Schmidt W, Boos R, Hendrik H J, Schmidt R
Geburtshilfe Frauenheilkd. 1986 Apr;46(4):206-12. doi: 10.1055/s-2008-1035900.
The present paper reports on the results of sonographic diagnosis of a pathologic insertion of the placenta after the 20th week of pregnancy and its importance with regard to the course of pregnancy and birth. The conversion of a primarily pathologic placental insertion to a "normal" insertion at term depends on the severity of the placental insertion disorder and the date of diagnosis. The frequency of pathologic insertions after the 20th week of pregnancy amounted to 4.2% of the patients examined. The rate of conversion from pathologic to normal placental insertion was 91%, if marginal/partial and total placenta previa are accepted as definitive diagnoses at term. The insertion remained unchanged up to term in approximately 90% of the cases in which total placenta previa was sonographically diagnosed. The sonographic diagnosis of "pathologic insertion of the placenta" after the 20th week of pregnancy is associated with severe complications in the subsequent course of pregnancy and birth. There is a significant cluster of vaginal hemorrhage in the last trimester of pregnancy; cesarean deliveries are common; there are more cases of transfer to pediatric clinics, and the incidence of retarded fetal growth and perinatal mortality is higher. The present authors believe that where the diagnosis of placenta previa has been confirmed sonographically, prophylactic measures and, in the last resort, a planned cesarean delivery can contribute to a reduction in maternal morbidity and also to a decrease in perinatal morbidity and mortality.
本文报告了妊娠20周后胎盘病理性附着的超声诊断结果及其对妊娠和分娩过程的重要性。足月时原发性病理性胎盘附着转变为“正常”附着取决于胎盘附着异常的严重程度和诊断时间。妊娠20周后病理性附着的发生率占受检患者的4.2%。如果将边缘性/部分性前置胎盘和完全性前置胎盘视为足月时的确诊诊断，病理性胎盘附着转变为正常附着的比例为91%。在超声诊断为完全性前置胎盘的病例中，约90%的病例其胎盘附着直至足月仍无变化。妊娠20周后“胎盘病理性附着”的超声诊断与随后妊娠和分娩过程中的严重并发症相关。妊娠晚期有明显的阴道出血聚集现象；剖宫产很常见；转至儿科诊所的病例更多，胎儿生长受限和围产期死亡率的发生率更高。本文作者认为，在超声确诊前置胎盘的情况下，采取预防措施并在最后手段时进行计划性剖宫产有助于降低孕产妇发病率，也有助于降低围产期发病率和死亡率。
