Rac Martha W F, Wells C Edward, Twickler Diane M, Moschos Elysia, McIntire Donald D, Dashe Jodi S
Departments of Obstetrics and Gynecology and Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
Obstet Gynecol. 2015 Apr;125(4):808-813. doi: 10.1097/AOG.0000000000000674.
To evaluate the incidence of vaginal bleeding in women with placenta accreta according to gestational age at delivery.
This is a retrospective cohort study of women with prior cesarean delivery and persistent placenta previa delivered at our institution between December 1997 and December 2011. Diagnosis of invasion was based on hysterectomy performed for an abnormally adherent placenta with histologic confirmation. Suspicion for invasion was based on the impression of the attending physician at the time of ultrasonography. Records were reviewed to identify indication for delivery and estimated blood loss. Statistical analyses were performed using Student's t test, χ2 test, and Mantel-Haenszel and Jonckheere-Terpstra tests for trend.
Of 216 women with prior cesarean delivery and persistent previa, 65 (30%) required cesarean hysterectomy and had histologic confirmation of invasion. Urgent delivery for bleeding was performed in 20% of these pregnancies (13/65). Delivery for bleeding decreased significantly with advancing gestation (P=.001). In our series, 71% with accreta were delivered at 36 weeks of gestation or greater with delivery for bleeding in five (11%), and estimated blood loss was not increased in these pregnancies. Of 79 women with ultrasonographic suspicion for accreta, the incidence of vaginal bleeding prompting urgent delivery also decreased with advancing gestation (P<.001).
Likelihood of vaginal bleeding necessitating delivery declined with advancing gestation in pregnancies with placenta accreta as did blood loss. Most were delivered at 36 weeks of gestation or greater, nearly 90% in the absence of bleeding complications. Thus, although preterm delivery is an important consideration when placenta accreta is suspected, our findings support individualizing delivery planning.
根据分娩时的孕周评估胎盘植入女性的阴道出血发生率。
这是一项对1997年12月至2011年12月在我院分娩的有剖宫产史且持续性前置胎盘的女性进行的回顾性队列研究。侵袭的诊断基于因胎盘异常粘连行子宫切除术并经组织学证实。侵袭的怀疑基于超声检查时主治医生的印象。查阅记录以确定分娩指征和估计失血量。采用Student's t检验、χ2检验以及Mantel-Haenszel和Jonckheere-Terpstra趋势检验进行统计分析。
在216例有剖宫产史且持续性前置胎盘的女性中，65例（30%）需要行剖宫产子宫切除术且有侵袭的组织学证实。这些妊娠中有20%（13/65）因出血行紧急分娩。随着孕周增加，因出血而进行的分娩显著减少（P = 0.001）。在我们的系列研究中，71%的胎盘植入患者在妊娠36周及以后分娩，其中5例（11%）因出血分娩，这些妊娠的估计失血量并未增加。在79例超声怀疑有胎盘植入的女性中，因阴道出血促使紧急分娩的发生率也随着孕周增加而降低（P < 0.001）。
胎盘植入妊娠中因阴道出血而需要分娩的可能性随着孕周增加而下降，失血量也是如此。大多数患者在妊娠36周及以后分娩，近90%没有出血并发症。因此，尽管怀疑胎盘植入时早产是一个重要考虑因素，但我们的研究结果支持分娩计划个体化。
