Heiskanen Nonna, Kröger Jaana, Kainulainen Sakari, Heinonen Seppo
Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.
Am J Perinatol. 2008 Feb;25(2):91-2. doi: 10.1055/s-2007-1004831. Epub 2008 Jan 4.
Our patient was a 24-year-old gravida 2 para 0 woman. After delivery, placenta percreta was noticed. There was no postpartum hemorrhage, and the patient desired future pregnancies. Although placenta percreta is rare, its sequelae include potentially lethal hemorrhage and loss of reproduction function. Placenta percreta was confirmed histologically and with ultrasonography and magnetic resonance imaging (MRI). Placenta percreta was treated conservatively with methotrexate. On follow-up, MRI showed a small calcified transmural extension of the placenta throughout the uterus in the right fundal area. Color Doppler ultrasonography showed no blood flow in the corresponding area, and maternal serum human chorionic gonadotropin (hCG) was undetectable. Use of MRI is a new method to detect abnormal placentation, and it could be used on follow-up in selective cases with other follow-up modalities. However, it seems likely that conservative management to preserve future fertility remains a secured and reasonable alternative when a patient has no active bleeding.
我们的患者是一名24岁、孕2产0的女性。分娩后，发现存在穿透性胎盘植入。患者没有产后出血，并且希望未来再次怀孕。虽然穿透性胎盘植入很少见，但其后遗症包括潜在的致命性出血和生殖功能丧失。通过组织学检查、超声检查和磁共振成像（MRI）确诊为穿透性胎盘植入。采用甲氨蝶呤对穿透性胎盘植入进行保守治疗。随访时，MRI显示胎盘在子宫右底部区域有一小片钙化的全层延伸。彩色多普勒超声显示相应区域无血流，且母体血清人绒毛膜促性腺激素（hCG）检测不到。MRI的应用是检测胎盘植入异常的一种新方法，在选择性病例中可与其他随访方式一起用于随访。然而，当患者没有活动性出血时，保留未来生育能力的保守治疗似乎仍是一种安全且合理的选择。
