Hunt Jennifer C
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Women's Hospital, Room WS125, 735 Notre Dame Avenue, Winnipeg, MB, Canada R3E 0L8.
J Pregnancy. 2010;2010:329618. doi: 10.1155/2010/329618. Epub 2010 Sep 30.
Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was unsuccessful and led to the development of a disseminated intrauterine infection complicated by a bowel obstruction, requiring both a hysterectomy and small bowel resection. In hemodynamically stable patients, conservative management of placenta accreta may involve leaving placental tissue in situ with subsequent administration of methotrexate. However, ongoing close observation is required to identify complications.
胎盘植入是指胎盘任何异常侵入性的着床。产后怀疑诊断为胎盘植入，表现为胎盘残留无法娩出。大量产科出血是已知的并发症，常需在围产期行子宫切除术。我们报告一例患者在人工剥离胎盘残留失败后疑似胎盘植入的病例。我们描述了对一名希望未来生育且病情稳定的患者尝试用甲氨蝶呤进行保守治疗。治疗未成功，导致发生播散性宫内感染并伴有肠梗阻，需要行子宫切除术和小肠切除术。对于血流动力学稳定的胎盘植入患者，保守治疗可能包括将胎盘组织留在原位，随后给予甲氨蝶呤。然而，需要持续密切观察以识别并发症。
