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超聲系列3:超聲看胎盤(pán)

出處：@段濤大夫 日期：2024-08-03 18:39:29 編輯：網(wǎng)絡(luò)收集

胎盤(pán)位置

胎盤(pán)位置分為正常位置胎盤(pán)和前置胎盤(pán)，根據(jù)胎盤(pán)下緣與宮頸的關(guān)系，前置胎盤(pán)又分為完全性前置胎盤(pán)、部分性前置胎盤(pán)、邊緣性前置胎盤(pán)和低置胎盤(pán)。

在早中孕期胎盤(pán)位置低更常見(jiàn)，隨著孕周的增加，胎盤(pán)位置會(huì)逐漸上移，到了足月依然是胎盤(pán)位置低的概率通常不會(huì)超過(guò)3-5%。

只要在足月的時(shí)候，胎盤(pán)下緣距離宮頸內(nèi)口的距離超過(guò)2.5厘米，絕大多數(shù)是可以安全分娩，不用擔(dān)心產(chǎn)時(shí)出血的風(fēng)險(xiǎn)增加。

胎盤(pán)厚度

正常胎盤(pán)的厚度在2-4厘米之間，如果胎盤(pán)厚度超過(guò)4厘米以上，可能和母體病毒感染、母體糖尿病、巨大兒、Beckwith-Wiedemann綜合征、胎兒水腫有關(guān)，需要進(jìn)一步檢查和判斷。

胎盤(pán)分級(jí)

根據(jù)胎盤(pán)的鈣化程度可以將胎盤(pán)成熟度分為0-3級(jí)，級(jí)別越高，成熟度越高。在胎兒足月之前，如果胎盤(pán)過(guò)早出現(xiàn)鈣化，過(guò)度成熟，提示可能會(huì)有胎兒不良結(jié)局的風(fēng)險(xiǎn)增加，但是胎盤(pán)成熟度并不是一個(gè)可靠的不良胎兒預(yù)后的預(yù)測(cè)指標(biāo)。

胎盤(pán)血池

胎盤(pán)血池也被稱(chēng)為胎盤(pán)血竇，是胎盤(pán)內(nèi)部形成的血液聚集區(qū)，是來(lái)自于母體的胎盤(pán)靜脈血液池，并不是異常的出血。胎盤(pán)血池在超聲檢查時(shí)表現(xiàn)為低回聲，可以檢測(cè)到血液流動(dòng)。

胎盤(pán)血池通常是不會(huì)發(fā)生破裂的，也不會(huì)影響到胎兒和正常分娩。

胎盤(pán)后血腫/積液

這是胎盤(pán)后出血形成的血腫，隨著時(shí)間的推移，血腫逐漸縮小或消失，回聲降低，會(huì)呈現(xiàn)為積液，只要面積不大，沒(méi)有導(dǎo)致陰道出血或腹痛，多數(shù)不用擔(dān)心。

胎盤(pán)早剝

指的是妊娠20周后正常位置的胎盤(pán)在胎兒娩出前，部分或全部從子宮壁剝離，發(fā)病率約為1%。屬于妊娠晚期嚴(yán)重并發(fā)癥，疾病發(fā)展迅猛，若處理不及時(shí)可危及母兒生命。

副胎盤(pán)

指的是一個(gè)或多個(gè)附屬胎盤(pán)小葉通過(guò)血管和主胎盤(pán)相連，是一種胎盤(pán)發(fā)育的變異，多數(shù)不會(huì)影響宮內(nèi)胎兒。

球拍狀胎盤(pán)

正常情況下，臍帶附著于胎盤(pán)胎兒面的近中央處，若附著于胎盤(pán)邊緣，形似球拍，稱(chēng)為球拍狀胎盤(pán)。球拍狀胎盤(pán)通常不會(huì)帶來(lái)額外風(fēng)險(xiǎn)，可以正常分娩。如果胎盤(pán)低置，臍帶附著處位于宮頸內(nèi)口，分娩時(shí)容易壓迫臍帶血管，有一定的概率可能會(huì)導(dǎo)致胎兒窘迫，在分娩時(shí)需要密切觀察。

帆狀胎盤(pán)

臍帶如果附著于胎膜上，臍帶血管通過(guò)羊膜與絨毛膜間進(jìn)入胎盤(pán)，稱(chēng)為臍帶帆狀附著（帆狀胎盤(pán)），如果沒(méi)有胎盤(pán)低置，帆狀胎盤(pán)不會(huì)帶來(lái)額外風(fēng)險(xiǎn)，可以正常分娩。若胎膜上的血管跨過(guò)宮頸內(nèi)口位于胎先露部前方，稱(chēng)為前置血管。在分娩時(shí)前置血管容易受到壓迫或發(fā)生破膜時(shí)血管斷裂，導(dǎo)致胎兒窘迫，甚至突然死亡。在妊娠晚期超聲發(fā)現(xiàn)胎盤(pán)低于正常位置者，應(yīng)進(jìn)一步評(píng)價(jià)臍帶的插入位置。如果診斷為前置血管，妊娠期應(yīng)嚴(yán)密觀察，胎兒成熟后行擇期剖宮產(chǎn)，以降低圍產(chǎn)兒死亡率。

兇險(xiǎn)性前置胎盤(pán)

既往有剖宮產(chǎn)史及子宮肌瘤切除術(shù)史，此次妊娠為前置胎盤(pán)，胎盤(pán)附著于原手術(shù)瘢痕部位者，發(fā)生胎盤(pán)粘連、植入和致命性大出血的風(fēng)險(xiǎn)高，稱(chēng)之為兇險(xiǎn)性前置胎盤(pán)，多數(shù)需要剖宮產(chǎn)分娩。

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