Obstet Gynecol. 2018 Dec;132(6):1519-1521. doi: 10.1097/AOG.0000000000002984.
Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. The most favored hypothesis regarding the etiology of placenta accreta spectrum is that a defect of the endometrial-myometrial interface leads to a failure of normal decidualization in the area of a uterine scar, which allows abnormally deep placental anchoring villi and trophoblast infiltration. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. Although ultrasound evaluation is important, the absence of ultrasound findings does not preclude a diagnosis of placenta accreta spectrum; thus, clinical risk factors remain equally important as predictors of placenta accreta spectrum by ultrasound findings. There are several risk factors for placenta accreta spectrum. The most common is a previous cesarean delivery, with the incidence of placenta accreta spectrum increasing with the number of prior cesarean deliveries. Antenatal diagnosis of placenta accreta spectrum is highly desirable because outcomes are optimized when delivery occurs at a level III or IV maternal care facility before the onset of labor or bleeding and with avoidance of placental disruption. The most generally accepted approach to placenta accreta spectrum is cesarean hysterectomy with the placenta left in situ after delivery of the fetus (attempts at placental removal are associated with significant risk of hemorrhage). Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. In addition, established infrastructure and strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place, and access to a blood bank capable of employing massive transfusion protocols should help guide decisions about delivery location.(Table is included in full-text article.).
胎盘植入谱系疾病，以前称为粘连性胎盘，是指胎盘的病理附着范围，包括胎盘植入、胎盘穿透和胎盘粘连。胎盘植入谱系疾病病因的最流行假说认为，子宫内膜-子宫肌层界面的缺陷导致子宫瘢痕部位的正常蜕膜化失败，这使得胎盘异常深入地锚定于绒毛和滋养层浸润。由于严重且有时危及生命的出血，产妇发病率和死亡率可能会发生，这通常需要输血。尽管超声评估很重要，但没有超声发现并不能排除胎盘植入谱系疾病的诊断；因此，临床危险因素与超声发现同样重要，可作为胎盘植入谱系疾病的预测因素。胎盘植入谱系疾病有几个危险因素。最常见的是既往剖宫产史，随着剖宫产次数的增加，胎盘植入谱系疾病的发生率也随之增加。胎盘植入谱系疾病的产前诊断是非常理想的，因为在分娩前或出血前在三级或四级产妇保健机构分娩，并避免胎盘破裂，可以优化结局。胎盘植入谱系疾病最普遍接受的方法是在胎儿分娩后行剖宫产子宫切除术，胎盘留在原位（试图取出胎盘与严重出血风险相关）。最佳管理涉及一个标准化的方法，有一个熟悉胎盘植入谱系疾病管理的全面多学科护理团队。此外，应建立基础设施和强大的护理领导团队，习惯于管理高水平产后出血，并能够获得能够实施大量输血方案的血库，这有助于指导分娩地点的决策。（全文包括表格。）
