From the Departments of Obstetrics and Gynecology, Angers University Hospital, Angers; Rouen University Hospital, Charles Nicolle, Rouen; Rennes University Hospital, Rennes; Maternité Port-Royal Hospital, Cochin APHP, University René Descartes, Paris; Centre Hospitalier Intercommunal de Créteil, University of Paris XII, Henri Mondor, Créteil; Conception Hospital, University of Mediterranee, Marseille; North Hospital, University of Mediterranee, Marseille; Antoine Béclère Hospital, University Paris Sud, Paris; Kremlin-Bicètre Hospital, University Paris Sud, Paris; Tours University Hospital, Tours; Nantes University Hospital, Nantes; CHU La Milétrie Hospital, University of Poitiers, Poitiers; Hôpital Necker-Enfants Malades, University René Descartes, Paris; Caen University Hospital, Caen; and Hôpital Bichat Claude-Bernard, APHP, University Paris-VII, Paris, France.
Obstet Gynecol. 2010 Mar;115(3):526-534. doi: 10.1097/AOG.0b013e3181d066d4.
To estimate maternal outcome after conservative management of placenta accreta.
This retrospective multicenter study sought to include all women treated conservatively for placenta accreta in tertiary university hospital centers in France from 1993 to 2007. Conservative management was defined by the obstetrician's decision to leave the placenta in situ, partially or totally, with no attempt to remove it forcibly. The primary outcome was success of conservative treatment, defined by uterine preservation. The secondary outcome was a composite measure of severe maternal morbidity including sepsis, septic shock, peritonitis, uterine necrosis, fistula, injury to adjacent organs, acute pulmonary edema, acute renal failure, deep vein thrombophlebitis or pulmonary embolism, or death.
Of the 40 university hospitals that agreed to participate in this study, 25 institutions had used conservative treatment at least once (range 1-46) and had treated a total of 167 women. Conservative treatment was successful for 131 of the women (78.4%, 95% confidence interval [CI] 71.4-84.4%); of the remaining 36 women, 18 had primary hysterectomy and 18 had delayed hysterectomy (10.8% each, 95% CI 6.5-16.5%). Severe maternal morbidity occurred in 10 cases (6.0%, 95% CI 2.9-10.7%). One woman died of myelosuppression and nephrotoxicity related to intraumbilical methotrexate administration. Spontaneous placental resorption occurred in 87 of 116 cases (75.0%, 95% CI 66.1-82.6%), with a median delay from delivery of 13.5 weeks (range 4-60 weeks).
Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources.
评估胎盘植入采用保守治疗后的母婴结局。
本回顾性多中心研究旨在纳入法国三级大学医院中心自 1993 年至 2007 年期间采用保守治疗的所有胎盘植入患者。保守治疗是指产科医生决定不强行取出胎盘，而是将其部分或全部保留在原位。主要结局是评估保留子宫的保守治疗成功率。次要结局是严重产妇发病率的综合指标，包括败血症、感染性休克、腹膜炎、子宫坏死、瘘管、邻近器官损伤、急性肺水肿、急性肾衰竭、深静脉血栓形成或肺栓塞，或死亡。
在同意参与本研究的 40 家大学医院中，有 25 家机构至少使用过一次保守治疗（范围 1-46），共治疗了 167 名妇女。131 名妇女（78.4%，95%置信区间[CI]71.4-84.4%）的保守治疗成功；其余 36 名妇女中，18 例行原发性子宫切除术，18 例行延迟性子宫切除术（各 10.8%，95%CI 6.5-16.5%）。10 例（6.0%，95%CI 2.9-10.7%）发生严重产妇发病率。1 例因经脐部甲氨蝶呤给药引起骨髓抑制和肾毒性而死亡。116 例中有 87 例（75.0%，95%CI 66.1-82.6%）发生自发性胎盘吸收，从分娩到胎盘吸收的中位时间为 13.5 周（范围 4-60 周）。
在设备和资源充足的中心，胎盘植入采用保守治疗可帮助妇女避免子宫切除术，且严重产妇发病率较低。
