| Objective: Severe preeclampsia(s PE)is a type of hypertensive disorder complicating pregnancy which belongs to a specific disease in pregnancy.Severe preeclampsia is divided into early onset severe preeclampsia and late onset severe preeclampsia.In recent years,with the rapid development of perinatal medicine,the severe preeclampsia maternal and perinatal outcomes of gestational age after 34 weeks were improved obviously,so the experts at home and abroad are mostly to define early and late onset for the standard of34 weeks of pregnancy.Severe preeclampsia can cause multiple organ damage,seriously endangers maternal and fetal health,accounting for second in the leading cause of maternal death in China,so in recent years,severe preeclampsia has aroused the attention and research interest in perinatal medicine.The etiology and pathogenesis of severe preeclampsia are still unclear.The academic circles widely accepted earlier onset "two stages" hypothesis,in recent years in the two stage of development and basic hypothesis of the formation of "three stage" theory of etiology,that placenta derived lesions is a pathophysiological link in the pathogenesis of sPE.And because of the severe preeclampsia patients in most pregnancy termination,after delivery of the placenta,the clinical symptoms and signs quickly eased,pathological examination of patients with severe preeclampsia placenta apoptosis increased significantly,and the trophoblast invasion is limited,shallow placental implantation,spiral artery stenosis,vascular thrombosis,recasting disorder cause the placenta local hypoperfusion,placental ischemia,so that the foundation and placental dysfunction is related to the incidence of severe preeclampsia,placenta pathological change and severe preeclampsia are closely related,because the researchers more and more specialized subject of placenta.The placenta is fetal appendages,somewhere between the mother and the fetus,fetal growth is an important organ to maintain growth,with nutrition,exchange,metabolic and endocrine functions,the establishment of the fetal placental circulation is the material exchange between mother and fetus,ensure fetal growth and development.In patients with severe preeclampsia placenta implantation shallow,affect placental development,resulting in a marked decrease in the number of placental villi,vascular network formation disorder,maternal fetal exchange area decreased,directly affect fetal development in intrauterine growth restriction,fetal body weight increase,leading to fetal weight than normal pregnancy is low,research shows that low body the quality of children can lead to the occurrence of adult metabolic syndrome.At present,the microvessel density(MVD)was used to detect and evaluate the angiogenesis,in which the CD34 antigen is a marker of the capillary density of placental villi.Therefore,we can use CD34 to mark the placental villous blood vessels to count the amount of placental villi MVD,in order to observe the quantitative changes of placental villi,and compare the relationship between placental MVD and neonatal birth weight.The pathological changes of placenta were observed under microscope,and the qualitative changes of placenta were observed.To compare the relationship between the severity of pathological changes of placenta and neonatal birth weight.Therefore,through the study of pathological changes in patients with severe preeclampsia placenta in the etiology,pathogenesis,and reveal the correlation between pathological changes and neonatal birth weight in severe preeclampsia placenta,thus for clinical diagnosis,treatment and monitoring of severe preeclampsia patients,and provide a new theoretical basis for the way.Methods: Research object from Harrison international Heping Hospital obstetric regular prenatal of 2015.1 ~ 2016.12,the hospital childbirth puerpera,measurement of placental thickness by a physician before delivery,collection of neonatal birth weight,collect the placenta,all the patients' informed consent.One group,110 cases of severe preeclampsia group,namely it according togestational disease can be divided into 3 groups: group 1(gestational age of 28 to 31 + 6 weeks)35 cases,group 2(gestational age of 32-33 + 6 weeks)36 cases,group 3(gestational age 34 weeks)of 39 cases.No choice in the same period in hospital childbirth complications of patients with preterm and term to produce 110 cases as control group,also according to gestational age is divided into three groups: control group 1:35 cases(28 to 31 + 6 weeks),control group 2(32-33 + 6 weeks)36 cases,control group 3 39 cases(34weeks).The study group 1 and the control group1,the study group2 and the control group 2,the study group 3and the control group3,there was no significant difference in age,gestational age(P > 0.05).Sample preparation: Cut off immediately after delivery of the placenta fetal membrane and umbilical cord and placenta,weighing and measuring the long diameter and short diameter.After washing the placenta with physiological saline,5 pieces of tissue size of about 1 * 1cm * were randomly cut through the middle of the placenta,fixed with 4% formaldehyde,and paraffin embedding,random five section,HE stain.Every slice under the objective 5 pictures taken at random,and non-overlapping,after photos into the computer.Sliced the paraffin embedding the placenta,used in the immunohistochemical detection.Detect the expression of CD34 in placental tissue.Polyclonal antibody CD34 markers capillaries.Breast cancer tissue biopsies do positive control,negative control to replace CD34 antibody PBS.Analysis methods:The differences were compared among the study groups and the corresponding control groups in placental weight,the longest and shortest diameter,placental thickness of placentaplacental and neonatal birth weight;the morphological changes of placenta in the study group were observed;the expression of CD34 in each group was measured and the microvessel density(MVD)was compared;Analysis of the size of placentaplacental,placental weight,placental microvessel density and neonatal birth weight have no correlation.Data processing and statistical analysis: using statistical softwareSPSS16.0 statistical analysis of the data: the measurement data with the standard deviation indicated that two independent samples were compared by test,three samples were compared using analysis of variance,linear correlation analysis with the size,weight,microvessel density of placental and fetal birth relationship between body mass.Taking P=0.05 as the significant test level.Results:1 The general situation of the study group and the control group was compared with that of the placenta :there was no significant difference in the placenta of pregnant women in age,gestational age(P > 0.05);there were both statistically significant difference in placental weight,placental present,neonatal birth weight(P < 0.05);there was no significant difference in placental thickness(P > 0.05);and there is a positive correlation between placental weight,placental present and neonatal birth weight(P < 0.05).2 Placental tissue was observed under light microscope results: Study Group 1 and 2 of placental syncytial nodules were seen in observation,less number of villi with vascular syncytial cell membrane,fibrinoid necrosis and fibrin deposition around the villi,chronic chorioamnionitis,focal hemorrhagic infarction with villous degeneration and lacuna narrowed more;in group 3placental syncytiotrophoblast nodules visible,the number of villi with vascular syncytial cell membrane less,fibrinoid necrosis more;the control group had less placental villus syncytiotrophoblast nodules,number of villi have more vascular syncytial cell membrane,fibrinoid necrosis and fibrin deposition around the villi,chronic chorioamnionitis is very rare.The number of microvascular thrombosis of placental villi in the study groups was significantly higher than that of the control groups,and the earlier the onset of gestational age,the more the number of microvascular thrombosis of placental villi.3 Comparison of placental villi MVD: CD34 labeled endothelial cells,CD34 was mainly expressed in the cytoplasm of villous vascular endothelial cells.MVD in the study group with the severity of decline,the differenceswere statistically significant(P<0.05);study group 1 and control group 1,study group 2 and control group 2,group 3 and group 3 had significant difference(P<0.05);among the groups of placental microvascular density and neonatal birth weight was positively correlated(P<0.05).4 Perinatal outcome: Perinatal outcome: 110 cases of the study group:the study group 1 :5 cases of fetal distress and neonatal asphyxia in 4 cases,2cases of neonatal death,the incidence of adverse outcomes of the highest,followed by the study group 2:3 cases of fetal distress and neonatal asphyxia in 1 cases,0 cases of neonatal death;while the control group for 1 weeks of small fetal,low birth weight,there are 2 cases of fetal distress and neonatal asphyxia in 1 cases,0 cases of neonatal death;study group 3 and control group2,3 in the control group had no obvious adverse outcome.Conclusion:1 There was a positive correlation between placenta weight and neonatal birth weight in severe preeclampsia.Placental weight and neonatal birth weight are lowest in early onset severe preeclampsia compared with late onset preeclampsia.2 The morphological changes of placenta in severe preeclampsia were correlated with the birth weight of neonates.The more pathological changes under light microscopy,the lower the birth weight of newborns.There was a positive correlation between placental MVD and neonatal body weight.3 There is a positive correlation between the pathological changes of placenta and the severity of the disease in the preeclampsia,and is closely related to the outcome of the neonatal body weight. |
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