妊娠中期低位胎盘的最终结果：系统评价和荟萃分析。,European Journal of Obstetrics & Gynecology and Reproductive Biology

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妊娠中期低位胎盘的最终结果：系统评价和荟萃分析。
European Journal of Obstetrics & Gynecology and Reproductive Biology ( IF 2.1 ) Pub Date : 2019-07-04 , DOI: 10.1016/j.ejogrb.2019.06.020
Charlotte H J R Jansen ₁ , C Emily Kleinrouweler ₁ , Liesbeth van Leeuwen ₁ , Laura Ruiter ₁ , Jacqueline Limpens ₂ , Madelon van Wely ₃ , Ben W Mol ₄ , Eva Pajkrt ₁

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位于子宫下段（LUS）的低位胎盘（低位胎盘或前置胎盘）与产科风险增加相关。但是，大多数处于妊娠中期的低位胎盘在怀孕期间会分解，并且在妊娠晚期处于较高的位置，而不会带来任何风险。我们进行了系统的回顾和荟萃分析，以评估在妊娠中期处于眼底位置的妊娠中期低位胎盘的比例。我们的目标是找到一个临界值，该值包括胎盘在孕晚期保持较低水平的所有妇女，从而使她们发生产科并发症的风险增加。随后，我们评估了胎盘的位置是前位还是后位影响了这一比例。我们搜索了MEDLINE和EMBASE以及临床试验。截至2019年4月，用于研究妊娠中期低位胎盘的超声检查，胎龄超过15周时胎盘与宫颈内部os的距离为20 mm或更小在28周后上升。使用Newcastle-Ottowa量表（NOS）对方法质量进行研究评分。进行荟萃分析，以总结妊娠中期低位胎盘与眼底位置的比例。我们计算了从胎盘边缘到子宫颈内部os的距离（0 mm，10 mm和20 mm）的不同截止值的比例。此外，比较了前后胎盘和有无剖宫产的妇女。我们纳入了11项合格研究，这些研究报告了3586名妊娠中期低胎盘妇女。妊娠晚期胎盘占眼底的比例在0.63至1.0之间。对于IOD <10 mm，合并的比例为0.90（95％CI 0.87-0.93），对于IOD <0 mm为0.80（95％CI 0.74-0.85）。由于研究之间的异质性，无法合并<20 mm的亚组。总体而言，位于胎盘前部的胎盘在妊娠中期更倾向于眼底，但是研究确实报告了矛盾的结果。除<0 mm的IOD外，先前的剖宫产没有任何影响，在这种情况下，没有事先剖宫产的妇女更常向眼底放置胎盘。在随访时，大多数孕中期低位胎盘位于眼底附近。但是，我们无法确定包括所有高危女性在内的前胎盘和后胎盘的临界值。临界值，胎盘侧和先前的剖宫产应在一项大型的前瞻性观察研究中进行评估。

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Final outcome of a second trimester low-positioned placenta: A systematic review and meta-analysis.

Low-positioned placentas which are located in the lower uterine segment (LUS), either a low-lying placenta or a placenta previa, are associated with increased obstetric risks. However, most second trimester low-positioned placentas resolve during pregnancy and have a higher position in the third trimester, without posing any risks. We performed a systematic review and meta-analysis to evaluate the proportion of second trimester low-positioned placentas that have a position towards the fundus in the third trimester. Our aim was to find a cut-off value that included all women in whom the placenta will remain low in the third trimester, thus who are at increased risk of obstetric complications. Subsequently, we assessed whether an anterior or posterior placental location influenced this proportion. We searched MEDLINE and EMBASE and clinicaltrials.gov up to April 2019 for studies on the sonographic follow-up of second trimester low-positioned placentas, with a distance between the placenta and the internal os of the cervix of 20 mm or less at a gestational age of above 15 week and a follow up after 28 weeks. Studies were scored on methodological quality using the Newcastle-Ottowa Scale (NOS). A meta-analysis was conducted to summarize the proportion of second trimester low-positioned placentas with a position towards the fundus in the third trimester. We calculated the proportion at different cut-off values of the distance from the placental edge to the internal os of the cervix (0 mm, 10 mm and 20 mm). Also, anteriorly and posteriorly located placentas and women with and without a prior cesarean delivery were compared. We included 11 eligible studies which reported on 3586 women with a low-positioned placenta in the second trimester. Proportions of placentas with a position towards the fundus in the third trimester ranged between 0.63 and 1.0. Pooled proportions were 0.90 (95% CI 0.87-0.93) for IOD <10 mm and 0.80 (95% CI 0.74-0.85) for IOD < 0 mm. Due to heterogeneity between studies, the subgroup of <20 mm could not be pooled. Overall, anteriorly located placentas more often had a position towards the fundus in the third trimester, but studies did report conflicting results. Prior cesarean section had no influence except for an IOD of <0 mm, in which women without a prior cesarean delivery more often had a placenta towards the fundus. The majority of second trimester low-positioned placentas will be located towards the fundus at the time of follow-up. However, we could not determine a cut-off value for anterior and posterior placentas that included all women at high risk. The cut-off value, placental side and prior cesarean section should be assessed in a large prospective observational study.

更新日期：2019-11-01

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