Yu Pao-Chu, Ou Hsin-You, Tsang Leo Leung-Chit, Kung Fu-Tsai, Hsu Te-Yao, Cheng Yu-Fan
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Fertil Steril. 2009 May;91(5):1951-5. doi: 10.1016/j.fertnstert.2008.02.170. Epub 2008 May 23.
To determine whether prophylactic intraoperative uterine artery embolization (UAE) reduces blood loss and minimizes morbidity and mortality in cases of placenta accreta, increta, and percreta.
A prospective, nonrandomized clinical trial.
A university-based, high-risk pregnancy unit and department of interventional radiology.
PATIENT(S): Eleven patients who were diagnosed prenatally with placenta accreta, increta, and percreta.
INTERVENTION(S): Patients with suspected placenta accreta were treated with prophylactic, intraoperative UAE immediately after fetal delivery and before removal of the placenta. Patients with suspected placenta increta were treated with UAE; the placenta remained in situ, or a hysterectomy was performed. Patients with suspected placenta percreta were treated with UAE, and the placenta remained in situ.
MAIN OUTCOME MEASURE(S): Intraoperative blood loss, maternal mortality, fetal mortality, need for hysterectomy.
RESULT(S): Eleven viable fetuses were born with no radiation exposure. There were no maternal or fetal mortalities. Nine of 11 patients had an estimated blood loss between 500 and 2300 mL. Emergency hysterectomy was performed in two patients because of massive bleeding. The complications, including peritonitis and endometritis, occurred in another two patients after embolization.
CONCLUSION(S): Prophylactic, intraoperative UAE before placental expulsion appears to reduce the risk of postpartum hemorrhage, decrease morbidity and mortality, and increase the chance of preservation of the uterus in patients with placenta accreta, increta, and percreta.
确定预防性术中子宫动脉栓塞术（UAE）是否能减少胎盘植入、穿透性胎盘植入和植入性胎盘患者的出血量，并将发病率和死亡率降至最低。
一项前瞻性、非随机临床试验。
一家大学附属的高危妊娠科室和介入放射科。
11例产前诊断为胎盘植入、穿透性胎盘植入和植入性胎盘的患者。
疑似胎盘植入患者在胎儿娩出后、胎盘娩出前立即接受预防性术中UAE治疗。疑似穿透性胎盘植入患者接受UAE治疗；胎盘原位保留，或行子宫切除术。疑似植入性胎盘患者接受UAE治疗，胎盘原位保留。
术中出血量、孕产妇死亡率、胎儿死亡率、子宫切除需求。
11例存活胎儿出生，无辐射暴露。无孕产妇或胎儿死亡。11例患者中有9例估计失血量在500至2300毫升之间。2例患者因大出血行急诊子宫切除术。另外2例患者栓塞后出现包括腹膜炎和子宫内膜炎在内的并发症。
在胎盘娩出前进行预防性术中UAE似乎可以降低胎盘植入、穿透性胎盘植入和植入性胎盘患者产后出血的风险，降低发病率和死亡率，并增加保留子宫的机会。
