Department of Visceral and Vascular Radiology, Centre Hopistalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand cedex 1, Clermont-Ferrand, France.
J Vasc Interv Radiol. 2010 May;21(5):644-8. doi: 10.1016/j.jvir.2010.01.015. Epub 2010 Mar 15.
To report on the management of placenta accreta with uterine artery embolization (UAE) and to analyze the outcomes.
A retrospective study was performed over a 128-month period of all women with placenta accreta who underwent UAE in a single center. Seventeen patients were included, and they were further divided into two groups: a preventive group (diagnosis was made in the prenatal period, n = 6) and a curative group (diagnosis was made during delivery, n = 11). The mean patient age was 34.6 years +/- 5.5 in the preventive group and 31.4 years +/- 4.3 in the curative group. The mean term of pregnancy was 35 weeks +/- 2 of amenorrhea in the preventive group and 38 weeks +/- 2 in the curative group.
The primary success of embolization was 100% in both groups. In the preventive group, massive bleeding occurred in a patient 2 days after unsuccessful manual placenta delivery resulted in an hysterectomy; in a second case, delayed bleeding (2 months after the procedure) was controlled with a second embolization. There were no episodes of repeat bleeding in the curative group. In the preventive group, two patients presented with uterine scarring, with synechiae in one and endometrial atrophy in the other. In the curative group, one patient presented with secondary amenorrhea. The delay before embolization was significantly different in the two groups (23.3 minutes +/- 5.1 in the preventive group vs 73 minutes +/- 44.7 in the curative group, P < .01), and total blood loss was 0.7 L +/- 0.8 in the preventive group and 2.6 L +/- 1.2 in the curative group (P < .01).
Prenatal diagnosis of placenta accreta permits its preventive management, which reduces time to embolization and blood loss.
报告子宫动脉栓塞术（UAE）治疗胎盘植入的管理情况，并分析其结果。
对 128 个月内在单一中心接受 UAE 治疗的所有胎盘植入患者进行回顾性研究。共纳入 17 例患者，分为两组：预防组（产前诊断，n=6）和治疗组（分娩时诊断，n=11）。预防组患者的平均年龄为 34.6 岁±5.5 岁，治疗组为 31.4 岁±4.3 岁。预防组的平均妊娠期限为闭经 35 周±2 周，治疗组为 38 周±2 周。
两组栓塞的初次成功率均为 100%。预防组中有 1 例患者在手动胎盘剥离不成功后 2 天发生大出血，导致子宫切除；另 1 例患者在栓塞后 2 个月发生迟发性出血，需再次栓塞治疗。治疗组中无再次出血病例。预防组中有 2 例患者出现子宫瘢痕，其中 1 例出现粘连，另 1 例出现子宫内膜萎缩。治疗组中有 1 例患者出现继发性闭经。两组患者栓塞前的延迟时间差异有统计学意义（预防组为 23.3 分钟±5.1 分钟，治疗组为 73 分钟±44.7 分钟，P<0.01），总出血量分别为预防组 0.7 L±0.8 L，治疗组 2.6 L±1.2 L（P<0.01）。
胎盘植入的产前诊断可进行预防性管理，从而缩短栓塞时间和出血量。
