Cheng Katherine K N, Lee Menelik M H
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Jordan, Hong Kong.
Hong Kong Med J. 2015 Dec;21(6):511-7. doi: 10.12809/hkmj154599. Epub 2015 Nov 6.
To identify the incidence of morbidly adherent placenta in the context of a rising caesarean delivery rate within a single institution in the past 15 years, and to determine the contribution of morbidly adherent placenta to the incidence of massive postpartum haemorrhage requiring hysterectomy.
A regional obstetric unit in Hong Kong.
Patients with a morbidly adherent placenta with or without previous caesarean section scar from 1999 to 2013.
A total of 39 patients with morbidly adherent placenta were identified during 1999 to 2013. The overall rate of morbidly adherent placenta was 0.48/1000 births, which increased from 0.17/1000 births in 1999-2003 to 0.79/1000 births in 2009-2013. The rate of morbidly adherent placenta with previous caesarean section scar and unscarred uterus also increased significantly. Previous caesarean section (odds ratio=24) and co-existing placenta praevia (odds ratio=585) remained the major risk factors for morbidly adherent placenta. With an increasing rate of morbidly adherent placenta, more patients had haemorrhage with a consequent increased need for peripartum hysterectomy. No significant difference in the hysterectomy rate of morbidly adherent placenta in caesarean scarred uterus (19/25) compared with unscarred uterus (8/14) was noted. This may have been due to increased detection of placenta praevia by ultrasound and awareness of possible adherent placenta in the scarred uterus, as well as more invasive interventions applied to conserve the uterus.
Presence of a caesarean section scar remained the main risk factor for morbidly adherent placenta. Application of caesarean section should be minimised, especially in those who wish to pursue another future pregnancy, to prevent the subsequent morbidity consequent to a morbidly adherent placenta, in particular, massive postpartum haemorrhage and hysterectomy.
确定在过去15年中，单一机构剖宫产率上升背景下凶险性前置胎盘的发生率，并确定凶险性前置胎盘对需要行子宫切除术的产后大出血发生率的影响。
香港一家区域产科单位。
1999年至2013年患有凶险性前置胎盘且有或无既往剖宫产瘢痕的患者。
1999年至2013年共识别出39例凶险性前置胎盘患者。凶险性前置胎盘的总体发生率为0.48/1000例分娩，从1999 - 2003年的0.17/1000例分娩增加到2009 - 2013年的0.79/1000例分娩。有既往剖宫产瘢痕和无瘢痕子宫的凶险性前置胎盘发生率也显著增加。既往剖宫产（比值比 = 24）和并存前置胎盘（比值比 = 585）仍然是凶险性前置胎盘的主要危险因素。随着凶险性前置胎盘发生率的增加，更多患者发生出血，因此对围产期子宫切除术的需求增加。在剖宫产瘢痕子宫（19/25）与无瘢痕子宫（8/14）中，凶险性前置胎盘的子宫切除率无显著差异。这可能是由于超声对前置胎盘的检测增加，以及对瘢痕子宫中可能存在粘连胎盘的认识提高，同时采取了更多的侵入性干预措施来保留子宫。
剖宫产瘢痕仍然是凶险性前置胎盘的主要危险因素。应尽量减少剖宫产的应用，尤其是对于那些希望未来再次怀孕的患者，以预防凶险性前置胎盘带来的后续并发症，特别是产后大出血和子宫切除术。
