Kutuk Mehmet S, Ak Mehmet, Ozgun Mahmut T
Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Int J Gynaecol Obstet. 2018 Mar;140(3):338-344. doi: 10.1002/ijgo.12308. Epub 2017 Sep 18.
To compare different treatment methods in the management of placenta accreta spectrum (PAS) disorders.
In a retrospective cohort study, medical records were retrieved for patients who underwent elective surgery at 24 weeks of pregnancy or more after a diagnosis of PAS disorder (creta, increta, or percreta) at a center in Turkey between May 2, 2010, and August 10, 2016. The final analysis included patients whose diagnosis was confirmed intraoperatively and for whom complete data were available. Patients were divided into three groups: group 1 included those who underwent hysterectomy without placental removal, group 2 included patients whose placenta was left in situ, and group 3 included those who underwent placental removal and conservative surgery.
Among 79 included patients (33 creta, 18 increta, 28 percreta), 27 (34%) were in group 1, 15 (19%) in group 2, and 37 (47%) in group 3. Total blood loss and the amounts of blood products transfused were lowest in group 2; significant differences between groups were noted (all P ≤ 0.001). Surgical complication rates were similar between groups (4/27 [15%], 1/15 [7%], and 11/37 [30%], respectively; P=0.119). Overall uterine preservation rates were not significantly different between groups 2 and 3 (14/15 [93%] vs 33/37 [89%]; P>0.99).
Leaving the placenta in situ could become the treatment of choice for PAS disorders.
比较胎盘植入谱系障碍（PAS）的不同治疗方法。
在一项回顾性队列研究中，检索了2010年5月2日至2016年8月10日期间在土耳其某中心诊断为PAS障碍（粘连性胎盘、植入性胎盘或穿透性胎盘）后在妊娠24周及以上接受择期手术患者的病历。最终分析纳入术中诊断得到证实且有完整数据的患者。患者分为三组：第1组包括那些未取出胎盘而行子宫切除术的患者，第2组包括胎盘原位保留的患者，第3组包括那些进行了胎盘切除及保守手术的患者。
在纳入的79例患者（33例粘连性胎盘、18例植入性胎盘、28例穿透性胎盘）中，第1组有27例（34%），第2组有15例（19%），第3组有37例（47%）。第2组的总失血量和输注的血制品量最低；组间差异有统计学意义（均P≤0.001）。各组手术并发症发生率相似（分别为4/27 [15%]、1/15 [7%]和11/37 [30%]；P = 0.119）。第2组和第3组的总体子宫保留率差异无统计学意义（14/15 [93%] 对33/37 [89%]；P>0.99）。
胎盘原位保留可成为PAS障碍的首选治疗方法。
