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Relationship between placental histologic features and umbilical cord blood gases in preterm gestations.

Abstract

OBJECTIVE

Our purpose was to test the hypothesis that placental histologic lesions reflect abnormal placental respiratory function in preterm gestations.

STUDY DESIGN

A retrospective study of preterm deliveries from 22 to 32 weeks revealed 431 patients with umbilical venous or arterial blood gas values. Excluded were stillbirth, multiple gestations, placenta previa, maternal medical diseases, and fetal anomalies. Charts were reviewed for principal indication of delivery, diagnosis of labor, and mode of delivery. Blood gases were studied within 10 minutes of delivery on a model 178 automatic pH analyzer (Corning Med, Boston). Placental data included uteroplacental vascular lesions and related villous lesions, lesions of acute inflammation, chronic inflammation, and coagulation. Contingency tables and analysis of variance considered p < 0.05 as significant.

RESULTS

Mean +/- SD umbilical vein pH was 7.36 +/- 0.07 (range 6.94 to 7.56) and umbilical artery pH was 7.30 +/- 0.08 (range 6.83 to 7.55). Increasing severity of uteroplacental thrombosis, villous lesions reflective of uteroplacental vascular pathologic mechanisms, avascular villi, histologic evidence of abruptio placentae, chronic villitis, and increased circulating erythrocytes were associated with decrease in umbilical vein and artery pH, increase in umbilical vein and artery PCO2, and decrease in umbilical vein and artery PO2. Histologic evidence of acute infection and villous edema were associated with a higher pH and PO2 and a lower PCO2 in both umbilical vein and artery. Umbilical vein or artery base excess was not related to placental lesions. Labor was not related to blood gas values in this data set, although a subset of cases of extremely preterm premature rupture of membranes and preterm labor who labored and were delivered by cesarean section had significantly poorer umbilical venous and fetal arterial blood gas values (all p < 0.005). Lesions related to poorer blood gas values were significantly more frequent in preterm preeclampsia and nonhypertensive abruptio placentae than in premature rupture of membranes or preterm labor.

CONCLUSIONS

Changes in umbilical vein and artery pH, PO2, and PCO2 are significantly related to lesions of uteroplacental vascular pathologic mechanisms and intraplacental thrombosis. Placental lesions may be associated with chronic fetal distress by altering fetal oxygen availability and acid-base status. Placental immaturity resulting from prematurity may be associated with inefficient placental respiratory function and an increased likelihood of cesarean delivery in cases of premature rupture of membranes or preterm labor. Altered fetal acid-base balance plus excess numbers of circulating nucleated erythrocytes suggests that placental respiratory function is functionally abnormal when these lesions are present and leads to fetal tissue hypoxia.

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  • Authors+Show Affiliations

    ,

    Division of Anatomic Pathology, University of Connecticut Health Center, Farmington, USA.

    , , , ,

    Source

    MeSH

    Acidosis
    Analysis of Variance
    Blood Gas Analysis
    Carbon Dioxide
    Cell Respiration
    Chorionic Villi
    Edema
    Female
    Fetal Blood
    Fetal Diseases
    Fetal Hypoxia
    Humans
    Hydrogen-Ion Concentration
    Infant, Newborn
    Infant, Premature
    Obstetric Labor, Premature
    Oxygen
    Placenta
    Placenta Diseases
    Pregnancy
    Pregnancy Complications, Infectious
    Retrospective Studies
    Thrombosis
    Umbilical Arteries
    Umbilical Veins

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    7485293

    Citation

    Salafia, C M., et al. "Relationship Between Placental Histologic Features and Umbilical Cord Blood Gases in Preterm Gestations." American Journal of Obstetrics and Gynecology, vol. 173, no. 4, 1995, pp. 1058-64.
    Salafia CM, Minior VK, López-Zeno JA, et al. Relationship between placental histologic features and umbilical cord blood gases in preterm gestations. Am J Obstet Gynecol. 1995;173(4):1058-64.
    Salafia, C. M., Minior, V. K., López-Zeno, J. A., Whittington, S. S., Pezzullo, J. C., & Vintzileos, A. M. (1995). Relationship between placental histologic features and umbilical cord blood gases in preterm gestations. American Journal of Obstetrics and Gynecology, 173(4), pp. 1058-64.
    Salafia CM, et al. Relationship Between Placental Histologic Features and Umbilical Cord Blood Gases in Preterm Gestations. Am J Obstet Gynecol. 1995;173(4):1058-64. PubMed PMID: 7485293.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Relationship between placental histologic features and umbilical cord blood gases in preterm gestations. AU - Salafia,C M, AU - Minior,V K, AU - López-Zeno,J A, AU - Whittington,S S, AU - Pezzullo,J C, AU - Vintzileos,A M, PY - 1995/10/1/pubmed PY - 1995/10/1/medline PY - 1995/10/1/entrez SP - 1058 EP - 64 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 173 IS - 4 N2 - OBJECTIVE: Our purpose was to test the hypothesis that placental histologic lesions reflect abnormal placental respiratory function in preterm gestations. STUDY DESIGN: A retrospective study of preterm deliveries from 22 to 32 weeks revealed 431 patients with umbilical venous or arterial blood gas values. Excluded were stillbirth, multiple gestations, placenta previa, maternal medical diseases, and fetal anomalies. Charts were reviewed for principal indication of delivery, diagnosis of labor, and mode of delivery. Blood gases were studied within 10 minutes of delivery on a model 178 automatic pH analyzer (Corning Med, Boston). Placental data included uteroplacental vascular lesions and related villous lesions, lesions of acute inflammation, chronic inflammation, and coagulation. Contingency tables and analysis of variance considered p < 0.05 as significant. RESULTS: Mean +/- SD umbilical vein pH was 7.36 +/- 0.07 (range 6.94 to 7.56) and umbilical artery pH was 7.30 +/- 0.08 (range 6.83 to 7.55). Increasing severity of uteroplacental thrombosis, villous lesions reflective of uteroplacental vascular pathologic mechanisms, avascular villi, histologic evidence of abruptio placentae, chronic villitis, and increased circulating erythrocytes were associated with decrease in umbilical vein and artery pH, increase in umbilical vein and artery PCO2, and decrease in umbilical vein and artery PO2. Histologic evidence of acute infection and villous edema were associated with a higher pH and PO2 and a lower PCO2 in both umbilical vein and artery. Umbilical vein or artery base excess was not related to placental lesions. Labor was not related to blood gas values in this data set, although a subset of cases of extremely preterm premature rupture of membranes and preterm labor who labored and were delivered by cesarean section had significantly poorer umbilical venous and fetal arterial blood gas values (all p < 0.005). Lesions related to poorer blood gas values were significantly more frequent in preterm preeclampsia and nonhypertensive abruptio placentae than in premature rupture of membranes or preterm labor. CONCLUSIONS: Changes in umbilical vein and artery pH, PO2, and PCO2 are significantly related to lesions of uteroplacental vascular pathologic mechanisms and intraplacental thrombosis. Placental lesions may be associated with chronic fetal distress by altering fetal oxygen availability and acid-base status. Placental immaturity resulting from prematurity may be associated with inefficient placental respiratory function and an increased likelihood of cesarean delivery in cases of premature rupture of membranes or preterm labor. Altered fetal acid-base balance plus excess numbers of circulating nucleated erythrocytes suggests that placental respiratory function is functionally abnormal when these lesions are present and leads to fetal tissue hypoxia. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/7485293/Relationship_between_placental_histologic_features_and_umbilical_cord_blood_gases_in_preterm_gestations_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0002-9378(95)91326-2 DB - PRIME DP - Unbound Medicine ER -