Yu Mei, Liu Xin-yan, Dai Qing, Cui Quan-cai, Jin Zheng-yu, Lang Jing-he
Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2010 Oct;32(5):501-4. doi: 10.3881/j.issn.1000-503X.2010.05.006.
To summarize our experiences in the diagnosis and treatment of placenta accreta in the second trimester of pregnancy.
We retrospectively analyzed the clinical data of 31 patients were admitted to Peking Union Medical College Hospital with placenta accreta in the second trimester of pregnancy from January 2002 to January 2010.
Among 31 cases, one case (3.2%) was suspected to be with placenta accreta by ultrasound examination and 30 cases (96.8%) were normal before delivery. Placenta accreta was identified during follow-up in 12 cases (38.7%) after delivery. Fourteen patients underwent curettage again after delivery,which was effective in 6 patients (42.9%) and failed in 8 patients,in whom uterine artery embolization (UAE) was further applied. Thirteen patients underwent UAE without curettage. In total,21 cases underwent UAE, which was effective in 19 patients (90.5%); one patient with abnormal β-human chorionic gonadotropin (β-HCG) 5 months after embolization underwent lesion resection and one case with slightly increased β-HCG were lost to follow-up. Hysteroscopy was effective in 3 patients,of whom two patients underwent lesion resection by hysteroscopy and one case who was suspected to be with trophoblastic disease by ultrasonography before surgery and confirmed to be placenta accreta during hysteroscopy examination underwent lesion resection. One case experienced hemorrhagic shock during vaginal delivery and underwent emergency laparotomy. Among all these 31 patients,massive hemorrhage occurred in 13 cases during delivery and hemorrhagic shock in 2 cases. Three cases had postpartum hemorrhage and stopped bleeding after UAE. None needed hysterectomy.
Placenta accreta in the second trimester of pregnancy is usually diagnosed after childbirth,which may be delayed in some cases. Therefore,special attention should be paid to this disease during follow-up. Conservative treatment was the main therapy of placenta accreta in the second trimester of pregnancy. UAE is effective in stopping bleeding.
总结妊娠中期胎盘植入的诊断与治疗经验。
回顾性分析2002年1月至2010年1月在北京协和医院住院的31例妊娠中期胎盘植入患者的临床资料。
31例中，1例（3.2%）产前超声检查怀疑胎盘植入，30例（96.8%）产前检查正常。产后随访确诊胎盘植入12例（38.7%）。14例产后再次刮宫，6例（42.9%）有效，8例无效，对无效的8例进一步行子宫动脉栓塞术（UAE）。13例未刮宫直接行UAE。共21例行UAE，19例（90.5%）有效；1例栓塞后5个月β-人绒毛膜促性腺激素（β-HCG）异常者行病灶切除，1例β-HCG轻度升高者失访。宫腔镜治疗3例有效，其中2例行宫腔镜下病灶切除，1例术前超声怀疑滋养细胞疾病、宫腔镜检查确诊为胎盘植入者行病灶切除。1例经阴道分娩时发生失血性休克，行急诊剖腹探查。31例中，13例分娩时发生大出血，2例发生失血性休克。3例产后出血，行UAE后止血。无一例行子宫切除术。
妊娠中期胎盘植入多在产后确诊，部分病例诊断可能延迟，故随访时应特别关注此病。保守治疗是妊娠中期胎盘植入的主要治疗方法。UAE止血效果良好。
