Beuker J M, Erwich J J H M, Khong T Y
Department of Histopathology, Women's and Children's Hospital, North Adelaide SA 5006, Australia.
J Clin Pathol. 2005 Mar;58(3):273-5. doi: 10.1136/jcp.2004.020602.
To determine the frequency with which myometrium is removed during vacuum terminations of pregnancy or dilatation and curettage after miscarriage, and to relate these findings to subsequent placenta accreta or its proxies.
Archival tissues from vacuum termination of pregnancy or dilatation and blunt curettage after miscarriage were examined for the presence of myometrium. The subsequent obstetric histories were scrutinised for manual removal of placenta, postpartum haemorrhage, or retained placenta. A retrospective study comparing the frequency of miscarriage and termination in women who had or did not have a manual removal was also performed.
Myometrium was seen in the products of conception in 44% and 35% of termination and miscarriage tissues, respectively. One of nine women with myometrium at miscarriage had a postpartum haemorrhage in a subsequent pregnancy whereas, of the 21 women without myometrium at miscarriage, three required manual removal and seven had a postpartum haemorrhage afterwards. A past history of termination and/or miscarriage was more frequent in multigravid women who had a manual removal than those who did not.
Endomyometrial injury is frequent at termination or dilatation and curettage after miscarriage, but the relation to subsequent placenta accreta remains unclear. Women requiring a manual removal of the placenta were likely to have had a past history of termination and/or miscarriage.
确定在妊娠真空终止或流产后刮宫术中子宫肌层被切除的频率，并将这些结果与随后发生的胎盘植入或其替代情况相关联。
检查妊娠真空终止或流产后钝性刮宫的存档组织中是否存在子宫肌层。仔细审查随后的产科病史，以了解是否有徒手剥离胎盘、产后出血或胎盘残留情况。还进行了一项回顾性研究，比较有或没有徒手剥离胎盘的女性中流产和终止妊娠的频率。
在终止妊娠和流产组织的妊娠产物中，分别有44%和35%可见子宫肌层。流产时子宫肌层存在的9名女性中有1名在随后的妊娠中发生了产后出血，而流产时无子宫肌层的21名女性中，有3名需要徒手剥离胎盘，7名随后发生了产后出血。有徒手剥离胎盘史的多产女性既往终止妊娠和/或流产的病史比没有徒手剥离胎盘史的女性更常见。
流产后终止妊娠或刮宫时子宫内膜肌层损伤很常见，但与随后胎盘植入的关系仍不清楚。需要徒手剥离胎盘的女性可能既往有终止妊娠和/或流产史。
