剖腹产痕植入在胎盘的演变中 Accreta 频谱:对识别和临床管理的影响
Ilan E Timor-Tritsch1, Karin A Fox1, Yalda Afshar1
1Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, and Molecular Biology Institute, UCLA, Los Angeles, California.
剖腹产痕怀孕是胎盘积分谱 (PAS) 疾病的早期迹象. 早期超声波查和统一管理对于剖腹产后高风险妊娠至关重要.
科学领域:
- 生殖医学 生殖医学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 妇科病理学 妇科病理学
背景情况:
- 剖腹产痕怀孕 (CSP) 越来越被认为是胎盘积分谱 (PAS) 疾病的早期表现.
- 在全球范围内,剖腹产率的上升与PAS发病率的增加相关,PAS与痕肌肉部位的异常胎盘附着有关.
- 组织病理学相似性表明CSP和PAS可能代表同一病理生理过程的不同阶段.
研究的目的:
- 检查证据支持CSP作为PAS的前身.
- 倡导对CSP和PAS采取统一的临床方法.
- 为早期识别和风险分层提出有针对性的查策略.
主要方法:
- 对CSP和PAS的累积证据和组织病理学研究的审查.
- 对第一季度超声波结果和分类系统的分析 (例如,交叉标志,与子宫中线相对的植入部位).
- 对预期管理的CSP到PAS的进展率的评估.
主要成果:
- 在预期管理的CSP病例中,高达70%的病例在交付时进展到PAS.
- 超声波分类系统可以预测PAS的严重程度和结果.
- CSP和PAS共享不可区分的自身病理学特征,表明一种连续的病理生理过程.
结论:
- 剖腹产痕怀孕应该被视为胎盘增殖谱的最早可检测的表现.
- 对于高风险妇女 (剖腹产前,子宫手术,CSP) 建议在妊娠5-7周和11-14周进行有针对性的查.
- 早期识别和风险分层化有助于主动管理,减少孕产妇的发病率和保持生育能力.
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