Pregnancy outcome and pathological changes of the placenta in preeclampsia with fetal growth restriction

doi:10.3877/cma.j.issn.2095-3259.2023.02.005

Abstract

Abstract:

Objective

To analyze and compare the adverse outcomes of women and infants with Preeclampsia (PE) combined with fetal growth restriction (FGR) and the pathological changes of maternal placenta, and explore whether the adverse outcomes of women and infants with PE combined with FGR are worse. In the case of PE pregnant women with FGR, whether the maternal placenta has more serious lesions, and explore the correlation between the severity of maternal placenta lesions and adverse maternal and infant outcomes.

Methods

The pregnancy outcomes and maternal placenta pathology data of 148 women with PE who were hospitalized and gave birth in the Obstetrics Department of The Third Affiliated Hospital of Guangzhou Medical University from January 2019 to June 2022 were retrospectively analyzed, and 148 women were divided into two groups according to whether the pregnant women were combined with FGR: The FGR group (44 cases, 29.7%) was the observation group, and the non-FGR group (104 cases, 70.3%) was the control group.

Results

(1) There was no significant difference in age and basic body mass index between the two groups. However, the proportion of first-time mothers and previous history of hypertension or FGR in the FGR group were higher than those in the non-FGR group [61.36% (27/44) vs 37.50% (39/104), 11.36% (5/44) vs 2.88% (3/104), 4.55% (2/44) vs 0% (0/104)], (all P<0.05), the difference was statistically significant. (2) The birth weight of newborns in the FGR group was lower than that in the non-FGR group [(1434.6±536.4) g vs (2288.7±976.7) g, t= 5.456, P<0.001], and the difference was statistically significant. The incidence of preterm birth and admission to neonatal department after birth in the FGR group was higher than that in the non-FGR group [79.5% (35/44) vs 50.0% (52/104) and 86.4% (38/44) vs 46.2% (48/104), P<0.001], the difference was statistically significant. (3) The incidence of related maternal complications in the FGR group was higher than that in the non-FGR group, especially the incidence of hypoproteinemia, which was significantly higher in the FGR group than in the non-FGR group [29.6% (13/44) vs10.6% (11/104)] (χ²=8.188, P=0.004). The difference was statistically significant. The incidence of liver and kidney dysfunction and thoracoabdominal effusion in patients with FGR was higher than that in patients without FGR [11.4% (5/44) vs. 3.9% (4/104), 13.6% (6/44) vs. 6.7% (7/104) and 9.1% (4/44) vs. 5.8% (6/104)]. There was no significant difference (P>0.05). (4) The placental weight in the FGR group was significantly lower than that in the non-FGR group [(345.93±101.06) g vs (436.78±125.70) g, t=4.246, P<0.001], and the placental coefficient was higher than that in the non-FGR group. [(0.26±0.09) vs (0.21±0.08), t=3.181, P=0.002], the differences were statistically significant, indicating that the placental hypoplasia of pregnant women with FGR was more significant. (5) The incidence of various placental lesions in the FGR group was higher than that in the non-FGR group, especially the incidence of decidua vascular disease and villus hypoplasia was about 2 times higher than that in the non-FGR group, and the placental lesions in the FGR group were mostly severe or diffuse.

Conclusions

The overall incidence of maternal complications in the FGR group was higher than that in the non-FGR group, and the perinatal preterm birth and low birth weight were more serious. The placental lesions in the FGR group were more serious, that is, the incidence of related placental lesions was higher, and the lesions were mainly diffuse or severe. Severe placental pathology is likely to be associated with worse perinatal adverse outcomes.

Key words: Preeclampsia, Fetal growth retardation, Placenta, Pregnancy outcome

Xiaofang Zheng, Songquan Wei, Zhenxuan Huang, Wenshi Wu, Guimin Li, Hongxia Zhang, Qingping Jiang, Dunjin Chen, Lin Yu. Pregnancy outcome and pathological changes of the placenta in preeclampsia with fetal growth restriction[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2023, 12(02): 85-92.

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References 33

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组别	例数	年龄[岁，(±s)]	BMI[kg/m², (±s)]	既往有高血压病史[例(%)]	既往有FGR病史[例(%)]	初产妇构成比[例(%)]
观察组	44	30.73±2.12	22.54±1.35	5(11.36)	2(4.55)	27(61.36)
对照组	104	31.86±2.15	22.33±1.21	3(2.88)	0(0)	39(37.50)
统计值		t＝0.122	t＝0.932	χ²＝4.374	χ²＝4.792	χ²＝8.385
P值		0.099	0.352	0.037	0.029	0.003

组别	例数	年龄[岁，(±s)]	BMI[kg/m², (±s)]	既往有高血压病史[例(%)]	既往有FGR病史[例(%)]	初产妇构成比[例(%)]
观察组	44	30.73±2.12	22.54±1.35	5(11.36)	2(4.55)	27(61.36)
对照组	104	31.86±2.15	22.33±1.21	3(2.88)	0(0)	39(37.50)
统计值		t＝0.122	t＝0.932	χ²＝4.374	χ²＝4.792	χ²＝8.385
P值		0.099	0.352	0.037	0.029	0.003

组别	例数	新生儿出生体重[(±s)g]	<37周早产[例(%)]	胎儿窘迫[例(%)]	1 min Apgar评分≤7分[例(%)]	入住新生儿科[例(%)]	羊水过少[例(%)]
观察组	44	1434.6±536.4	35(79.5)	12(27.3)	10(22.8)	38(86.4)	6(13.6)
对照组	104	2288.7±976.7	52(50.0)	27(25.9)	16(15.3)	48(46.2)	9(8.7)
统计值		t＝5.456	χ²＝11.139	χ²＝0.027	χ²＝1.151	χ²＝20.536	χ²＝0.842
P值		<0.001	<0.001	0.868	0.283	<0.001	0.358

组别	例数	新生儿出生体重[(±s)g]	<37周早产[例(%)]	胎儿窘迫[例(%)]	1 min Apgar评分≤7分[例(%)]	入住新生儿科[例(%)]	羊水过少[例(%)]
观察组	44	1434.6±536.4	35(79.5)	12(27.3)	10(22.8)	38(86.4)	6(13.6)
对照组	104	2288.7±976.7	52(50.0)	27(25.9)	16(15.3)	48(46.2)	9(8.7)
统计值		t＝5.456	χ²＝11.139	χ²＝0.027	χ²＝1.151	χ²＝20.536	χ²＝0.842
P值		<0.001	<0.001	0.868	0.283	<0.001	0.358

组别	例数	胎盘早剥	HELLP综合征	肝功能异常	肾功能异常	心力衰竭或肺水肿	胸腹腔积液	低蛋白血症	产后转重症监护病房
观察组	44	4(9.1)	3(6.8)	5(11.4)	6(13.6)	3(6.8)	4(9.1)	13(29.6)	4(9.1)
对照组	104	8(7.7)	6(5.8)	4(3.9)	7(6.7)	7(6.7)	6(5.8)	11(10.6)	9(8.7)
χ²值		0.081	0.060	3.059	1.0840	0.000	0.541	8.188	0.007
P值		0.776	0.807	0.080	0.175	0.985	0.462	0.004	0.932

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