凶险型前置胎盘的诊断及处理

Diagnosis and treatment of pernicious placenta previa

凶险型前置胎盘指继发于剖宫产后覆盖子宫瘢痕的前置胎盘。因其胎盘植入发生率高,诊断及处理具有特殊性。凶险型前置胎盘的产前诊断主要依靠超声及核磁共振(MRI)等影像学检查,而胎盘植入需要病理检查证实。凶险型前置胎盘的规范处理包括早期明确诊断、优化转诊流程、合理期待治疗、重视围术期处理、产后出血抢救等多个环节。

Pernicious placenta previa means that the placenta overlies uterine sear after previous cesarean section. Because of the high incidence of placenta accreta associated with it, the special diagnosis and treatment should be made. The prenatal diagnosis of pernicious placenta previa is usually made by ultrasonography or magnetic resonance imaging （MRI）. And the histopathological examination is necessary for the final confirmation of placenta accreta. The standardized treatment strategy includes early accu- rate diagnosis, optimized patient transfer process, reasonable expectant therapy, emphasis on perioperative management, and appropriate management of postpartum hemorrhage.