Wang Yeou-Lih, Weng Shih-Shien, Huang Wen-Chu
Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan.
Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2019 Jan;58(1):10-14. doi: 10.1016/j.tjog.2018.11.032.
Placenta accreta is a potentially life-threatening condition that may complicate a first-trimester abortion in rare occasions, and it can be difficult to recognize. We reviewed the literature in PubMed-indexed English journals through August 2018 for first-trimester postabortal placenta accreta, after which 19 articles and 23 case reports were included. The risk factors for the development of abnormal placentation are previous cesarean section (87%), previous history of uterine curettage (43.5%), and previous history of surgical evacuation of a retained placenta (4.3%). Ten patients (43.5%) had an advanced age (≧35 years). Most patients clinically presented with vaginal bleeding, ranging from intermittent or irregular bleeding, persistent bleeding, and profuse or massive bleeding. The onset of symptoms might be during the intra- or immediate postoperative period. Some patients had delayed symptoms 1 week to 2 years postoperatively. Conservative management may be attempted as the primary rescue, including uterine artery embolization (UAE), transcatheter arterial chemoembolization (TACE) with dactinomycin, and laparoscopic hysterotomy with placental tissue removal. However, most reports in the literature suggested either abdominal or laparoscopic hysterectomy as the definitive treatment for first-trimester postabortal placenta accreta. High index of clinical suspicion with anticipation of placenta accreta in early pregnancy is highly essential for timely diagnosis, providing the physician better opportunities to promptly manage this emergent condition and improve outcomes.
胎盘植入是一种可能危及生命的情况，在极少数情况下可能使早期流产复杂化，且可能难以识别。我们检索了截至2018年8月PubMed索引的英文期刊中有关早期流产后胎盘植入的文献，之后纳入了19篇文章和23例病例报告。异常胎盘形成的危险因素包括既往剖宫产史（87%）、既往子宫刮宫史（43.5%）和既往胎盘残留手术清除史（4.3%）。10例患者（43.5%）年龄较大（≧35岁）。大多数患者临床表现为阴道出血，范围从间歇性或不规则出血、持续性出血到大量或大出血。症状可能在术中或术后即刻出现。一些患者术后1周至2年出现延迟症状。可尝试将保守治疗作为主要抢救措施，包括子宫动脉栓塞术（UAE）、放线菌素经导管动脉化疗栓塞术（TACE）以及腹腔镜子宫切开术并清除胎盘组织。然而，文献中的大多数报告建议将腹部或腹腔镜子宫切除术作为早期流产后胎盘植入的确定性治疗方法。对早期妊娠时胎盘植入保持高度临床怀疑指数对于及时诊断至关重要，这为医生提供了更好的机会来迅速处理这种紧急情况并改善结局。
