Wax J R, Seiler A, Horowitz S, Ingardia C J
University of Connecticut School of Medicine, USA.
Conn Med. 2000 Nov;64(11):659-61.
To determine if the interval from a previous delivery or cesarean to the next conception differs between patients with abnormally adherent placentas as compared to those with normally implanted placentas.
We identified all histologically confirmed placentas--accreta, increta, and percreta--at our hospital from 1992-1999. Subjects were excluded for primigravidity in the affected pregnancy or inability to identify matched controls. Cases were matched to the next three consecutive women delivering for maternal age (> or = 35 years or < 35 years), placenta previa (yes or no), prior cesarean (yes or no), prior uterine curettage (yes or no), and prior vaginal delivery (yes or no). The primary outcomes were delivery-to-conception and cesarean-to-conception intervals. Secondary outcomes included measures of maternal and neonatal morbidity.
Delivery-to-conception intervals for cases and controls were 37.1 +/- 18.7 months and 37.9 +/- 22.7 months, respectively (P = .91). Cesarean-to-conception intervals for cases and controls were 35.2 +/- 18.2 and 48.1 +/- 31.0 months, respectively (P = .35). Cases were more likely to require uterine curettage (54.5 vs 0%), hysterectomy (81.8 vs 0%), and transfusion (72.7 vs 0%), all P < .001. Subjects with accreta delivered earlier (31.7 +/- 9.4 vs 38.1 +/- 2.6 weeks, P = .054) and smaller infants (2,158 +/- 1,180 g vs 3,159 +/- 781 g, P = .006) who were more likely to have five-minute Apgar scores < 7 (18.2% vs 0%, P = .038).
Cesarean-to-conception intervals but not delivery-to-conception intervals are shorter in patients with abnormally adherent placentas. Placenta accreta is associated with significant maternal and perinatal morbidity.
确定与胎盘正常植入的患者相比，胎盘异常粘连的患者从上一次分娩或剖宫产到下一次受孕的间隔时间是否存在差异。
我们识别了1992年至1999年我院所有经组织学确诊的胎盘——植入性胎盘、穿透性胎盘和侵入性胎盘。受影响妊娠为初孕或无法识别匹配对照的受试者被排除。病例与接下来连续三位因产妇年龄（≥35岁或＜35岁）、前置胎盘（是或否）、既往剖宫产史（是或否）、既往刮宫史（是或否）和既往阴道分娩史（是或否）而分娩的女性进行匹配。主要结局为分娩至受孕间隔时间和剖宫产至受孕间隔时间。次要结局包括孕产妇和新生儿发病率的指标。
病例组和对照组的分娩至受孕间隔时间分别为37.1±18.7个月和37.9±22.7个月（P = 0.91）。病例组和对照组的剖宫产至受孕间隔时间分别为35.2±18.2个月和48.1±31.0个月（P = 0.35）。病例组更有可能需要刮宫（54.5%对0%）、子宫切除术（81.8%对0%）和输血（72.7%对0%），所有P均＜0.001。植入性胎盘的受试者分娩时间更早（31.7±9.4周对38.1±2.6周，P = 0.054），婴儿体重更小（2158±1180克对3159±781克，P = 0.006），且5分钟阿氏评分＜7分的可能性更大（18.2%对0%，P = 0.038）。
胎盘异常粘连的患者剖宫产至受孕间隔时间较短，但分娩至受孕间隔时间无差异。植入性胎盘与严重的孕产妇和围产期发病率相关。
