Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
Acta Obstet Gynecol Scand. 2013 Nov;92(11):1250-5. doi: 10.1111/aogs.12230. Epub 2013 Sep 7.
To evaluate the outcome of three different modes of management of abnormally invasive placenta over a 6-year period.
Retrospective cohort study.
Tertiary hospital in Hong Kong.
In 39 757 deliveries, 25 cases of abnormally invasive placenta were identified at cesarean section.
Identification of cases by hospital database and review of medical records.
Blood loss, blood transfusion requirement, operative time, duration of hospital stay, secondary postpartum hemorrhage and endometritis.
Six women were managed by leaving the placenta in situ and by postoperative uterine artery embolization. Ten women were managed by an extirpative approach and nine women with direct cesarean hysterectomy. The success rate of nonremoval of the placenta with uterine artery embolization was 4/6 (67%). The intraoperative blood loss, blood transfusion requirements and operation times were lowest in the group with nonremoval of the placenta, although a higher secondary complication rate and a longer hospital stay followed.
Nonremoval of an abnormally invasive placenta at cesarean section and prophylactic postoperative uterine artery embolization are an alternative to elective cesarean hysterectomy.
评估 6 年内 3 种不同处理方式在异常性胎盘植入中的结局。
回顾性队列研究。
香港的一所三级医院。
在 39757 例分娩中，25 例剖宫产时发现异常性胎盘植入。
通过医院数据库和病历回顾进行病例识别。
出血量、输血需求、手术时间、住院时间、继发性产后出血和子宫内膜炎。
6 例患者采用胎盘原位保留加术后子宫动脉栓塞治疗，10 例患者采用切除术治疗，9 例患者采用直接剖宫产子宫切除术。子宫动脉栓塞保留胎盘的成功率为 4/6（67%）。虽然该组的继发性并发症发生率较高，且住院时间较长，但术中出血量、输血需求和手术时间均最低。
剖宫产时不切除异常性胎盘并预防性行术后子宫动脉栓塞术，是择期行剖宫产子宫切除术的一种替代方法。
