Department of Obstetrics and Gynaecology, University of Fukui, Fukui, Japan.
BJOG. 2013 Aug;120(9):1144-9. doi: 10.1111/1471-0528.12252. Epub 2013 May 2.
To determine the feasibility and safety of transverse fundal incision with manual placental removal in women with placenta praevia and possible placenta accreta.
Case series.
Four level-three Japanese obstetric centres.
Thirty-four women with prior caesarean section and placenta praevia that widely covers the anterior uterine wall, in whom placenta accreta cannot be ruled out.
A transverse fundal incision was performed at the time of caesarean section and manual placental removal was attempted under direct observation.
Operative fluid loss.
The total volume of fluid lost during our operative procedure compares favourably with the volume lost during our routine transverse lower-segment caesarean sections performed in patients without placenta praevia or accreta. The average fluid loss was 1370 g. No patients required transfer to intensive care, and there were no cases of fetal anaemia.
This procedure has the potential to reduce the heavy bleeding that arises from caesarean deliveries in women with placenta praevia and placenta accreta.
确定经横向宫底切口联合徒手胎盘剥离术治疗前置胎盘伴胎盘植入患者的可行性和安全性。
病例系列研究。
日本四家三级产科中心。
34 名既往有剖宫产史且胎盘前置、广泛覆盖子宫前壁且不能排除胎盘植入的患者。
在剖宫产时行横向宫底切口，并在直接观察下尝试进行徒手胎盘剥离。
手术失血量。
与我们在无前置胎盘或植入的患者中进行的常规横向下段剖宫产相比，我们的手术过程中总的失血量更具优势。平均失血量为 1370g。没有患者需要转入重症监护病房，也没有胎儿贫血的病例。
对于前置胎盘伴胎盘植入的剖宫产患者，该手术方法有减少大出血的潜力。
