Zhang Chunhua, Li Hongyan, Zuo Changting, Wang Xietong
Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan, China.
Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, China.
J Obstet Gynaecol Res. 2018 May;44(5):907-913. doi: 10.1111/jog.13590. Epub 2018 Feb 27.
To evaluate the efficacy of conservative treatment with methotrexate against placenta increta by two different routes of administration through retrospective analysis.
A total of 54 women diagnosed with placenta increta after vaginal delivery were enrolled in this retrospective study. The participants accepted conservative management with methotrexate through either intravenous injection or local multi-point injection under ultrasound guidance. The treatment was considered effective if no hysterectomy was mandatory during the follow-up period.
Out of the 54 cases, 21 patients were treated with methotrexate intravenously (group 1), and 33 patients received local multi-point injection to the placenta increta under ultrasound guidance (group 2). No maternal death occurred. In group 1, 10 patients expelled the placentas spontaneously, 7 patients underwent uterine curettage and 4 patients underwent hysterectomy for uncontrollable post-partum hemorrhage and infection. In group 2, 25 patients expelled placentas spontaneously and 8 patients underwent uterine curettage with no incidence of hysterectomy. The success rate in group 1 and group 2 was 17/21 and 33/33, respectively. The average time of the spontaneous placenta expulsion was 79.13 ± 29.87 days in group 1 and 42.42 ± 31.83 days in group 2.
Local multi-point methotrexate injection under ultrasound guidance is a better alternative for patients with placenta increta, especially for preserving fertility.
通过回顾性分析评估甲氨蝶呤两种不同给药途径保守治疗胎盘植入的疗效。
本回顾性研究纳入了54例阴道分娩后诊断为胎盘植入的女性。参与者接受了甲氨蝶呤保守治疗，通过静脉注射或在超声引导下局部多点注射。如果在随访期间无需行子宫切除术，则认为治疗有效。
54例患者中，21例患者接受甲氨蝶呤静脉注射治疗（第1组），33例患者在超声引导下接受胎盘植入局部多点注射治疗（第2组）。无孕产妇死亡。第1组中，10例患者自然排出胎盘，7例患者接受了刮宫术，4例患者因产后出血和感染无法控制而行子宫切除术。第2组中，25例患者自然排出胎盘，8例患者接受了刮宫术，无子宫切除病例。第1组和第2组的成功率分别为17/21和33/33。第1组自然排出胎盘的平均时间为79.13±29.87天，第2组为42.42±31.83天。
超声引导下局部多点注射甲氨蝶呤是胎盘植入患者更好的治疗选择，尤其是对于保留生育功能而言。
