Department of Obstetrics and Gynecology, La Conception University Hospital, Marseille, France.
Int J Gynaecol Obstet. 2010 May;109(2):147-50. doi: 10.1016/j.ijgo.2009.12.011. Epub 2010 Feb 12.
To determine the fertility and obstetric outcomes after conservative management of placenta accreta.
A retrospective observational cohort study of all identified cases of placenta accreta from 1993 to 2007 in 2 tertiary university hospitals in France. For patients treated conservatively, maternal and fetal morbidity, reproductive function, fertility, and subsequent pregnancies were recorded.
During the study period, 46 patients were treated by conservative management; 6 patients underwent a secondary hysterectomy. Of the remaining 40 patients, 35 were followed up for a median of 65 months (range 18-156 months). Patients resumed their menstrual cycles after a median of 130 days (range 48-176 days). Menses were irregular in 11 patients (31%), but none had amenorrhea. Twelve of the 14 patients desiring another pregnancy achieved a total of 15 pregnancies; 2 patients had recurrent placenta accreta. Five spontaneous abortions and 1 termination of pregnancy occurred during the first trimester. The median term at delivery was 37 weeks (range, 35-40 weeks). Four patients delivered prematurely.
Conservative management of placenta accreta can preserve fertility, although the risk of recurrent placenta accreta appears to be high.
确定胎盘植入保守管理后的生育和产科结局。
这是一项在法国 2 所三级大学医院对 1993 年至 2007 年间所有确诊的胎盘植入病例进行的回顾性观察性队列研究。对接受保守治疗的患者，记录母婴发病率、生殖功能、生育能力和后续妊娠情况。
研究期间，46 例患者接受保守治疗；6 例患者接受了二次子宫切除术。在其余 40 例患者中，35 例的中位随访时间为 65 个月（范围 18-156 个月）。患者的月经周期在中位 130 天后恢复（范围 48-176 天）。11 例患者（31%）月经不规则，但均无闭经。14 例有生育要求的患者中有 12 例成功妊娠 15 次；2 例患者再次发生胎盘植入。5 例在孕早期发生自然流产，1 例终止妊娠。中位分娩期为 37 周（范围 35-40 周）。4 例早产。
胎盘植入的保守管理可以保留生育能力，尽管再次发生胎盘植入的风险似乎很高。
