Courbière B, Bretelle F, Porcu G, Gamerre M, Blanc B
Service de Gynécologie-Obstétrique, CHU La Conception, 147, boulevard Baille, 13385 Marseille Cedex.
J Gynecol Obstet Biol Reprod (Paris). 2003 Oct;32(6):549-54.
Examination of modalities and results of conservative treatment of placenta accreta.
Ten-year hospital records were reviewed, with analysis of patients who had diagnosis of placenta accreta associated with conservative treatment.
During the study period, 21259 deliveries were registered, with an incidence of placenta accreta of 1 per 1 000 deliveries (n=23). Conservative treatment was applied in 13 patients. All of them had factors commonly associated with placenta accreta: prior cesarean sections (7/13), prior curettage or endouterine surgery (11/13), placenta praevia (11/13). Antenatal diagnosis was performed in only 64% of the cases (n=7). In our conservative strategy, placenta accreta was always left in situ, with an associated treatment in most of cases (n=10): Bilateral hypogastric artery ligation (n=7), medical treatment with methotrexate (n=5), uterine artery embolization (n=2). There was no case of maternal mortality. Conservative treatment was successful in 11 patients. It failed in 2 cases: hysterectomy was performed in one case for life-threatening hemorrhage, and in the other case for post-embolization uterine necrosis. The morbidity described was blood transfusion (n=7), endometritis (n=1), and one late hemorrhage with expelling necrotic tissue. Afterwards, 2 women became pregnant: one miscarriage and one normal term delivery.
Conservative treatment of placenta accreta appears to be a efficient way to preserve fertility. Antepartum diagnosis should be improved among patients with a high risk of placenta accreta in order to optimize conservative strategy.
研究胎盘植入保守治疗的方式及结果。
回顾十年的医院记录，分析诊断为胎盘植入并接受保守治疗的患者。
在研究期间，共登记分娩21259例，胎盘植入发生率为每1000例分娩中有1例（n = 23）。13例患者接受了保守治疗。所有患者均有与胎盘植入相关的常见因素：既往剖宫产史（7/13）、既往刮宫或子宫内手术史（11/13）、前置胎盘（11/13）。仅64%的病例（n = 7）进行了产前诊断。在我们的保守治疗策略中，胎盘植入均原位保留，大多数病例（n = 10）采取了相关治疗：双侧髂内动脉结扎（n = 7）、甲氨蝶呤药物治疗（n = 5）、子宫动脉栓塞（n = 2）。无孕产妇死亡病例。11例患者保守治疗成功。2例失败：1例因危及生命的出血行子宫切除术，另1例因栓塞后子宫坏死行子宫切除术。所描述的并发症包括输血（n = 7）、子宫内膜炎（n = 1）以及1例排出坏死组织的晚期出血。之后，2名女性再次怀孕：1例流产，1例足月分娩。
胎盘植入的保守治疗似乎是一种有效的保留生育能力的方法。对于胎盘植入高危患者，应改善产前诊断以优化保守治疗策略。
