胎盘间叶发育不良一例报告及文献复习  

Placental mesenchymal dysplasia: a case report and literature review

作　　者：石松荔[1] 曹雅静[1] Shi Songli;Cao Yajing(Department of Pathology,Tianjin Union Medical Center,Tianjin 300121,China)

机构地区：[1]天津市人民医院病理科,300121

出　　处：《中华围产医学杂志》2019年第10期729-734,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨胎盘间叶发育不良(placental mesenchymal dysplasia, PMD)的临床特点。方法报告天津市人民医院收治的1例PMD病例的诊治经过。同时检索国内PMD的相关文献,分析国内PMD病例的临床特点及母儿预后等资料。结果(1)病例资料:患者因发现血压升高入院,诊断为重度子痫前期、胎儿窘迫,于孕30周+1剖宫产分娩。经胎盘病理检查诊断为PMD。术后口服降压药控制血压,患者血压逐渐平稳出院。随访至2018年8月,母儿均未见异常。(2)文献复习:包括本例在内,共获得国内报告的PMD病例14例。14例患者年龄23~42岁,平均27.9岁;死产及活产各7例;男性胎儿2例,女性胎儿10例,2例未报告性别。14例中的10例B超表现为伴有弥漫存在的低回声区的囊性胎盘。5例检测了人绒毛膜促性腺激素水平,均在正常范围内。1例检测了甲胎蛋白水平,发现其水平明显升高。2例发生子痫前期。6例出现胎死宫内,3例出现胎儿窘迫,1例出现胎膜早破。14例中的7例胎儿活产,其中4例为早产。病理学检查发现并有记录的7例胎盘平均质量665 g,8例胎盘体积大于相应孕周。11例表面均可见葡萄状的透明水泡样结构。12例显微镜下均无滋养叶细胞增生及滋养叶细胞包涵体。结论PMD主要表现为孕期B超发现胎盘中出现囊性低回声区,同时血清人绒毛膜促性腺激素水平处于正常范围,血清甲胎蛋白水平多显著升高,胎儿染色体检查多为正常,并以女性胎儿为多。病理学检查常发现胎盘体积和质量均显著增加,表面可见葡萄状的串珠样结构。部分母体在孕期可能合并有高血压等并发症,并由于胎儿窘迫等原因而提前分娩,但母婴结局多良好。对PMD妊娠的孕妇及胎儿进行密切的监测,或可改善PMD孕期的预后。Objective To summarize the clinical,sonographic and pathological characteristics,and the perinatal outcomes of pregnancies complicated by placental mesenchymal dysplasia (PMD). Methods We reported the diagnosis and treatment of a case of PMD in Tianjin Union Medical Center. Pertinent Chinese literatures on PMD were reviewed to analyze the clinical features and the outcomes for mothers and infants. Results(1) Case report: The patient was admitted to our hospital with elevated blood pressure in July 2011 and underwent caesarean section at 30+1 gestational weeks indicated by severe preeclampsia and fetal distress. PMD was diagnosed by placental pathological examination. The patient was discharged from the hospital after oral antihypertensives treatment with stabilized blood pressure. Both the mother and the child were healthy during follow-ups until August 2018.(2) Literature review: A total of 14 cases of PMD were reported domestically including the index case. The average maternal age was 27.9(23-42). Of all the 14 fetuses, half were born alive and half were died in the uterus;two were male, 10 were female and two of unknown sex. Sonographic findings of 10 cases showed thickened placenta with hypoechoic areas. Human chorionic gonadotropin (hCG) was tested in five cases, and the results were all normal. One case was tested for maternal serum alpha fetoprotein (AFP), which was increased. Among the 14 cases, there were two of preeclampsia, six of intrauterine death, three of fetal distress and one of the premature rupture of fetal membranes. Four out of the seven live births were born prematurely. According to the medical record, the average weight of placentas of seven gravidas was 665 g, and eight placentas were larger than the gestational age in size. Pathological examinations showed 11 placentas were covered with grape-like cystic vesicles. No trophoblastic proliferation or stromal trophoblastic inclusion was observed in 12 cases under the microscope. Conclusions PMD is mainly characterized by enlarged and cystic

关 键 词：胎盘疾病 葡萄胎 诊断 鉴别 妊娠结局 

分 类 号：R714[医药卫生—妇产科学]