Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
Am J Obstet Gynecol. 2018 Jan;218(1):B2-B8. doi: 10.1016/j.ajog.2017.10.019. Epub 2017 Oct 25.
Third-trimester bleeding is a common complication arising from a variety of etiologies, some of which may initially present in the late preterm period. Previous management recommendations have not been specific to this gestational age window, which carries a potentially lower threshold for delivery. The purpose of this document is to provide guidance on management of late preterm (34 0/7-36 6/7 weeks of gestation) vaginal bleeding. The following are Society for Maternal-Fetal Medicine recommendations: (1) we recommend delivery at 36-37 6/7 weeks of gestation for stable women with placenta previa without bleeding or other obstetric complications (GRADE 1B); (2) we do not recommend routine cervical length screening for women with placenta previa in the late preterm period due to a lack of data on an appropriate management strategy (GRADE 2C); (3) we recommend delivery between 34 and 37 weeks of gestation for stable women with placenta accreta (GRADE 1B); (4) we recommend delivery between 34 and 37 weeks of gestation for stable women with vasa previa (GRADE 1B); (5) we recommend that in women with active hemorrhage in the late preterm period, delivery should not be delayed for the purpose of administering antenatal corticosteroids (GRADE 1B); (6) we recommend that fetal lung maturity testing should not be used to guide management in the late preterm period when an indication for delivery is present (GRADE 1B); and (7) we recommend that antenatal corticosteroids should be administered to women who are eligible and are managed expectantly if delivery is likely within 7 days, the gestational age is between 34 0/7 and 36 6/7 weeks of gestation, and antenatal corticosteroids have not previously been administered (GRADE 1A).
晚期早产（34 周零 0/7-36 周零 6/7 天）阴道出血是一种常见的并发症，其病因多种多样，其中一些可能最初出现在晚期早产阶段。之前的管理建议并没有针对这个特定的孕龄窗口，而这个窗口的分娩阈值可能较低。本文件旨在提供晚期早产（34 周零 0/7-36 周零 6/7 天）阴道出血管理指南。以下是母胎医学学会的建议：（1）我们建议稳定的前置胎盘且无出血或其他产科并发症的女性在 36-37 周零 6/7 天行剖宫产术（GRADE 1B）；（2）我们不建议在晚期早产的前置胎盘女性中常规进行宫颈长度筛查，因为缺乏适当管理策略的数据（GRADE 2C）；（3）我们建议稳定的胎盘植入患者在 34-37 周零 6/7 天行剖宫产术（GRADE 1B）；（4）我们建议稳定的帆状胎盘前置血管患者在 34-37 周零 6/7 天行剖宫产术（GRADE 1B）；（5）我们建议在晚期早产有活动性出血的女性中，不应为了给予产前皮质激素而延迟分娩（GRADE 1B）；（6）我们建议在有分娩指征时，不应用胎儿肺成熟度试验来指导晚期早产的管理（GRADE 1B）；（7）我们建议对有分娩可能且在 7 天内、孕龄在 34 周零 0/7-36 周零 6/7 天、且未使用过产前皮质激素的合格产妇给予产前皮质激素，并期待治疗（GRADE 1A）。
