Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Hofheimer Hall, 825 Fairfax Ave, Suite 310, Norfolk, VA 23507.
Semin Perinatol. 2013 Oct;37(5):359-64. doi: 10.1053/j.semperi.2013.06.014.
Morbidly adherent placenta, which describes placenta accreta, increta, and percreta, implies an abnormal implantation of the placenta into the uterine wall. The incidence of placenta accreta has increased significantly over the past several decades, with the main risk factors include prior cesarean section and placental previa. Sonographic markers of placenta accreta can be present as early as the first trimester and include a low uterine implantation of a gestational sac, multiple vascular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and abnormality of the uterine serosa-bladder interface, among others. Ultrasound has high sensitivity and specificity for the diagnosis of placenta accreta and MRI should be reserved for rare cases in which the ultrasound is non-diagnostic. The optimum time for planned delivery for a patient with placenta accreta is around 34-35 weeks following a course of corticosteroid injection. The successful management of placenta accreta includes a multidisciplinary care team approach with the successful management relying heavily on the prenatal diagnosis of this entity and preparing for the surgical management in a multidisciplinary approach by assuring the most skilled team is available for those patients.
胎盘粘连，描述了胎盘植入、胎盘植入和胎盘穿透，意味着胎盘异常植入子宫壁。过去几十年，胎盘粘连的发病率显著增加，主要危险因素包括剖宫产史和前置胎盘。胎盘粘连的超声标志物早在孕早期就可出现，包括孕囊在子宫下段的低着床、胎盘内多个血管腔隙、正常低回声胎盘后间隙的缺失以及子宫浆膜-膀胱界面的异常等。超声对胎盘粘连的诊断具有较高的灵敏度和特异性，对于超声检查无诊断价值的罕见病例，应保留 MRI 检查。对于胎盘粘连患者，计划分娩的最佳时间是在接受皮质类固醇注射后约 34-35 周。胎盘粘连的成功管理包括多学科护理团队的方法，成功管理主要依赖于该疾病的产前诊断，并通过确保最熟练的团队可用于这些患者，以多学科的方法为手术管理做好准备。
