Vergani Patrizia, Ornaghi Sara, Pozzi Ilaria, Beretta Pietro, Russo Francesca Maria, Follesa Ilaria, Ghidini Alessandro
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy.
Am J Obstet Gynecol. 2009 Sep;201(3):266.e1-5. doi: 10.1016/j.ajog.2009.06.009. Epub 2009 Jul 24.
The purpose of this study was to relate the mode of delivery and outcomes in a cohort of cases of placenta previa that had the last transvaginal ultrasonographic scan <28 days before delivery.
Cases in which the placental edge overlapped the internal cervical (n = 42) underwent cesarean section delivery. Labor was allowed in those with placental edge to internal os distance of 1-10 mm (group 1, 24 women) and those with a distance of 11-20 mm (group 2, 29 women).
Rates of cesarean section delivery (75% vs 31%; odds ratio, 6.7; 95% confidence interval [CI], 2-22) and of bleeding before labor (29% vs 3%; odds ratio, 11.5; 95% CI, 1.6-76.7) were higher in group 1 than in group 2. Blood loss at delivery (662 +/- 466 mL vs 510 +/- 547 mL) and rate of severe postpartum hemorrhage (21% vs 10%; odds ratio, 2.3; 95% CI, 0.5-9.7) were similar in the 2 groups.
More than two-thirds of women with a placental edge to cervical os distance of >10 mm deliver vaginally without increased risk of hemorrhage.
本研究旨在探讨分娩前最后一次经阴道超声扫描在28天内的前置胎盘病例的分娩方式与结局之间的关系。
胎盘边缘覆盖宫颈内口的病例（n = 42）行剖宫产。胎盘边缘距宫颈内口1 - 10 mm的产妇（第1组，24名）和胎盘边缘距宫颈内口11 - 20 mm的产妇（第2组，29名）允许经阴道分娩。
第1组剖宫产率（75%对31%；优势比，6.7；95%置信区间[CI]，2 - 22）和分娩前出血率（29%对3%；优势比，11.5；95% CI，1.6 - 76.7）高于第2组。两组分娩时失血量（662±466 mL对510±547 mL）和严重产后出血率（21%对10%；优势比，2.3；95% CI，0.5 - 9.7）相似。
胎盘边缘距宫颈内口距离>10 mm的产妇中，超过三分之二可经阴道分娩，且出血风险未增加。
