Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Academic Department of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, United Kingdom.
Am J Obstet Gynecol. 2018 Apr;218(4):443.e1-443.e8. doi: 10.1016/j.ajog.2018.01.017. Epub 2018 Jan 17.
Placenta accreta spectrum and vasa previa (VP) are congenital disorders of placentation associated with high morbidity and mortality for both mothers and newborns when undiagnosed before delivery. Prenatal diagnosis of these conditions is essential to allow multidisciplinary management and thus improve perinatal outcomes.
The objective of the study was to compare perinatal outcome in women with placenta accreta spectrum or vasa previa before and after implementation of targeted scanning protocols.
This retrospective study included 2 nonconcurrent cohorts for each condition before and after implementation of the corresponding protocols (2004-1012 vs 2013-2016 for placenta accreta spectrum and 1988-2007 vs 2008-2016 for vasa previa). Clinical reports of women diagnosed with placenta accreta spectrum and vasa previa during the study periods were reviewed and outcomes were compared.
In total, there were 97 cases of placenta accreta spectrum and 51 cases with vasa previa, all confirmed at delivery. In both cohorts, the prenatal detection rate increased after implementation of the scanning protocols (28 of 65 cases [43.1%] vs 31 of 32 cases [96.9%], P < .001, for placenta accreta spectrum and 9 of 18 cases [50%] vs 29 of 33 cases [87.9%], 87.9%, P < .01 for vasa previa). The perinatal outcome improved also significantly in both cohorts after implementation of the protocols. In the placenta accreta spectrum cohort, the estimated blood loss and the postoperative hospitalization stay decreased between periods (1520 ± 845 vs 1168 ± 707 mL, P < .01, and 10.9 ± 14.1 vs 5.7 ± 2.2 days, P < .05, respectively). In the vasa previa cohort, the number of 5 minute Apgar score ≤5 and umbilical cord pH <7 decreased between periods (5 of 18 cases [27.8%] vs 1 of 33 cases [3%]; P < .05, and 4 of 18 cases [22.2%] vs 1 of 33 cases [3%], P < .05, respectively).
The implementation of standardized prenatal targeted scanning protocols for pregnant women with risk factors for placenta accreta spectrum and vasa previa was associated with improved maternal and neonatal outcomes. The continuous increases in the rates of caesarean deliveries and use of assisted reproductive technology highlights the need to develop training programs and introduce targeted scanning protocols at the national and international levels.
胎盘植入谱系疾病和前置血管（VP）是先天性胎盘着床异常，在分娩前未诊断时，母婴发病率和死亡率均较高。对这些疾病进行产前诊断对于多学科管理至关重要，从而改善围产期结局。
本研究旨在比较胎盘植入谱系疾病或前置血管患者在实施靶向扫描方案前后的围生期结局。
本回顾性研究为每个疾病分别设立了两个非同期队列，分别为实施相应方案前后（2004-2012 年 vs 2013-2016 年，胎盘植入谱系疾病；1988-2007 年 vs 2008-2016 年，前置血管）。对研究期间诊断为胎盘植入谱系疾病和前置血管的女性的临床报告进行了回顾，并比较了结局。
共 97 例胎盘植入谱系疾病和 51 例前置血管患者，所有患者在分娩时均确诊。在两个队列中，实施扫描方案后产前检出率均增加（胎盘植入谱系疾病：28/65 例[43.1%] vs 31/32 例[96.9%]，P<.001；前置血管：9/18 例[50%] vs 29/33 例[87.9%]，P<.01）。两个队列在实施方案后围生期结局也显著改善。在胎盘植入谱系疾病队列中，估计失血量和术后住院时间在两个时期之间下降（1520±845 比 1168±707 mL，P<.01；10.9±14.1 比 5.7±2.2 天，P<.05）。在前置血管队列中，5 分钟 Apgar 评分≤5 和脐动脉 pH<7 的数量在两个时期之间下降（18 例中有 5 例[27.8%] vs 33 例中有 1 例[3%]，P<.05；18 例中有 4 例[22.2%] vs 33 例中有 1 例[3%]，P<.05）。
对有胎盘植入谱系疾病和前置血管风险因素的孕妇实施标准化产前靶向扫描方案与改善母婴结局相关。剖宫产率和辅助生殖技术使用率的持续增加突出表明需要在国家和国际层面制定培训计划并引入靶向扫描方案。
