Nishtar A, Wood P L
Department of Obstetrics & Gynaecology, Northampton General Hospital, Northampton, UK.
J Obstet Gynaecol. 2012 Jul;32(5):413-8. doi: 10.3109/01443615.2012.673038.
Vasa praevia can cause acute severe fetal haemorrhage prior to or during rupture of the membranes, contributing to perinatal morbidity and mortality. There are no large prospective studies relating to vasa praevia and there is no place for a randomised controlled trial as it would be ethically unjustifiable given the poor prognosis. There are no national guidelines for the management of vasa praevia. Identification of vasa praevia by the 3rd trimester of pregnancy warrants the offer of delivery by planned caesarean section to avoid the complications. This is essentially intuitive and logical rather than based on any randomised trials. A universal screening programme for vasa praevia is not currently supported by a robust evidence base; however, the role of prenatal diagnosis requires an informed debate, as high quality data may not be forthcoming, given the low evidence of the condition. Increasing awareness and understanding of the clinical situations can accumulate information, which identify and treat this tragic complication of childbirth.
前置血管可在胎膜破裂前或破裂时导致急性严重胎儿出血，从而导致围产期发病率和死亡率。目前尚无关于前置血管的大型前瞻性研究，也没有随机对照试验的空间，因为鉴于预后较差，从伦理角度来看这是不合理的。目前尚无关于前置血管管理的国家指南。在妊娠晚期识别前置血管后，应建议通过计划剖宫产分娩以避免并发症。这本质上是直观且合乎逻辑的，而非基于任何随机试验。目前，一个强有力的证据基础并不支持对前置血管进行普遍筛查；然而，鉴于该病症的证据较少，高质量数据可能难以获得，产前诊断的作用需要进行充分的讨论。提高对临床情况的认识和理解可以积累信息，从而识别和治疗这种分娩时的悲惨并发症。
