Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK.
Department of Obstetrics and Gynecology, South General Hospital, Stockholm, Sweden.
Am J Obstet Gynecol. 2019 Jun;220(6):511-526. doi: 10.1016/j.ajog.2019.02.054. Epub 2019 Mar 5.
The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.
全世界异常胎盘植入的发病率随着剖宫产率的增加而迅速上升。它是一种异质性疾病，具有较高的孕产妇发病率和死亡率，在分娩过程中存在特定的挑战。由于其罕见性，大多数临床医生难以发展个体化专业知识。国际异常胎盘植入学会旨在提高临床医生对这种棘手疾病的管理理解和技能。通过汇集不同医疗保健系统中获得的知识、经验和专业知识，该学会旨在改善全球异常胎盘植入女性的结局。本研究采用改良 Delphi 技术提出了以下建议，这些建议基于最佳现有证据。每个建议的证据基础都使用正式的分级系统呈现。选择的主题针对异常胎盘植入的分娩期管理方面最相关的问题，涉及与临床相关的结局，包括以下内容：卓越中心的定义；产前住院的要求；产前血红蛋白优化；分娩的最佳妊娠龄；产前皮质类固醇给药；术前膀胱镜检查、输尿管支架和预防性骨盆动脉球囊导管的使用；手术时的产妇体位；皮肤切口类型；子宫切口位置；术中超声的使用；催产素的预防性给药；术中诊断的最佳方法；期待治疗的使用；期待治疗的辅助治疗；局部手术切除的使用；子宫切除术的类型；延迟性子宫切除术的使用；治疗危及生命的出血的术中措施；以及保守治疗后的生育能力。
