上海交通大学医学院：《妇产科学》（双语） 38 前置胎盘

前置胎盘 汪希鹏 妇产科

前置胎盘 汪希鹏 妇产科

定义 孕28周后,胎盘附于子宫下段,甚至胎盘下缘达 到或覆盖宫颈内口,位置低于胎儿先露部,称 为前置胎盘

定义 孕28周后，胎盘附于子宫下段，甚至胎盘下缘达 到或覆盖宫颈内口，位置低于胎儿先露部，称 为前置胎盘

分类 中央型前置胎盘: the internal cervical os is covered completely by placenta. 部分性前置胎盘: the internal os is partially covered by placenta 边缘性前置胎盘: the edge of the placenta is at the margin of the internal os >低置胎盘: the placenta is implanted in the lower uterine segment such that the placenta edge actually does not reach the internal os but is in close proximity to it

分类 ➢ 中央型前置胎盘: the internal cervical os is covered completely by placenta. ➢ 部分性前置胎盘: the internal os is partially covered by placenta. ➢ 边缘性前置胎盘: the edge of the placenta is at the margin of the internal os. ➢ 低置胎盘: the placenta is implanted in the lower uterine segment such that the placenta edge actually does not reach the internal os but is in close proximity to it

分类 TOTAL PARTIAL MARGINAL

分类

前置胎盘类型判定 >根据检查当时,宫口扩张和胎盘位置关 系确定如低置胎盘在宫口开2厘米时,能 变成部分性前置胎盘。 >肛查确定宫口扩张和胎盘关系是非常危 险,引发严重大出血( Severe hemorrhage)

前置胎盘类型判定 ➢ 根据检查当时，宫口扩张和胎盘位置关 系确定如低置胎盘在宫口开2厘米时，能 变成部分性前置胎盘。 ➢ 肛查确定宫口扩张和胎盘关系是非常危 险，引发严重大出血（ severe hemorrhage）

胎盘移行 Gestational age at Previa or hemorrhage sonography(wk) at delivery (%) <20 2.3 20-25 3.2 25-30 5.2 30-35 24

胎盘移行 Gestational age at sonography(wk) Previa or hemorrhage at delivery (%) <20 20-25 25-30 30-35 2.3 3.2 5.2 24

发病率 Incidence 前置胎盘发病率约05%(1in200) deliveries

发病率 Incidence ➢ 前置胎盘发病率约0.5% (1 in 200) deliveries

病因 Etiology >孕妇年龄 >多产次 Multiparity >剖宫产史 Prior cesarean section 吸烟 Smoking

病因 Etiology ➢ 孕妇年龄 ➢ 多产次 Multiparity ➢ 剖宫产史Prior cesarean section ➢ 吸烟 Smoking

Etiology孕母年龄 >孕母年龄增大与前置胎盘发病率成正比 >小于19岁产妇,前置胎盘发生率是1in 1500;年龄大于35岁孕妇,发生率是1 in100

Etiology 孕母年龄 ➢ 孕母年龄增大与前置胎盘发病率成正比 ➢ 小于19岁产妇，前置胎盘发生率是 1 in 1500；年龄大于35岁孕妇，发生率是1 in 100

Etiology多产 multiparity 多产超过5次的孕妇,其前置胎盘发生率约 2,2%,显著高于少产次孕妇

Etiology 多产 multiparity 多产超过5次的孕妇，其前置胎盘发生率约 2.2%，显著高于少产次孕妇