Weeks Andrew D
School of Reproductive and Developmental Medicine, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK.
Best Pract Res Clin Obstet Gynaecol. 2008 Dec;22(6):1103-17. doi: 10.1016/j.bpobgyn.2008.07.005. Epub 2008 Sep 14.
The incidence and importance of retained placenta (RP) varies greatly around the world. In less developed countries, it affects about 0.1% of deliveries but has up to 10% case fatality rate. In more developed countries, it is more common (about 3% of vaginal deliveries) but very rarely associated with mortality. There are three main types of retained placenta following the vagina delivery: placenta adherens (when there is failed contraction of the myometrium behind the placenta), trapped placenta (a detached placenta trapped behind a closed cervix) and partial accreta (when there is a small area of accreta preventing detachment). All can be treated by manual removal of placenta, which should be carried out at 30-60 minutes postpartum. Medical management is also an option for placenta adherens and trapped placenta. The need for manual removal can be reduced by 20% by the use of intraumbilical oxytocin (30 i.u. in 30 mL saline). A trapped placenta may respond to glyceryl trinitrate (500 mcg sublingually) or gentle, persistent, controlled cord traction.
全球范围内，胎盘滞留（RP）的发生率及严重性差异很大。在欠发达国家，其影响约0.1%的分娩，但病死率高达10%。在较发达国家，胎盘滞留更为常见（约占阴道分娩的3%），但很少导致死亡。阴道分娩后主要有三种胎盘滞留类型：粘连性胎盘（胎盘后方子宫肌层收缩失败）、嵌顿性胎盘（已剥离的胎盘嵌顿于紧闭的宫颈后方）和部分植入性胎盘（存在一小片植入性胎盘组织导致胎盘无法剥离）。所有这些情况都可通过人工剥离胎盘进行治疗，应在产后30至60分钟内进行。对于粘连性胎盘和嵌顿性胎盘，药物治疗也是一种选择。使用脐内催产素（30单位溶于30毫升生理盐水中）可使人工剥离胎盘的需求减少20%。嵌顿性胎盘可能对硝酸甘油（舌下含服500微克）或轻柔、持续、可控的脐带牵引有反应。
