). Cytotrophoblasts hyperplasia nodules increased and villous vessels wall fibrinoid necrosis in gestational age differences had no statistical significance(P > 0.05). 6. The incidence of placental villi infarction, calcifications, fibrin depositions and villi vascular fibrinoid degeneration in cesarean section and vaginal delivery was no significant difference(P > 0.05). The incidence of inflammation of the placenta with vaginal delivery was significantly higher(P < 0.05). The incidence of cytotrophoblasts hyperplasia nodules increased with cesarean section was significantly higher(P < 0.05). 7. The incidence of puerperal infection was no significant difference(P > 0.05),no matter there was inflammation of the placenta or not. 8. 131 cases of 277 newborns occurred neonatal infections. The incidence of neonatal infection was 56.32% in who the placenta was in inflammation, higher than that of placenta no inflammatory cell infiltrate, compared the two groups had significant difference(P < 0.05). 9. 54 cases of 277 newborns occured neonatal asphyxia. The incidence of neonatal asphyxia in placenta calcification was higher than without calcification, the difference was statistically significant(P < 0.05). Placental villi infarction, fibrin deposition, inflammation of the placenta, cytotrophoblasts hyperplasia nodules increased and villous vessels wall fibrinoid necrosis in neonatal asphyxia rate had no significant difference(P > 0.05).Conclusion: 1. We gradually pay attention to the placental pathologic examination in high pregnancy, but the rate of placental pathologic examination is still low. We should recognize the importance of the placental pathologic examination. 2. Different risk factors has its special pathological changes, and interaction effects between different pathological changes. 3. The placenta pathology types were significantly correlated with neonatal prognosis. Inflammation of the placenta were associated with neonatal infections. The placenta calcifications were associated with neonatal asphyxia...