Placental abruption
Placental abruption
复制标题
DOI：
10.1097/01.aog.0000239439.04364.9a
复制
发表时间：
2006-10-01
影响因子：
7.2
通讯作者：
Ananth, Cande V.
中科院分区：
文献类型：
--
作者：
Oyelese, Yinka;Ananth, Cande V.
胎盘早剥使约1%的妊娠并发症，并且是妊娠后半期阴道出血的主要原因。这也是围产期死亡和发病的一个重要原因。妊娠对母体的影响主要取决于其严重程度，而对胎儿的影响则取决于其严重程度和发生时的胎龄。流产的危险因素包括既往流产、吸烟、创伤、可卡因使用、多胎妊娠、高血压、先兆子痫、血栓形成倾向、高龄产妇、早产胎膜早破、宫内感染和羊水过多。超过50%的胎盘早剥常与胎儿死亡有关。胎盘早剥的诊断是临床诊断，超声检查和Kleihauer-Betke试验的价值有限。胎盘早剥的治疗应根据胎盘早剥的严重程度和发生的胎龄进行个体化。在发生胎儿死亡的情况下，阴道分娩是优选的。弥散性血管内凝血病应积极治疗。当妊娠发生在足月或近足月，且母儿状况良好时，以阴道分娩为目标的保守治疗可能是合理的。然而，在胎儿或母亲的危害存在，及时剖宫产往往是指。同样，在极早产的情况下，在选定的稳定病例中，可以保守地进行预防，如果发生恶化，则进行密切监测和快速分娩。大多数胎盘早剥病例无法预测或预防。然而，在某些情况下，可以通过关注保守治疗的风险和益处，持续评估胎儿和孕产妇的健康状况，以及在适当的情况下通过快速分娩来优化母婴结局。
Placental abruption complicates about 1% of pregnancies and is a leading cause of vaginal bleeding in the latter half of pregnancy. It is also an important cause of perinatal mortality and morbidity. The maternal effect of abruption depends primarily on its severity, whereas its effect on the fetus is determined both by its severity and the gestational age at which it occurs. Risk factors for abruption include prior abruption, smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, thrombophilias, advanced maternal age, preterm premature rupture of the membranes, intrauterine infections, and hydramnios. Abruption involving more than 50% of the placenta is frequently associated with fetal death. The diagnosis of abruption is a clinical one, and ultrasonography and the Kleihauer-Betke test are of limited value.The management of abruption should be individualized on a case-by-case basis depending on the severity of the abruption and the gestational age at which it occurs. In cases where fetal demise has occurred, vaginal delivery is preferable. Disseminated intravascular coagulopathy should be managed aggressively. When abruption occurs at or near term and maternal and fetal status are reassuring, conservative management with the goal of vaginal delivery may be reasonable. However, in the presence of fetal or maternal compromise, prompt delivery by cesarean is often indicated. Similarly, abruption at extremely preterm gestations may be managed conservatively in selected stable cases, with close monitoring and rapid delivery should deterioration occur. Most cases of placental abruption cannot be predicted or prevented. However, in some cases, maternal and infant outcomes can be optimized through attention to the risks and benefits of conservative management, ongoing evaluation of fetal and maternal well-being, and through expeditious delivery where appropriate.