Wong Hong Soo, Hutton John, Zuccollo Jane, Tait John, Pringle Kevin C
Department of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Otago, Wellington, PO Box 7343, Wellington South, New Zealand.
N Z Med J. 2008 Jul 4;121(1277):30-8.
To evaluate the effects of antenatal diagnosis and subsequent placental non-separation at delivery on the maternal outcome in confirmed cases of placenta accreta.
The perinatal database and medical records for women who delivered in the period 2000-6 in a teaching hospital in New Zealand with a diagnosis of placenta accreta or postpartum haemorrhage or hysterectomy were reviewed. In confirmed placenta accreta cases, the amount of blood loss and blood transfused at delivery and subsequent emergency hysterectomy were analysed in respect to the presence/absence of antenatal diagnosis and the management at delivery.
16 women had placenta accreta confirmed (15 histologically and 1 visually). Antenatal diagnosis was made in 7 women, elective Caesarean delivery planned in all, hysterectomy to follow in 5 (4 elective, 1 emergency preterm), and elective placental separation in 2 women. When an antenatal diagnosis was not made (n=9), attempted placental separation led to emergency hysterectomy for all (p=0.001). Antenatal diagnosis and placental non-separation resulted in less mean blood loss (1.4 L vs 3.6 L, p=0.003; 1.0 L vs 3.4 L, p<0.001) and mean units of blood transfused (1.2 vs 5.1, p=0.005) in the latter.
In placenta accreta, antenatal diagnosis and avoidance of placental separation may result in better maternal outcome.
评估产前诊断及分娩时胎盘不剥离对确诊的胎盘植入病例产妇结局的影响。
回顾了2000年至2006年期间在新西兰一家教学医院分娩且诊断为胎盘植入、产后出血或子宫切除术的妇女的围产期数据库和病历。在确诊的胎盘植入病例中，分析了分娩时的失血量、输血量以及随后的急诊子宫切除术与产前诊断的有无及分娩时的处理情况。
16名妇女确诊为胎盘植入（15例经组织学确诊，1例经肉眼确诊）。7名妇女进行了产前诊断，均计划择期剖宫产，其中5名（4例择期，1例急诊早产）随后进行了子宫切除术，2名妇女进行了择期胎盘剥离。未进行产前诊断的9名妇女（n = 9），尝试胎盘剥离后均进行了急诊子宫切除术（p = 0.001）。产前诊断且胎盘不剥离导致后者的平均失血量（1.4升对3.6升，p = 0.003；1.0升对3.4升，p < 0.001）和平均输血量（1.2单位对5.1单位，p = 0.005）均较少。
在胎盘植入病例中，产前诊断并避免胎盘剥离可能会改善产妇结局。
