Department of Obstetrics and Gynecology, CHR Citadelle, Liège, Belgium.
Acta Obstet Gynecol Scand. 2013 Apr;92(4):439-44. doi: 10.1111/aogs.12081.
Abnormally invasive placenta (AIP) poses diagnostic and therapeutic challenges. We analyzed clinical cases with confirmed placenta increta or percreta.
Retrospective case series.
Multicenter study.
Pregnant women with AIP.
Chart review.
Prenatal detection rates, treatment choices, morbidity, mortality and short-term outcome.
Sixty-six cases were analyzed. All women and all but three fetuses survived; 57/64 women (89%) had previous uterine surgery. In 26 women (39%) the diagnosis was not known before delivery (Group 1), in the remaining 40 (61%) diagnosis had been made between 14 and 37 weeks of gestation (Group 2). Placenta previa was present in 36 women (54%). In Groups 1 and 2, 50% (13/26) and 62% (25/40) of the women required hysterectomy, respectively. In Group 1 (unknown at the time of delivery) 69% (9/13) required (emergency) hysterectomy for severe hemorrhage in the immediate peripartum period compared with only 12% (3/25) in Group 2 (p = 0.0004). Mass transfusions were more frequently required in Group 1 (46%, 12/26 vs. 20%, 8/40; p = 0.025). In 18/40 women (45%) from Group 2 the placenta was intentionally left in situ; secondary hysterectomies and infections were equally frequent (18%) among these differently treated women. Overall, postpartum infections occurred in 11% and 20% of women in Groups 1 and 2, respectively.
AIP was known before delivery in more than half of the cases. Unknown AIP led to significantly more emergency hysterectomies and mass transfusions during or immediately after delivery. Prenatal diagnosis of AIP reduces morbidity. Future studies should also address the selection criteria for cases appropriate for leaving the placenta in situ.
异常侵袭性胎盘（AIP）带来了诊断和治疗方面的挑战。我们分析了经确认存在胎盘植入或穿透性胎盘的病例。
回顾性病例系列研究。
多中心研究。
患有 AIP 的孕妇。
图表回顾。
产前检出率、治疗选择、发病率、死亡率和短期结局。
共分析了 66 例病例。所有孕妇和除 3 例胎儿外的所有胎儿均存活；57/64 名（89%）的妇女既往有子宫手术史。26 名（39%）妇女在分娩前未确诊（第 1 组），其余 40 名（61%）在妊娠 14-37 周时确诊（第 2 组）。36 名（54%）妇女存在前置胎盘。第 1 组和第 2 组中，分别有 50%（13/26）和 62%（25/40）的妇女需要行子宫切除术。第 1 组（分娩时未知）中，69%（9/13）因围产期立即出现严重出血而需要（紧急）子宫切除术，而第 2 组中仅 12%（3/25）需要（p=0.0004）。第 1 组（26 例）中更常需要大量输血（46%，12/26 比 20%，8/40；p=0.025）。第 2 组（40 例）中 18/40（45%）名妇女有意保留胎盘原位；这些接受不同治疗的妇女中，继发性子宫切除术和感染的发生率相同（18%）。总体而言，第 1 组和第 2 组中分别有 11%和 20%的妇女发生产后感染。
AIP 在一半以上的病例中于分娩前确诊。未知 AIP 导致分娩时或分娩后立即进行紧急子宫切除术和大量输血的情况显著增加。AIP 的产前诊断可降低发病率。未来的研究还应针对适合保留胎盘原位的病例的选择标准进行探讨。
