摘要目的 探讨小于胎龄儿(SGA)与胎盘病理学异常间的关系.方法 收集上海市长宁区妇幼保健院2010年1月至2011年12月送检的晚孕、活产、单胎、小于胎龄儿胎盘共100例(SGA组)与紧随各SGA后送检的2例晚孕、活产、单胎、适龄儿胎盘共200例(AGA组),进行仔细的大体及镜下观察,比较其差异.结果 SGA组的孕周、新生儿出生体质量、足月新生儿出生体质量、早产率及自然分娩率均明显低于AGA组(P＜0.002).足月胎盘体积、胎盘质量及胎儿/胎盘质量比在SGA组明显小于AGA组(P＜0.05)；而脐带附着异常和脐带螺旋过多在SGA组中更多见(P＜0.05).SGA组中合体结节增多、无血管绒毛及绒毛梗死明显多于AGA组(P＜0.005)；而绒毛间血栓、慢性绒毛炎及绒毛膜血管病在两组中差异无统计学意义(P＞0.05).妊娠期高血压疾病及产前胎儿监护异常等在SGA组中较AGA组更常见(P＜0.05).结论 妊娠期高血压疾病是SGA发生的主要临床因素.胎盘的某些大体观察及镜下异常可影响胎儿宫内的生长发育.

abstractsObjective To investigate the relationship between pathological abnormalities of placenta and small-for-gestational-age neonates.Methods One hundred placentas of small-for-gestational-age (SGA group) and 200 appropriate-for-gestational-age (AGA group) with single living birth in third trimester were investigated by gross and microscopic examination.The AGA placentas were collected from 2 cases following every SGA placenta.All cases were collected from Shanghai Changning District Maternity and Infant Health Hospital from January 2010 to December 2011.Results The gestational week,neonatal birth weight,fullterm neonatal birth weight,the preterm birth rate and vaginal spontaneous delivery rate were significantly lower in SGA group than that in AGA group (P ＜ 0.002).Full-term placental volume,placental weight and fetal placental weight ratio were lower in SGA group than that in AGA group (P＜0.05).Unusual insertion and torsion of umbilical cord were more common in SGA group (P＜0.05).Syncytial knots increase,avascular villi and villous infarcts were significantly higher in SGA group (P ＜0.005),but there were no significant difference between SGA group and AGA group in intervillous thrombi,chronic villitis and chorangiosis (P＞0.05).Gestational hypertension disease and abnormality of fetal monitoring were more common in SGA group (P＜0.05).Conclusions Gestational hypertension disease is the main clinical cause of SGA.Some placental abnormality can affect the growth and development of intrauterine fetus.