Sumigama Seiji, Itakura Atsuo, Ota Toyohiro, Okada Mayumi, Kotani Tomomi, Hayakawa Hiromi, Yoshida Kana, Ishikawa Kaoru, Hayashi Kazumasa, Kurauchi Osamu, Yamada Satoru, Nakamura Hiromi, Matsusawa Katsuji, Sakakibara Katsumi, Ito Mitsuaki, Kawai Michiyasu, Kikkawa Fumitaka
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Obstet Gynaecol Res. 2007 Oct;33(5):606-11. doi: 10.1111/j.1447-0756.2007.00619.x.
Placenta accreta is an abnormally firm attachment of placental villi to the uterine wall, which may cause postpartum hemorrhage resulting in maternal morbidity and mortality. The purpose of the present study was to clarify the incidence, clinical background and prognosis of placenta previa increta/percreta treated with different modalities in Japan.
Medical records of cases with placenta previa increta/percreta in eight tertiary centers between January 1994 and December 2004 were reviewed. Placenta accreta without actual invasion into the myometrium confirmed by pathology was not included in placenta increta/percreta. Details of obstetric history, maternal background, ultrasonographical findings, the course of delivery, subsequent complications and management were noted.
Among the total of 59,008 deliveries, 45,261 were by the vaginal route (76.7%) and 13 747 by cesarean section (23.3%). In this study, 408 cases were diagnosed as placenta previa (0.69%), 18 of these being placenta increta and 5 placenta percreta. Only 1.1% of cases of placenta previa without prior cesarean section were increta/percreta, in contrast to 37% of placenta previa after prior cesarean sections. Mean intraoperation blood loss was 3630 +/- 2216 g (increta) and 12,140 +/- 8343 g (percreta). One patient with placenta previa percreta died of hemorrhage. Stepwise treatment (cesarean section without separation of the placenta, arterial embolization and hysterectomy) was applied for 4 cases, which had the least blood loss.
Placenta previa increta/percreta is a life-threatening disease. Patients who undergo hysterectomy after uterine arterial embolization demonstrate reduced intraoperation blood loss, and this treatment should be incorporated to reduce maternal morbidity.
胎盘植入是指胎盘绒毛异常牢固地附着于子宫壁，可导致产后出血，进而引起产妇发病和死亡。本研究的目的是阐明日本采用不同治疗方式治疗的植入性/穿透性前置胎盘的发病率、临床背景及预后情况。
回顾了1994年1月至2004年12月期间8个三级医疗中心收治的植入性/穿透性前置胎盘病例的医疗记录。病理证实未实际侵入子宫肌层的胎盘粘连不包括在植入性/穿透性胎盘内。记录了产科病史、产妇背景、超声检查结果、分娩过程、随后的并发症及处理情况。
在总共59008例分娩中，45261例经阴道分娩（76.7%），13747例经剖宫产分娩（23.3%）。在本研究中，408例被诊断为前置胎盘（0.69%），其中18例为植入性胎盘，5例为穿透性胎盘。未行剖宫产史的前置胎盘病例中，仅1.1%为植入性/穿透性胎盘，而有剖宫产史的前置胎盘病例中这一比例为37%。植入性胎盘术中平均失血量为3630±2216克，穿透性胎盘为12140±8343克。1例穿透性前置胎盘患者死于出血。4例患者采用了逐步治疗（剖宫产不剥离胎盘、动脉栓塞和子宫切除术），失血量最少。
植入性/穿透性前置胎盘是一种危及生命的疾病。子宫动脉栓塞后行子宫切除术的患者术中失血量减少，应采用这种治疗方法以降低产妇发病率。
