Altered fetal growth, placental abnormalities, and stillbirth

被引：58

作者：

Bukowski, Radek ^{[1
]}

Hansen, Nellie I. ^{[2
]}

Pinar, Halit ^{[3
]}

Willinger, Marian ^{[4
]}

Reddy, Uma M. ^{[4
]}

Parker, Corette B. ^{[2
]}

Silver, Robert M. ^{[5
,6
]}

Dudley, Donald J. ^{[7
]}

Stoll, Barbara J. ^{[8
]}

Saade, George R. ^{[9
]}

Koch, Matthew A. ^{[2
]}

Hogue, Carol ^{[10
]}

Varner, Michael W. ^{[5
,6
]}

Conway, Deborah L. ^{[11
]}

Coustan, Donald ^{[3
]}

Goldenberg, Robert L. ^{[12
]}

机构：

[1] Univ Texas Austin, Dell Med Sch, Austin, TX 78712 USA

[2] RTI Int, Res Triangle Pk, NC USA

[3] Brown Univ, Sch Med, Providence, RI 02912 USA

[4] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Pregnancy & Perinatol Branch, NIH, Bethesda, MD USA

[5] Univ Utah, Sch Med, Salt Lake City, UT USA

[6] Intermt Hlth Care, Salt Lake City, UT USA

[7] Univ Virginia, Sch Med, Charlottesville, VA 22908 USA

[8] Univ Texas Hlth Sci Ctr Houston, Houston, TX 77030 USA

[9] Univ Texas Med Branch, Galveston, TX 77555 USA

[10] Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA

[11] Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA

[12] Columbia Univ, Med Ctr, New York, NY USA

来源：

PLOS ONE | 2017年 / 12卷 / 08期

关键词：

GESTATIONAL-AGE; DEATH; WEIGHT; VOLUME; TIME; RISK;

D O I：

10.1371/journal.pone.0182874

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background Worldwide, stillbirth is one of the leading causes of death. Altered fetal growth and placental abnormalities are the strongest and most prevalent known risk factors for stillbirth. The aim of this study was to identify patterns of association between placental abnormalities, fetal growth, and stillbirth. Methods and findings Population-based case-control study of all stillbirths and a representative sample of live births in 59 hospitals in 5 geographic areas in the U.S. Fetal growth abnormalities were categorized as small (<10th percentile) and large (>90th percentile) for gestational age at death (stillbirth) or delivery (live birth) using a published algorithm. Placental examination by perinatal pathologists was performed using a standardized protocol. Data were weighted to account for the sampling design. Among 319 singleton stillbirths and 1119 singleton live births at >= 24 weeks at death or delivery respectively, 25 placental findings were investigated. Fifteen findings were significantly associated with stillbirth. Ten of the 15 were also associated with fetal growth abnormalities (single umbilical artery; velamentous insertion; terminal villous immaturity; retroplacental hematoma; parenchymal infarction; intraparenchymal thrombus; avascular villi; placental edema; placental weight; ratio birth weight/placental weight) while 5 of the 15 associated with stillbirth were not associated with fetal growth abnormalities (acute chorioamnionitis of placental membranes; acute chorioamionitis of chorionic plate; chorionic plate vascular degenerative changes; perivillous, intervillous fibrin, fibrinoid deposition; fetal vascular thrombi in the chorionic plate). Five patterns were observed: placental findings associated with (1) stillbirth but not fetal growth abnormalities; (2) fetal growth abnormalities in stillbirths only; (3) fetal growth abnormalities in live births only; (4) fetal growth abnormalities in stillbirths and live births in a similar manner; (5) a different pattern of fetal growth abnormalities in stillbirths and live births. Conclusions The patterns of association between placental abnormalities, fetal growth, and stillbirth provide insights into the mechanism of impaired placental function and stillbirth. They also suggest implications for clinical care, especially for placental findings amenable to prenatal diagnosis using ultrasound that may be associated with term stillbirths.

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