Placenta Previa
1. Definition & Classification
1-1. Á¤ÀÇ : generally is defined as the implantation of the placenta over or near the internal os of the cervix
1-2. ºÐ·ù
Total placenta previa : ÀڱðæºÎ³»±¸°¡ Źݿ¡ ÀÇÇØ ¿ÏÀüÈ÷ µ¤¿©Á® ÀÖ´Â °æ¿ì
Partial placenta previa : °æºÎ³»±¸°¡ Źݿ¡ ÀÇÇØ ºÎºÐÀûÀ¸·Î µ¤¿©Á® ÀÖ´Â °æ¿ì
Marginal placenta previa : ŹÝÀÇ ³¡ºÎºÐÀÌ °æ±¸³»±¸ÀÇ º¯¿¬¿¡ À§Ä¡ÇÏ´Â °æ¿ì.
Low-lying placenta previa : ŹÝÀÇ ÀÚ±ÃÇÏÀýºÎ¿¡ Âø»óµÇ¾úÀ¸¸ç ŹÝÀÇ ³¡ÀÌ ½ÇÁ¦·Î °æ±¸³»±¸¿¡ ´êÁö ¾Ê°í ¸Å¿ì
±ÙÁ¢ÇØ ÀÖ´Â °æ¿ì.
2. Epidemiology
2-1. prevalence & motality rate
ºÐ¸¸½Ã ÀüġŹÝÀÇ ºóµµ´Â 0.5% À̸ç, »ç¸Á·üÀº 0.03% ÀÌ´Ù.
ÁÖ¿ä »ç¸Á ¿øÀÎ : uterine bleeding and the complication of disseminated intravascular coagulopathy
race : African American & Asian
2-2. accompanied by
- placenta accreta, placenta increta, placenta percreta ¿Í µ¿¹ÝµÉ ¼ö ÀÖÀ¸¸ç ÀÓ»óÀûÀ¸·Î À¯ÀÇÇÑ À¯ÂøÅÂ¹Ý Àº 7% Á¤µµ¿¡¼ µ¿¹ÝµÈ´Ù.
- C/sec Hx. °¡ ÀÖ´Â °æ¿ì¿¡´Â µ¿¹ÝµÇ´Â °æ¿ì°¡ 25%·Î Áõ°¡µÈ´Ù.
3. Etiology
- Prior uterine insult or injury ¡ç abnormal endometrial vascularization related to atrophy or scarring
- Risk factors
Prior previa (4-8%)
First subsequent pregnancy following a cesarean delivery(2¹è)
Multiparity (5% in grand multiparous patients)
Advanced maternal age(30¼¼ ÀÌÈÄ¿¡´Â ±×Àü ³ªÀÌ¿¡ ºñÇØ 3¹è)
Multiple gestation
Prior induced abortion
Smoking(2¹è¡çhypoxia¿¡ ÀÇÇØ ŹÝÀÌ ºñ´ëÇØÁö¹Ç·Î)
4. Manifestation
4-1. symptoms & signs & characteristic of bleeding
1) Vaginal bleeding
It is apt to occur suddenly during the third trimester.
Bleeding usually is bright red and painless.
Initial bleeding usually is not profuse enough to cause death; it spontaneously ceases, only to recur later.
The first bleed occurs (on average) at 27-32 weeks' gestation.
Contractions may or may not occur simultaneously with the bleeding(20%)
2) cause of bleeding
¤¡. dilatation of uterine lower segment ¡æ ŹÝÀÌ ºÙ¾î ÀÖ´Â °÷ÀÌ Âõ¾îÁü ¡æ hemorrhage
¤¤. À¯ÂøÅÂ¹Ý : Źݺи¸ÈÄ °úµµÇÑ ÃâÇ÷ °¡´É
4-2. coagulation defect
¼Ò¸ð¼º ÀÀ°íÀå¾Ö(DIC)ÀÇ Æ¯Â¡ÀÎ ÀÀ°íÀå¾Ö°¡ placenta abruptio¿¡¼ ÈçÇÏÁö¸¸ ŹÝÂø»óºÎÀ§¿¡¼ °úµµÇÑ Å¹ݹڸ®°¡ ÀÖ´Â °æ¿ì¿¡µµ placenta previa¿¡¼´Â µå¹°´Ù.
4-3. physical examination
Profuse hemorrhage
Hypotension
Tachycardia
Soft and nontender uterus
Normal fetal heart tones (usually)
Vaginal and rectal examinations
- Do not perform these examinations in the ED as they may provoke uncontrollable bleeding.
- Perform examinations in the operating room under double set-up conditions
5. Diagnosis
5-1. clinical suspicion
1) ÀÓ½ÅÀÇ ÈĹݺε¿¾È Àڱó» ÃâÇ÷ÀÌ ÀÖ´Â °æ¿ì ÀǽÉ.
2) ÃËÁøÀ¸·Î ÀÎÇÑ Áø´Ü
¤¡. ½ÉÇÑ ÃâÇ÷À» ÀÏÀ¸Å³ ¼ö ÀÖ´Ù.
¤¤. µû¶ó¼ ÀÀ±ÞÀ¸·Î C/S¸¦ ÇÒ ¼ö ÀÖ´Â ¼ö¼ú½Ç¿¡¼¸¸ ½ÃÇàÇØ¾ß ÇÑ´Ù.
¤§. ºÐ¸¸°èȹÀÌ ÀÖÀ» ¶§±îÁö ½ÃÇàÇØ¼´Â ¾ÈµÈ´Ù.
5-2. USG
1) transabdominal sonography
°¡Àå °£´ÜÇϰí Á¤È®ÇÏ¸ç ¾ÈÀüÇÑ ¹æ¹ý. Á¤È®µµ°¡ Æò±Õ 96%À̸ç ÃÖ°í 98%ÀÌ´Ù. À§¾ç¼ºÀº ¹æ±¤ÆØÃ¢¿¡ ÀÇÇÑ °æ¿ì°¡ ¸¹´Ù. ±×·¯¹Ç·Î ÃÊÀ½ÆÄ°Ë»ç»ó ÀüġŹÝÀÌ Áø´ÜµÇ¸é ¹æ±¤À» ºñ¿î ÈÄ ´Ù½Ã ÇÑ ¹ø ÃÊÀ½ÆÄ°Ë»ç¸¦ ½ÃÇàÇÏ¿© È®ÀÎÇÑ´Ù.
2) transvaginal sonography
¾ç¼º¿¹Ãø·üÀº 93%, À½¼º¿¹Ãø·üÀº 98%±îÁö º¸°íµÇ°í ÀÖ´Ù. ÇÏÀ§ÅÂ¹Ý À̳ª ŹÝÀÌ Àڱ󻱸¸¦ µ¤¾ú´ÂÁö¸¦ È®ÁøÇϱâ
À§ÇØ TV-USG¸¦ »ç¿ëÇÑ´Ù.
3) transperineal sonography; ¾ç¼º¿¹Ãø·üÀº 90%, À½¼º¿¹Ãø·üÀº 100%±îÁö º¸°íµÈ´Ù.
5-3. MRI
ÀÚ±â°ø¸í´ÜÃþÃÔ¿µ¹ýÀ» ÀÌ¿ëÇÏ¿© ŹÝÀÇ ÀÌ»óÀ» Áø´ÜÇÏ·Á´Â ³ë·ÂÀÌ ÀÖ¾î ¿ÔÀ¸³ª ÃÊÀ½ÆÄ°Ë»ç¸¦ ´ëüÇϱâ´Â Èûµé °ÍÀÌ´Ù.
5-4. placental migration
ÀӽŠÁ߱⿡ Àڱðæ°ü³»±¸¸¦ µ¤°í ÀÖ´Â ÅÂ¹Ý Áß ¾à 40%´Â ºÐ¸¸½Ã±îÁö ÀüÄ¡ ŹÝÀ¸·Î Áö¼ÓµÈ´Ù. ÀӽŠ2nd trimester ³ª 3rd trimester ÃÊ¿¡ °æ°ü³»±¸¸¦ µ¤°í ÀÖÁö ¾Ê°í Àڱ󻱸 °¡±îÀÌ À§Ä¡ÇÑ Å¹ÝÀº ÀÚ±ÃÀú·Î À̵¿ÇÒ °¡´É¼ºÀÌ ³ô´Ù. ÀӽŠ30ÁÖ ÀÌÀü¿¡ ÃÊÀ½ÆÄ°Ë»ç·Î ÀÎÁöµÈ ÀüġŹÝÀÌ Áö¼ÓµÇ´Â ºóµµ´Â ³·´Ù
¡æ GA 30wks ÀÌÈÄ¿¡ ÀüġŹÝÀÌ Áø´ÜµÇ¸é ÀÓ»êºÎÀÇ ¿îµ¿À» ÀÚÁ¦½ÃÄÑ¾ß ÇÑ´Ù.
5-5. Lab. data
DIC : CBC with platelet, PT, aPTT, FSP(fibrin split products)
aFP : risk for bleeding & preterm birth
6. Management of placenta previa
6-1. ÀüġŹÝÀÌ ÀÖ´Â Àӽźο¡¼ °í·ÁÇØ¾ßÇÒ »çÇ×
1) Á¶±âÁøÅëÀÌ ÀÖÁö¸¸ ºÐ¸¸ÇÒ Çʿ䰡 ¾ø´Â °æ¿ì
2) žư¡ ¼º¼÷ÇÑ °æ¿ì
3) ÁøÅëÁßÀÎ °æ¿ì
4) ¹Ì¼÷¾ÆÀÌÁö¸¸ ÃâÇ÷ÀÌ ½ÉÇÏ¿© ºÐ¸¸À» ÇÏ¿©¾ß ÇÏ´Â °æ¿ì
6-2. ÀüġŹݰú ¹Ì¼÷¾Æ¿¡ ÀÇÇØ ÇÕº´µÈ ÀÓ½ÅÀÇ Ã³Ä¡´Â ½ÇÁ¦ÀûÀÎ ÃâÇ÷ÀÌ ¾ø´Ù¸é ¸ðü¿Í žÆÀÇ ¾ÈÀü¿¡ ÁßÁ¡À» µÎ¾î¾ß ÇÑ´Ù. ÀÔ¿øÇÏ´Â °ÍÀÌ ÀÌ»óÀûÀ̳ª ½ÇÁ¦ÀûÀ¸·Î ÃâÇ÷ÀÌ ¸ØÃß°í žÆÀÇ °Ç°ÀÌ È®ÀεǸé ÀϹÝÀûÀ¸·Î Àӽźδ Åð¿øÇÏ°Ô µÈ´Ù.
6-3. delivery
1) Cesarean section
½ÇÁ¦ÀûÀ¸·Î ¸ðµç °æ¿ìÀÇ ÀüġŹݿ¡¼ ¸ðüÀÇ ¾È³çÀ» À§ÇØ ÀÎÁ¤µÇ´Â ºÐ¸¸¹æ¹ýÀÌ´Ù. ŹÝÀÌ ÈĹݿ¡ À§Ä¡ÇÏ¿© ÀÚ±ÃÇÏÀýºÎ(lower segment)¸¦ ȾÀ¸·Î Àý°³ÇÏ´õ¶óµµ Źݰú ¸¶ÁÖÄ¡Áö ¾ÊÀ¸¸é ȾÀý°³(transverse incision)°¡ ¹Ù¶÷Á÷ÇÏ´Ù. Àü¹æ¿¡ ŹÝÀÌ À§Ä¡ÇÑ ÀüġŹÝÀÇ °æ¿ì ¼öÁ÷ ÀÚ±ÃÀý°³°¡ º¸´Ù ¾ÈÀüÇÒ ¼ö ÀÖ´Ù.
2) ÁöÇ÷¹æ¹ý
- Âø»óºÎÀ§¸¦ 0-Å©·Ò(chromic catgut)À¸·Î °¨ÃÄ ²ç¸Ç´Ù.
- ¾çÃø Àڱõ¿¸ÆÀ» °áÂû.
- ¾çÃø ³»Àå°ñµ¿¸ÆÀ» °áÂû.
- ÀÚ±ÃÇÏÀýºÎ(lower segment)¸¦ gauze·Î ´Ü´ÜÇÏ°Ô ÃæÀüÇÏ¿© ÁöÇ÷, ÀÌ °æ¿ì 12½Ã°£ ÈÄ¿¡ ÁúÀ» ÅëÇØ °ÅÁ Á¦°Å.
¡æ ½ÇÆÐÇϸé hysterectomy ½ÃÇà
7. Prognosis
perinatal morbidity and mortality
- Á¶±âºÐ¸¸(placenta previaÀÇ 50%¿¡¼)Àº perinatal mortalityÀÇ ÁÖµÈ ¿øÀÎÀÌ´Ù.
- congenital anomalies (2.5¹è¡çunclear reason), transverse fetal positioning
- IUGR (20%)
8. Other Problems to be Considered:
Vasa previa
Cervical laceration
Vaginal sidewall laceration
Miscarriage (spontaneous abortion)
1-1. Á¤ÀÇ : generally is defined as the implantation of the placenta over or near the internal os of the cervix
1-2. ºÐ·ù
Total placenta previa : ÀڱðæºÎ³»±¸°¡ Źݿ¡ ÀÇÇØ ¿ÏÀüÈ÷ µ¤¿©Á® ÀÖ´Â °æ¿ì
Partial placenta previa : °æºÎ³»±¸°¡ Źݿ¡ ÀÇÇØ ºÎºÐÀûÀ¸·Î µ¤¿©Á® ÀÖ´Â °æ¿ì
Marginal placenta previa : ŹÝÀÇ ³¡ºÎºÐÀÌ °æ±¸³»±¸ÀÇ º¯¿¬¿¡ À§Ä¡ÇÏ´Â °æ¿ì.
Low-lying placenta previa : ŹÝÀÇ ÀÚ±ÃÇÏÀýºÎ¿¡ Âø»óµÇ¾úÀ¸¸ç ŹÝÀÇ ³¡ÀÌ ½ÇÁ¦·Î °æ±¸³»±¸¿¡ ´êÁö ¾Ê°í ¸Å¿ì
±ÙÁ¢ÇØ ÀÖ´Â °æ¿ì.
2. Epidemiology
2-1. prevalence & motality rate
ºÐ¸¸½Ã ÀüġŹÝÀÇ ºóµµ´Â 0.5% À̸ç, »ç¸Á·üÀº 0.03% ÀÌ´Ù.
ÁÖ¿ä »ç¸Á ¿øÀÎ : uterine bleeding and the complication of disseminated intravascular coagulopathy
race : African American & Asian
2-2. accompanied by
- placenta accreta, placenta increta, placenta percreta ¿Í µ¿¹ÝµÉ ¼ö ÀÖÀ¸¸ç ÀÓ»óÀûÀ¸·Î À¯ÀÇÇÑ À¯ÂøÅÂ¹Ý Àº 7% Á¤µµ¿¡¼ µ¿¹ÝµÈ´Ù.
- C/sec Hx. °¡ ÀÖ´Â °æ¿ì¿¡´Â µ¿¹ÝµÇ´Â °æ¿ì°¡ 25%·Î Áõ°¡µÈ´Ù.
3. Etiology
- Prior uterine insult or injury ¡ç abnormal endometrial vascularization related to atrophy or scarring
- Risk factors
Prior previa (4-8%)
First subsequent pregnancy following a cesarean delivery(2¹è)
Multiparity (5% in grand multiparous patients)
Advanced maternal age(30¼¼ ÀÌÈÄ¿¡´Â ±×Àü ³ªÀÌ¿¡ ºñÇØ 3¹è)
Multiple gestation
Prior induced abortion
Smoking(2¹è¡çhypoxia¿¡ ÀÇÇØ ŹÝÀÌ ºñ´ëÇØÁö¹Ç·Î)
4. Manifestation
4-1. symptoms & signs & characteristic of bleeding
1) Vaginal bleeding
It is apt to occur suddenly during the third trimester.
Bleeding usually is bright red and painless.
Initial bleeding usually is not profuse enough to cause death; it spontaneously ceases, only to recur later.
The first bleed occurs (on average) at 27-32 weeks' gestation.
Contractions may or may not occur simultaneously with the bleeding(20%)
2) cause of bleeding
¤¡. dilatation of uterine lower segment ¡æ ŹÝÀÌ ºÙ¾î ÀÖ´Â °÷ÀÌ Âõ¾îÁü ¡æ hemorrhage
¤¤. À¯ÂøÅÂ¹Ý : Źݺи¸ÈÄ °úµµÇÑ ÃâÇ÷ °¡´É
4-2. coagulation defect
¼Ò¸ð¼º ÀÀ°íÀå¾Ö(DIC)ÀÇ Æ¯Â¡ÀÎ ÀÀ°íÀå¾Ö°¡ placenta abruptio¿¡¼ ÈçÇÏÁö¸¸ ŹÝÂø»óºÎÀ§¿¡¼ °úµµÇÑ Å¹ݹڸ®°¡ ÀÖ´Â °æ¿ì¿¡µµ placenta previa¿¡¼´Â µå¹°´Ù.
4-3. physical examination
Profuse hemorrhage
Hypotension
Tachycardia
Soft and nontender uterus
Normal fetal heart tones (usually)
Vaginal and rectal examinations
- Do not perform these examinations in the ED as they may provoke uncontrollable bleeding.
- Perform examinations in the operating room under double set-up conditions
5. Diagnosis
5-1. clinical suspicion
1) ÀÓ½ÅÀÇ ÈĹݺε¿¾È Àڱó» ÃâÇ÷ÀÌ ÀÖ´Â °æ¿ì ÀǽÉ.
2) ÃËÁøÀ¸·Î ÀÎÇÑ Áø´Ü
¤¡. ½ÉÇÑ ÃâÇ÷À» ÀÏÀ¸Å³ ¼ö ÀÖ´Ù.
¤¤. µû¶ó¼ ÀÀ±ÞÀ¸·Î C/S¸¦ ÇÒ ¼ö ÀÖ´Â ¼ö¼ú½Ç¿¡¼¸¸ ½ÃÇàÇØ¾ß ÇÑ´Ù.
¤§. ºÐ¸¸°èȹÀÌ ÀÖÀ» ¶§±îÁö ½ÃÇàÇØ¼´Â ¾ÈµÈ´Ù.
5-2. USG
1) transabdominal sonography
°¡Àå °£´ÜÇϰí Á¤È®ÇÏ¸ç ¾ÈÀüÇÑ ¹æ¹ý. Á¤È®µµ°¡ Æò±Õ 96%À̸ç ÃÖ°í 98%ÀÌ´Ù. À§¾ç¼ºÀº ¹æ±¤ÆØÃ¢¿¡ ÀÇÇÑ °æ¿ì°¡ ¸¹´Ù. ±×·¯¹Ç·Î ÃÊÀ½ÆÄ°Ë»ç»ó ÀüġŹÝÀÌ Áø´ÜµÇ¸é ¹æ±¤À» ºñ¿î ÈÄ ´Ù½Ã ÇÑ ¹ø ÃÊÀ½ÆÄ°Ë»ç¸¦ ½ÃÇàÇÏ¿© È®ÀÎÇÑ´Ù.
2) transvaginal sonography
¾ç¼º¿¹Ãø·üÀº 93%, À½¼º¿¹Ãø·üÀº 98%±îÁö º¸°íµÇ°í ÀÖ´Ù. ÇÏÀ§ÅÂ¹Ý À̳ª ŹÝÀÌ Àڱ󻱸¸¦ µ¤¾ú´ÂÁö¸¦ È®ÁøÇϱâ
À§ÇØ TV-USG¸¦ »ç¿ëÇÑ´Ù.
3) transperineal sonography; ¾ç¼º¿¹Ãø·üÀº 90%, À½¼º¿¹Ãø·üÀº 100%±îÁö º¸°íµÈ´Ù.
5-3. MRI
ÀÚ±â°ø¸í´ÜÃþÃÔ¿µ¹ýÀ» ÀÌ¿ëÇÏ¿© ŹÝÀÇ ÀÌ»óÀ» Áø´ÜÇÏ·Á´Â ³ë·ÂÀÌ ÀÖ¾î ¿ÔÀ¸³ª ÃÊÀ½ÆÄ°Ë»ç¸¦ ´ëüÇϱâ´Â Èûµé °ÍÀÌ´Ù.
5-4. placental migration
ÀӽŠÁ߱⿡ Àڱðæ°ü³»±¸¸¦ µ¤°í ÀÖ´Â ÅÂ¹Ý Áß ¾à 40%´Â ºÐ¸¸½Ã±îÁö ÀüÄ¡ ŹÝÀ¸·Î Áö¼ÓµÈ´Ù. ÀӽŠ2nd trimester ³ª 3rd trimester ÃÊ¿¡ °æ°ü³»±¸¸¦ µ¤°í ÀÖÁö ¾Ê°í Àڱ󻱸 °¡±îÀÌ À§Ä¡ÇÑ Å¹ÝÀº ÀÚ±ÃÀú·Î À̵¿ÇÒ °¡´É¼ºÀÌ ³ô´Ù. ÀӽŠ30ÁÖ ÀÌÀü¿¡ ÃÊÀ½ÆÄ°Ë»ç·Î ÀÎÁöµÈ ÀüġŹÝÀÌ Áö¼ÓµÇ´Â ºóµµ´Â ³·´Ù
¡æ GA 30wks ÀÌÈÄ¿¡ ÀüġŹÝÀÌ Áø´ÜµÇ¸é ÀÓ»êºÎÀÇ ¿îµ¿À» ÀÚÁ¦½ÃÄÑ¾ß ÇÑ´Ù.
5-5. Lab. data
DIC : CBC with platelet, PT, aPTT, FSP(fibrin split products)
aFP : risk for bleeding & preterm birth
6. Management of placenta previa
6-1. ÀüġŹÝÀÌ ÀÖ´Â Àӽźο¡¼ °í·ÁÇØ¾ßÇÒ »çÇ×
1) Á¶±âÁøÅëÀÌ ÀÖÁö¸¸ ºÐ¸¸ÇÒ Çʿ䰡 ¾ø´Â °æ¿ì
2) žư¡ ¼º¼÷ÇÑ °æ¿ì
3) ÁøÅëÁßÀÎ °æ¿ì
4) ¹Ì¼÷¾ÆÀÌÁö¸¸ ÃâÇ÷ÀÌ ½ÉÇÏ¿© ºÐ¸¸À» ÇÏ¿©¾ß ÇÏ´Â °æ¿ì
6-2. ÀüġŹݰú ¹Ì¼÷¾Æ¿¡ ÀÇÇØ ÇÕº´µÈ ÀÓ½ÅÀÇ Ã³Ä¡´Â ½ÇÁ¦ÀûÀÎ ÃâÇ÷ÀÌ ¾ø´Ù¸é ¸ðü¿Í žÆÀÇ ¾ÈÀü¿¡ ÁßÁ¡À» µÎ¾î¾ß ÇÑ´Ù. ÀÔ¿øÇÏ´Â °ÍÀÌ ÀÌ»óÀûÀ̳ª ½ÇÁ¦ÀûÀ¸·Î ÃâÇ÷ÀÌ ¸ØÃß°í žÆÀÇ °Ç°ÀÌ È®ÀεǸé ÀϹÝÀûÀ¸·Î Àӽźδ Åð¿øÇÏ°Ô µÈ´Ù.
6-3. delivery
1) Cesarean section
½ÇÁ¦ÀûÀ¸·Î ¸ðµç °æ¿ìÀÇ ÀüġŹݿ¡¼ ¸ðüÀÇ ¾È³çÀ» À§ÇØ ÀÎÁ¤µÇ´Â ºÐ¸¸¹æ¹ýÀÌ´Ù. ŹÝÀÌ ÈĹݿ¡ À§Ä¡ÇÏ¿© ÀÚ±ÃÇÏÀýºÎ(lower segment)¸¦ ȾÀ¸·Î Àý°³ÇÏ´õ¶óµµ Źݰú ¸¶ÁÖÄ¡Áö ¾ÊÀ¸¸é ȾÀý°³(transverse incision)°¡ ¹Ù¶÷Á÷ÇÏ´Ù. Àü¹æ¿¡ ŹÝÀÌ À§Ä¡ÇÑ ÀüġŹÝÀÇ °æ¿ì ¼öÁ÷ ÀÚ±ÃÀý°³°¡ º¸´Ù ¾ÈÀüÇÒ ¼ö ÀÖ´Ù.
2) ÁöÇ÷¹æ¹ý
- Âø»óºÎÀ§¸¦ 0-Å©·Ò(chromic catgut)À¸·Î °¨ÃÄ ²ç¸Ç´Ù.
- ¾çÃø Àڱõ¿¸ÆÀ» °áÂû.
- ¾çÃø ³»Àå°ñµ¿¸ÆÀ» °áÂû.
- ÀÚ±ÃÇÏÀýºÎ(lower segment)¸¦ gauze·Î ´Ü´ÜÇÏ°Ô ÃæÀüÇÏ¿© ÁöÇ÷, ÀÌ °æ¿ì 12½Ã°£ ÈÄ¿¡ ÁúÀ» ÅëÇØ °ÅÁ Á¦°Å.
¡æ ½ÇÆÐÇϸé hysterectomy ½ÃÇà
7. Prognosis
perinatal morbidity and mortality
- Á¶±âºÐ¸¸(placenta previaÀÇ 50%¿¡¼)Àº perinatal mortalityÀÇ ÁÖµÈ ¿øÀÎÀÌ´Ù.
- congenital anomalies (2.5¹è¡çunclear reason), transverse fetal positioning
- IUGR (20%)
8. Other Problems to be Considered:
Vasa previa
Cervical laceration
Vaginal sidewall laceration
Miscarriage (spontaneous abortion)