Matsuzaki Satoko, Matsuzaki Shinya, Ueda Yutaka, Tanaka Yusuke, Kakuda Mamoru, Kanagawa Takeshi, Kimura Tadashi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
AJP Rep. 2015 Apr;5(1):e6-e11. doi: 10.1055/s-0034-1395992. Epub 2014 Dec 18.
Objective Concurrent placenta previa and placenta accreta increase the risk of massive obstetric hemorrhage. Despite extensive research on the management of placenta previa (including placenta accreta, increta, and percreta), the number and quality of previous studies are limited. We present a case of placenta accreta requiring an induced second-trimester abortion because of premature rupture of the membranes (PROM). Study Design Case report and review of the literature. Results A 41-year-old female presented at 20 weeks of gestation with placenta previa and PROM. Ultrasonography revealed placenta accreta with multiple placental lacunae. She then developed massive hemorrhaging just prior to a planned termination of pregnancy. We performed a hysterectomy with the intent of preserving life because of the failure of the placenta to detach and blood loss totaling 4,500 mL. Conclusion Previous studies suggest that second-trimester pregnancy terminations in cases of placenta previa which are not complicated with placenta accreta do not have a particularly high risk of hemorrhage. However, together with our case, the literature suggests that placenta previa complicated with placenta accreta presents a significant risk of hemorrhage both during delivery and intraoperatively. Further reports are needed to evaluate the most appropriate treatment options.
前置胎盘并发胎盘植入会增加产科大出血的风险。尽管对前置胎盘（包括胎盘植入、穿透性胎盘植入和完全性胎盘植入）的管理进行了广泛研究，但既往研究的数量和质量有限。我们报告一例因胎膜早破（PROM）而需要引产的胎盘植入病例。研究设计：病例报告及文献综述。结果：一名41岁女性在妊娠20周时因前置胎盘和胎膜早破就诊。超声检查显示胎盘植入并伴有多个胎盘血窦。在计划终止妊娠前，她出现了大量出血。由于胎盘无法剥离且失血总量达4500毫升，为挽救生命我们实施了子宫切除术。结论：既往研究表明，未并发胎盘植入的前置胎盘患者在孕中期终止妊娠时出血风险并非特别高。然而，结合我们的病例，文献表明前置胎盘并发胎盘植入在分娩期间和手术中均存在显著出血风险。需要更多报告来评估最合适的治疗方案。
