Meyer N P, Ward G H, Chandraharan E
Croydon University Hospital, Croydon, UK.
Ceylon Med J. 2012 Mar;57(1):36-9. doi: 10.4038/cmj.v57i1.4199.
To determine the effect of conservative management of morbidly adherent placentae on maternal morbidity and mortality and to review management options
All case notes of patients with placenta accreta and percreta between June 2008 and August 2010 were studied retrospectively.
Eight placentae percretae and 4 placentae accretae were identified out of a total of 11,358 deliveries.All 12 patients underwent caesarean section. Placentae percretae were intentionally left in situ. Interventional radiology was used in these cases. There was one emergency hysterectomy for massive obstetric haemorrhage,one case of disseminated intravascular coagulation,one case of early sepsis and 3 cases of delayed sepsis.Average blood loss was 2490 ml with the mean volume transfused being 1425 ml. The mean hospital stay was 7 days and 2 patients were admitted to intensive care. One patient was readmitted with sepsis complicated by a utero-cutaneous fistula (complete placenta praevia).Another patient required re-embolisation 5 months post delivery for persistent haemorrhage. No ureteric or bladder injuries occurred.
Conservative management of placenta percreta is an alternative to caesarean hysterectomy. It is associated with lower maternal morbidity rates.However, monitoring for sepsis and secondary postpartum haemorrhage is essential. Rare complications such as utero-cutanus fistulae may occur.
确定对植入性胎盘进行保守治疗对孕产妇发病率和死亡率的影响，并回顾治疗方案
对2008年6月至2010年8月期间胎盘植入和穿透性胎盘植入患者的所有病历进行回顾性研究。
在总共11358例分娩中，确诊8例穿透性胎盘植入和4例植入性胎盘植入。所有12例患者均行剖宫产术。穿透性胎盘植入均有意留在原位。这些病例采用了介入放射学方法。有1例因严重产科出血行急诊子宫切除术，1例发生弥散性血管内凝血，1例发生早期脓毒症，3例发生延迟性脓毒症。平均失血量为2490毫升，平均输血量为1425毫升。平均住院时间为7天，2例患者入住重症监护病房。1例患者因脓毒症并发子宫皮肤瘘（完全性前置胎盘）再次入院。另1例患者产后5个月因持续出血需要再次栓塞治疗。未发生输尿管或膀胱损伤。
穿透性胎盘植入的保守治疗是剖宫产子宫切除术的一种替代方法。它与较低的孕产妇发病率相关。然而，对脓毒症和继发性产后出血的监测至关重要。可能会发生子宫皮肤瘘等罕见并发症。
