对于合并胎盘植入的双胎妊娠，我们应采取什么措施来优化结局？病例报告。
What should we do to optimise outcome in twin pregnancy complicated with placenta percreta? A case report.
作者信息
Atalay Mehmet Aral, Oz Atalay Fatma, Cetinkaya Demir Bilge
机构信息
Department of Obstetrics and Gynecology, Uludag University School of Medicine, Bursa, Turkey.
Uludağ Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı, Görükle, 16059, Bursa, Turkey.
出版信息
BMC Pregnancy Childbirth. 2015 Nov 5;15:289. doi: 10.1186/s12884-015-0714-x.
BACKGROUND
Patients with morbidly adherent placenta (MAP) are under risk of massive bleeding. It readily necessitates very complicated surgery and massive blood transfusion, and even leads to mortality. Cesarean hysterectomy (CH) is the procedure that is acknowledged worldwide, since it helps to minimize complications.
CASE PRESENTATION
A patient with dichorionic twin pregnancy underwent to cesarean section (CS) due to preliminary diagnosis of placenta percreta at her 35(th) week of pregnancy. Both of the placentas were left in situ. The patient admitted with signs of infection. Emergency total abdominal hysterectomy was performed 7 weeks after CS. In the course of hysterectomy, 3 units of erythrocyte suspension and 2 units of fresh frozen plasma were transferred, whereas none was required during CS.
CONCLUSION
Abandoning placenta in situ seems to be a logical alternative to the CH in patients with placenta percreta in order to minimize complications related to massive blood transfusion and surgical technique. However, it appears to increase maternal morbidity due to maternal infection in twin pregnancy.
背景
胎盘植入患者面临大出血风险。这很容易需要非常复杂的手术和大量输血，甚至导致死亡。剖宫产子宫切除术（CH）是全球公认的手术方式，因为它有助于将并发症降至最低。
病例报告
一名双绒毛膜双胎妊娠患者在妊娠35周时因初步诊断为穿透性胎盘而接受剖宫产（CS）。两个胎盘均留在原位。患者因感染迹象入院。剖宫产术后7周进行了急诊全腹子宫切除术。在子宫切除术中，输注了3单位红细胞悬液和2单位新鲜冰冻血浆，而剖宫产术中未输血。
结论
对于穿透性胎盘患者，为了将与大量输血和手术技术相关的并发症降至最低，原位保留胎盘似乎是剖宫产子宫切除术的合理替代方案。然而，这似乎会因双胎妊娠的母体感染而增加母体发病率。
Zotero 插件