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目的探讨妊娠期糖尿病(GDM)并发巨大儿与胎儿生长受限(FGR)患者胎盘超微结构的改变。方法选取2009-2010年陕西省妇幼保健院住院足月剖宫产分娩孕妇15例胎盘组织,进行电镜观察其超微结构改变,其中8例为GDM合并巨大儿胎盘,4例为GDM并发FGR胎盘,3例为正常孕妇胎盘。结果 GDM合并巨大儿患者胎盘超微结构改变表现为微绒毛排列紊乱,部分缺失,线粒体、粗面内质网等细胞器肿胀受损;毛细血管增生,基底膜增厚。GDM合并FGR患者的胎盘超微结构改变表现为微绒毛稀疏细小,细胞核不规则;细胞质内有较多的空泡,细胞器数量减少;毛细血管减少。结论 GDM患者胎盘形态学改变可能直接影响了胎盘的供血和供氧功能,导致了不良妊娠结局。
Objective To investigate the changes of placental ultrastructure in patients with gestational diabetes mellitus (GDM) complicated with giant fetus and fetal growth restriction (FGR). Methods From 2009 to 2010, 15 cases of full-term cesarean delivery of pregnant women in maternal and child care hospital of Shaanxi Province were collected and examined by electron microscopy. Ultrastructural changes were observed in 8 cases of GDM with giant placenta, 4 cases of GDM complicated with FGR placenta , 3 cases of normal pregnant women placenta. Results The ultrastructural changes of placenta in giant GDM patients showed that the arrangement of microvilli was disordered and partially degenerated. The swelling of organelles such as mitochondria and rough endoplasmic reticulum was impaired. Capillary proliferation and basement membrane thickening were observed. The ultrastructural changes of the placenta in patients with GDM and FGR showed that the microvilli were sparse and small with irregular nuclei; more vacuoles were found in the cytoplasm, the number of organelles was reduced, and the number of capillaries was decreased. Conclusion The placental morphological changes in GDM patients may directly affect the placental blood supply and oxygen supply, resulting in adverse pregnancy outcomes.