Silver Robert M
University of Utah School of Medicine, Salt Lake City, Utah.
Obstet Gynecol. 2015 Sep;126(3):654-668. doi: 10.1097/AOG.0000000000001005.
Placental disorders such as placenta previa, placenta accreta, and vasa previa are all associated with vaginal bleeding in the second half of pregnancy. They are also important causes of serious fetal and maternal morbidity and even mortality. Moreover, the rates of previa and accreta are increasing, probably as a result of increasing rates of cesarean delivery, maternal age, and assisted reproductive technology. The routine use of obstetric ultrasonography as well as improving ultrasonographic technology allows for the antenatal diagnosis of these conditions. In turn, antenatal diagnosis facilitates optimal obstetric management. This review emphasizes an evidence-based approach to the clinical management of pregnancies with these conditions as well as highlights important knowledge gaps.
前置胎盘、胎盘植入和前置血管等胎盘疾病均与妊娠后半期的阴道出血有关。它们也是导致严重胎儿和母亲发病甚至死亡的重要原因。此外,前置胎盘和胎盘植入的发生率正在上升,这可能是剖宫产率上升、产妇年龄增加以及辅助生殖技术应用增多的结果。产科超声检查的常规使用以及超声技术的不断改进使得这些疾病能够在产前得到诊断。反过来,产前诊断有助于进行最佳的产科管理。本综述强调了针对患有这些疾病的妊娠进行临床管理的循证方法,并突出了重要的知识空白。