| Abstract | Cilj istraživanja: Utvrditi učestalost patohistoloških lezija posteljica, demografske karakteristike rodilja i novorođenčadi iz trudnoća kompliciranih kolestazom, te ispitivane parametre usporediti s onima iz urednih trudnoća.
Materijali i metode: Istraživanje je opservacijsko, retrospektivno i presječno. Ispitivani uzorak obuhvaća posteljice iz trudnoća kompliciranih kolestazom za razdoblje od 1. siječnja 2021. do 31. prosinca 2022. godine pohranjene na Klinici za patologiju, sudsku medicinu i citologiju KBC–a Split. Podaci o ispitanicama prikupljeni su iz središnje elektroničke bolničke evidencije.
Rezultati: Studija je obuhvatila 28 terminskih posteljica rodilja s dijagnozom kolestaze te 30 terminskih posteljica urednih trudnoća. U skupini kolestaze bilo je 16 posteljica iz biamnijalnih bikorijalnih blizanačkih trudnoća, dok u kontrolnoj skupini nije bila nijedna blizanačka posteljica. Rodilje u skupini kolestaze su bile statistički značajno starije od rodilja u kontrolnoj skupini (P=0,012). Gestacijska dob je bila statistički značajno niža kod rodilja s kolestazom u usporedbi s kontrolnom skupinom (P<0,001), kao i masa novorođenčadi (P=0,0001). U ispitivanoj skupini su zabilježena 4 IUZR-a, a u kontrolnoj skupini nijedan, što je bilo statistički značajno (P=0,019). Posteljice iz skupine kolestaze su imale statistički značajno kraću pupkovinu (P<0,0001) u usporedbi s posteljicama kontrolne skupine, bez razlike u promjeru pupkovine (P=0,352). Pupkovine iz skupine kolestaze su imale statistički značajno veći indeks torzije u usporedbi s pupkovinama kontrolne skupine (P=0,027). U skupini kolestaze zabilježeno je pet MVM i jedna FVM, dok je u kontrolnoj skupini bila jedna MVM i nijedna FVM što nije bilo statistički značajno (P=0,072) (P=0,301). U skupini kolestaze zabilježena su 3 slučaja majčinog upalnog odgovora naspram nijednog u kontrolnoj skupini, što nije bilo statistički značajno (P=0,068). Pojačano odlaganje periviloznog fibrina zabilježeno je kod 14 posteljica iz skupine kolestaze u odnosu na jednu posteljicu kontrolne skupine, što je bilo statistički značajno (P=0,0001).
Zaključak: Ovim istraživanjem dokazana je veća učestalost pojačanog odlaganja periviloznog fibrina i poremećaja pupkovine koji su uključivali kraću pupkovinu i veći indeks torzije u ispitivanoj skupini posteljica. MVM i majčin upalni odgovor su također bili učestaliji u ispitivanoj skupini ali je rezultat na granici statističke značajnosti. Novorođenčad je bila manje gestacijskoj dobi, manje mase i s učestalijim intrauterinim zastojem rasta u ispitivanoj skupini. Potrebne su daljnje studije na većem uzorku kako bi se razjasnio utjecaj kolestaze na morfologiju i funkciju posteljice. |
| Abstract (english) | The aim of the research: To determine the frequency of pathohistological lesions of the placenta, the demographic characteristics of mothers and newborns from pregnancies complicated by cholestasis and to compare the examined parameters with those from normal pregnancies.
Materials and methods: The research is observational, retrospective and cross-sectional. The examined sample includes placentas from pregnancies complicated by cholestasis in the period from January 1, 2021 to December 31, 2022, stored at the Clinic for Pathology, Forensic Medicine and Cytology of University Hospital of Split. Data on the subjects were collected from the central electronic hospital records.
Results: The study included 28 full-term placentas of mothers diagnosed with cholestasis and 30 full-term placentas from normal pregnancies. There were 16 placentas from biamnial bichorionic twin pregnancies in the cholestasis group, while there were no twin placentas in the control group. Parturients in the cholestasis group were statistically significantly older than parturients in the control group (P=0.012). Gestational age was statistically significantly lower in mothers with cholestasis compared to the control group (P<0.001), as was the weight of newborns (P=0.0001). In the examined group, 4 IUZR were recorded, and none in the control group, which was statistically significant (P=0.019). Placentas from the cholestasis group had a statistically significantly shorter umbilical cord (P<0.0001) compared to placentas from the control group, with no difference in cord diameter (P=0.352). The umbilical cords from the cholestasis group had a statistically significantly higher torsion index compared to the umbilical cords of the control group (P=0.027). Five MVM and one FVM were recorded in the cholestasis group, while in the control group there was one MVM and no FVM, which was not statistically significant (P=0.072) (P =0.301). In the cholestasis group, there were 3 cases of maternal inflammatory response compared to none in the control group, which was not statistically significant (P=0.068). Increased deposition of perivillous fibrin was recorded in 14 placentas from the cholestasis group compared to one placenta from the control group, which was statistically significant (P=0.0001).
Conclusion: This research proved a higher frequency of enhanced deposition of perivillous fibrin and umbilical cord disorders that included a shorter umbilical cord and a higher torsion index in the tested group of placentas. MVM and the mother's inflammatory response were also more frequent in the examined group, but the result is at the limit of statistical significance. Newborns were smaller for gestational age, less mass and with more frequent intrauterine growth retardation in the examined group. Further studies on a larger sample are needed to clarify the impact of cholestasis on placental morphology and function. |
