伴有母胎合并症及并发症妊娠的分娩时机

当继续妊娠伴随的母胎风险高于终止妊娠所带来的母婴风险时，就具有终止妊娠的指征，即分娩时机正合适。当母胎出现合并症和并发症时，大多数未能自然临产，临床中需要引产，因此，在决定引产前，确定最佳的分娩时机不仅是关乎围产结局的关键因素，也是产科精准医疗的临床再现。分娩时机不是一成不变的，也不是机械刻板的，遵循母婴安全为第一要务的宗旨，采取个体化医疗的原则，最适宜的才是最好的。文章从胎儿因素（胎儿生长受限、双胎妊娠）、母体及产科因素（妊娠期高血压疾病、妊娠合并糖尿病、胎膜早破、曾有不明原因的死胎或死产）、胎盘及子宫因素（前置胎盘、胎盘植入、瘢痕子宫、子宫破裂）三方面总结伴有母胎合并症及并发症妊娠的分娩时机。

Timing of delivery of women with maternal-fetal complications.

Abstract:The timing of deliveries is the optimal outcome for the mother，baby，or both，due to conditions that result in worse outcomes if pregnancy is allowed to continue.When complicated pregnancy occurs，most mothers fail to labor; therefore，prior to the decision to induce labor，the optimal delivery timing is not only the key factor for the perinatal outcome，but also the clinical representation of obstetrical precision medicine.Time of delivery is neither static nor rigid.The maternal and child safety is our first concern.Individualized optimum methods and timing of delivery should be planned.The most suitable is the best.These conditions may be categorized as fetal issues （fetal growth restriction，twin pregnancy），maternal and obstetrical issues （hypertension in pregnancy，diabetes mellitus in pregnancy，prelabor rupture of membrane，prior stillbirth-unexplained），placental and uterine issues （placenta previa，placenta accreta/increta/percreta，prior classical cesarean，prior myomectomy，uterine rupture）.This paper summarized the delivery timing for these conditions.