胎盘植入的治疗与结局
Morbidly adherent placenta treatments and outcomes.
作者信息
Bailit Jennifer L, Grobman William A, Rice Madeline Murguia, Reddy Uma M, Wapner Ronald J, Varner Michael W, Leveno Kenneth J, Iams Jay D, Tita Alan T N, Saade George, Rouse Dwight J, Blackwell Sean C
机构信息
Departments of Obstetrics and Gynecology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio; Prentice Women's Hospital, Northwestern University, Chicago, Illinois; Columbia University, New York, New York; the University of Utah Health Sciences Center, Salt Lake City, Utah; the University of Texas Southwestern Medical Center, Dallas, the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas; The Ohio State University, Columbus, Ohio; the University of Alabama at Birmingham, Birmingham, Alabama; Brown University, Providence, Rhode Island; The George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
出版信息
Obstet Gynecol. 2015 Mar;125(3):683-689. doi: 10.1097/AOG.0000000000000680.
OBJECTIVE
To describe recent maternal and neonatal delivery outcomes among women with a morbidly adherent placenta in major centers across the United States.
METHODS
This study reviewed a cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011 from the Assessment of Perinatal EXcellence data set. All cases of morbidly adherent placenta were identified. Maternal demographics, procedures undertaken, and maternal and neonatal outcomes were analyzed.
RESULTS
There were 158 women with a morbidly adherent placenta (1/731 births, 95% confidence interval 1/632-866). Eighteen percent of women with a morbidly adherent placenta were nulliparous and 37% had no prior cesarean delivery. Only 53% (84/158) were suspected to have a morbidly adherent placenta before delivery. Women with a prenatally suspected morbidly adherent placenta experienced large blood loss (33%), hysterectomy (92%), and intensive care unit admission (39%) compared with 19%, 45%, and 22%, respectively, in those not suspected prenatally to have a morbidly adherent placenta (P<.05 for all).
CONCLUSION
Eighteen percent of women with a morbidly adherent placenta were nulliparous. Half of the morbidly adherent placenta cases were suspected before delivery and outcomes were poorer in this group, probably because the more clinically significant morbidly adherent placentas are more likely to be suspected before delivery.
LEVEL OF EVIDENCE
: II.
目的
描述美国各大中心患有胎盘植入的孕妇及其新生儿近期的分娩结局。
方法
本研究回顾了2008年3月至2011年2月期间在美国25家医院出生的115,502名妇女及其新生儿的队列，数据来自围产期卓越评估数据集。识别出所有胎盘植入病例。分析产妇人口统计学、所采取的手术以及产妇和新生儿结局。
结果
有158名妇女患有胎盘植入（1/731例分娩，95%置信区间1/632 - 866）。胎盘植入妇女中有18%为初产妇，37%既往无剖宫产史。分娩前仅53%（84/158）的妇女被怀疑患有胎盘植入。产前怀疑有胎盘植入的妇女发生大出血（33%）、子宫切除术（92%）和入住重症监护病房（39%），而未产前怀疑有胎盘植入的妇女分别为19%、45%和22%（所有P<0.05）。
结论
胎盘植入妇女中有18%为初产妇。一半的胎盘植入病例在分娩前被怀疑，且该组结局较差，可能是因为临床上更严重的胎盘植入更有可能在分娩前被怀疑。
证据级别
II级。
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