Хистопатолошки промени на постелката и нивната корелација со микробната инвазија кај пациентките со предвремено породување

Abstract

Introduction: Preterm delivery, with over 15 million cases per year, represents one of the most serious, most challenging and most persistent problems of contemporary perinatology. Despite all the efforts, the rate of nearly 10% worldwide is still unchanged, showing a tendency to increase. The association of this syndrome with perinatal mortality rate, neonatal mortality and morbidity has been well defined and confirmed. Evaluation of the histopathological changes of the placenta within this entity, show a variable rate of the acute inflammatory changes of the placenta, fetal membranes and the umbilical cord, ranging from 22 to 60%. The same statement is valid for the rate of detected microbial invasion of the placental tissue that ranges from 7.4 to 72%. Aim: To determine the frequency of the acute inflammatory changes of the placenta, fetal membranes and the umbilical cord, their stage and grade, as well as the correlation between these changes and the presence of the microbial invasion, in the cases of preterm delivery, with or without preexisting premature rupture of the membranes, and to determine their impact on the perinatal outcome. Material and methods: This is a cross-sectional study which included 150 patients with singleton, first or other consecutive pregnancy, with clinically manifested signs of preterm delivery, gestational age from 24+0-37+0 weeks of gestation (w.g). Patients were stratified, according to the gestational age, in four subgroups: 24+0-27+6 w.g, 28+0-31+6 w.g, 32+0-34+0 w.g and 34+1-37+0 w.g. Regardless of the delivery mode, after the expulsion or the evacuation, the placenta was prepared for histopathological analysis according to the recommendations of the Amniotic Fluid Index Nosology Committee of the Perinatal Section of the Society of Pediatric Pathology. For the microbiological analysis, samples were taken from the sub chorionic fibrin layer at the border between the placental disc and the amniotic membranes, according to the recommendations incorporated in the Clinical practice guideline for perinatal mortality audit issued by the Perinatal Society of Australia and New Zealand. Statistical sample was provided from the patients admitted at the University Clinic for Obstetrics and Gynecology in Skopje, as a referent tertiary center. Results: Statistical analysis of the data showed that the rate of the histopathologically proven chorioamnionitis and funisitis, within the study group, is 59.3% for the maternal inflammatory response and 22.7% for the fetal inflammatory response. Declining trend of the acute inflammatory changes as a function of gestational age was confirmed. Data from the microbiological analysis showed a significant correlation between histopathological changes and positive microbiological findings. Histopathological changes of the placenta, fetal membranes and the umbilical cord showed a statistically significant influence over the values of the Apgar score in 1’ and 5’.