Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
Department of Obstetrics and Gynaecology Monash, University Monash Medical Centre, Melbourne, Australia.
Arch Gynecol Obstet. 2019 Jun;299(6):1579-1586. doi: 10.1007/s00404-019-05136-6. Epub 2019 Apr 5.
This study explored the probability and outcome of delivery in women with placenta accreta spectrum (PAS) according to gestational age at delivery.
A retrospective cohort study among women with PAS who had cesarean section was conducted. The gestational week (gw) of delivery and estimated blood loss (EBL) were recorded. The proportion of urgent delivery beyond 32 gw and EBL in women with or without antepartum suspected diagnosis of placenta accreta was compared.
Totally, 180 women with PAS were enrolled. Of these, 54 (30.0%, 95% CI 23.8-37.1%) were delivered by urgent cesarean delivery and 126 (70.0%, 95% CI 62.9-76.2%) by elective cesarean section. The probability of emergent delivery was increased from 3.1 to 5.7% at 33-36 weeks, and increased by > 10% beyond 37 weeks. Among 121 antenatal suspected PAS patients, 25 (20.7%, 95% CI 14.4-28.7%) had emergency cesarean section, and 96 (79.3%, 95% CI 71.3-85.6%) experienced elective cesarean. The EBL of PAS in both emergent group (r = - 0.276, p = 0.044) and elective group (r = - 0.370, p < 0.001) was significantly decreased with gestational age progression. The antepartum hemorrhage increased the risk of urgent delivery [OR 2.54 (1.19, 5.44)] (p = 0.016), while PAS with antepartum diagnosis decreased the risk [OR 0.21 (0.10, 0.43)] (p < 0.001).
Although the incidence of emergency operation in PAS patients was increased at 32-36 gw, there was no significant difference among the groups. The decision of timing for pregnancy termination should be made cautiously. We recommend scheduled operation at around 36-37 gw. In serious cases, the termination time could be arranged as early as appropriate.
本研究旨在探讨胎盘植入谱系（PAS）患者根据分娩时的孕周（GA）分娩的可能性和结局。
对行剖宫产术的 PAS 患者进行回顾性队列研究。记录分娩时的 GA 和估计失血量（EBL）。比较有或无产前疑似胎盘植入诊断的患者中 32 GW 以上紧急分娩的比例和 EBL。
共纳入 180 例 PAS 患者，其中 54 例（30.0%，95%CI 23.8-37.1%）行紧急剖宫产，126 例（70.0%，95%CI 62.9-76.2%）行择期剖宫产。33-36 周时紧急分娩的可能性从 3.1%增加到 5.7%，37 周以上时增加超过 10%。在 121 例产前疑似 PAS 患者中，25 例（20.7%，95%CI 14.4-28.7%）行急诊剖宫产，96 例（79.3%，95%CI 71.3-85.6%）行择期剖宫产。在紧急分娩组（r=-0.276，p=0.044）和择期分娩组（r=-0.370，p<0.001）中，随着 GA 的进展，PAS 的 EBL 均显著减少。产前出血增加了紧急分娩的风险[OR 2.54（1.19，5.44）]（p=0.016），而产前诊断 PAS 降低了这种风险[OR 0.21（0.10，0.43）]（p<0.001）。
尽管 32-36 GW 时 PAS 患者的急诊手术发生率增加，但各组之间无显著差异。终止妊娠的时机应谨慎决定。我们建议在 36-37 GW 左右进行计划手术。在严重的情况下，可以安排在适当的时候提前终止妊娠。
