正常妊娠
前置胎盘 (PP) 筛查不适用于这类人群,即使存在其他危险因素(不包括既往子宫瘢痕、既往前置胎盘、以及接受了 IVF 治疗)。综合了前置胎盘各种危险因素的预测模型效率太低,没有帮助。[9]Odibo AO, Cahill AG, Stamilio DM, et al. Predicting placental abruption and previa in women with a previous cesarean delivery. Am J Perinatol. 2007;24:299-306.http://www.ncbi.nlm.nih.gov/pubmed/17514600?tool=bestpractice.com 如果因其他原因需要超声检查,则应进行超声检查。[37]American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 101: ultrasonography in pregnancy. Obstet Gynecol. 2009;113:451-461.http://www.ncbi.nlm.nih.gov/pubmed/19155920?tool=bestpractice.com
既往子宫瘢痕
应在约 18 至 22 孕周时进行超声筛查(很可能进行彩色多普勒血流超声检查)。应将胎盘异常附着的风险告知影像科医生。至于是否需要磁共振成像 (MRI) 扫描,应寻求超声检查医生或产科主任医生的意见。[6]Getahun D, Oyelese Y, Salihu HM, et al. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol. 2006;107:771-778.http://www.ncbi.nlm.nih.gov/pubmed/16582111?tool=bestpractice.com[9]Odibo AO, Cahill AG, Stamilio DM, et al. Predicting placental abruption and previa in women with a previous cesarean delivery. Am J Perinatol. 2007;24:299-306.http://www.ncbi.nlm.nih.gov/pubmed/17514600?tool=bestpractice.com[10]Qublan HS, Tahat Y. Multiple cesarean section. The impact on maternal and fetal outcome. Saudi Med J. 2006;27:210-214.http://www.ncbi.nlm.nih.gov/pubmed/16501678?tool=bestpractice.com[23]Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192:1458-1461.http://www.ncbi.nlm.nih.gov/pubmed/15902137?tool=bestpractice.com[25]Kallen B, Finnstrom O, Nygren KG, et al. In vitro fertilisation in Sweden: obstetric characteristics, maternal morbidity and mortality. BJOG. 2005;112:1529-1535.http://www.ncbi.nlm.nih.gov/pubmed/16225574?tool=bestpractice.com[26]Shevell T, Malone FD, Vidaver J, et al. Assisted reproductive technology and pregnancy outcome. Obstet Gynecol. 2005;106:1039-1045.http://www.ncbi.nlm.nih.gov/pubmed/16260523?tool=bestpractice.com
既往前置胎盘
前置胎盘具有中度复发风险(约为 0.7%)。[13]Ananth CV, Demissie K, Smulian JC, et al. Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol. 2003;188:275-281.http://www.ncbi.nlm.nih.gov/pubmed/12548229?tool=bestpractice.com 在后续妊娠中应密切注意胎盘位置;应在中段妊娠中期进行超声检查。
体外受精 (In vitro fertilisation, IVF)
在体外受精 (IVF) 妊娠中,前置胎盘的风险约为 2%。[27]Reddy UM, Wapner RJ, Rebar RW, et al. Infertility, assisted reproductive technology, and adverse pregnancy outcomes: executive summary of a National Institute of Child Health and Human Development workshop. Obstet Gynecol. 2007;109:967-977.http://www.ncbi.nlm.nih.gov/pubmed/17400861?tool=bestpractice.com[28]Mukhopadhaya N, Arulkumaran S. Reproductive outcomes after in-vitro fertilization. Curr Opin Obstet Gynecol. 2007;19:113-119.http://www.ncbi.nlm.nih.gov/pubmed/17353678?tool=bestpractice.com[29]Romundstad LB, Romundstad PR, Sunde A, et al. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod. 2006;21:2353-2358.https://academic.oup.com/humrep/article/21/9/2353/2938873/Increased-risk-of-placenta-previa-in-pregnancieshttp://www.ncbi.nlm.nih.gov/pubmed/16728419?tool=bestpractice.com
需要在约 18 至 22 孕周时进行超声筛查。[27]Reddy UM, Wapner RJ, Rebar RW, et al. Infertility, assisted reproductive technology, and adverse pregnancy outcomes: executive summary of a National Institute of Child Health and Human Development workshop. Obstet Gynecol. 2007;109:967-977.http://www.ncbi.nlm.nih.gov/pubmed/17400861?tool=bestpractice.com[28]Mukhopadhaya N, Arulkumaran S. Reproductive outcomes after in-vitro fertilization. Curr Opin Obstet Gynecol. 2007;19:113-119.http://www.ncbi.nlm.nih.gov/pubmed/17353678?tool=bestpractice.com[29]Romundstad LB, Romundstad PR, Sunde A, et al. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod. 2006;21:2353-2358.https://academic.oup.com/humrep/article/21/9/2353/2938873/Increased-risk-of-placenta-previa-in-pregnancieshttp://www.ncbi.nlm.nih.gov/pubmed/16728419?tool=bestpractice.com