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在患有低躺胎盘的患者中产后出血:系统审查和元分析
Giulia Bonanni1, Maria C Lopez, Sofia M Tarchi
1Fetal Care and Surgery Center, Division of Fetal Medicine and Surgery, Boston Children's Hospital, Harvard Medical School, the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, and the Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; the Department of Women, Children, and Public Health Sciences, IRCCS Agostino Gemelli University Polyclinic Foundation, Catholic University of the Sacred Heart, Rome, and the Department of Biomedical Sciences, Humanitas University, Milan, Italy; Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia; the Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland; the HCA Healthcare and the HCA Healthcare Research Institute, Nashville, Tennessee; HCA Texas Maternal Fetal Medicine, Houston, Texas; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
低躺的胎盘诊断显著增加了产后出血 (PPH) 的风险两倍. 即使是已解决的病例也需要仔细监测,因为持续存在的PPH风险.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 生殖健康 生殖健康
背景情况:
- 在第二或第三季度诊断出低躺的胎盘可能会带来低估的产后出血 (PPH) 和胎盘增生谱 (PAS) 的风险.
- 量化这种风险及其根据胎盘与宫骨的距离和分离状态的变化对临床管理至关重要.
研究的目的:
- 进行系统性审查和元分析,以量化与低躺的胎盘诊断相关的PPH和PAS风险.
- 评估这种风险是如何根据胎盘与宫骨的特定距离以及胎盘在怀孕期间是否消失而变化的.
主要方法:
- 在主要数据库 (PubMed,ClinicalTrials.gov,EMBASE,Web of Science) 进行了系统的搜索,截至2024年4月30日.
- 包括21项研究,涉及3704名低卧胎盘患者和2555名正常胎盘患者,不包括2000年前的研究.
- 数据提取和质量评估由三个审查员独立地使用纽卡斯尔-太华尺度进行.
主要成果:
- 低躺的胎盘诊断与与正常胎盘相比,PPH的风险显著增加两倍 (RR 2.10).
- 低卧胎盘病例 (1-20毫米从骨) 的PPH发生率为16.0%,正常胎盘病例为5.8%.
- 在所有低躺的胎盘病例中,PAS障碍影响了9.0%,高PPH发病率即使在低躺的胎盘 (8%) 解决的情况下也持续存在.
结论:
- 低卧的胎盘产前诊断与PPH风险增加两倍有关.
- 聚合PPH比例为16.6% (1-10毫米) 和17.5% (11-20毫米) 的低躺胎盘,这些组之间没有显著差异.
- 这一元分析强调了对低卧胎盘怀孕的严格监测和分娩管理的需要,以减少PPH的孕产妇发病率.
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