胎盘植入谱系（PAS）疾病：埃及米尼亚一家三级转诊医院不同管理策略的发生率、风险因素和结局：一项前瞻性研究。
Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study.
机构信息
Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt.
Department of Anaesthesia and Intensive care, Faculty of Medicine, Minia University, Minia, Egypt.
出版信息
BMC Pregnancy Childbirth. 2019 Aug 27;19(1):313. doi: 10.1186/s12884-019-2466-5.
BACKGROUND
Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt.
METHODS
This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A), (n = 38) underwent cesarean hysterectomy, group (B), (n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C), (n = 16): the placenta was left in place.
RESULTS
The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate.
CONCLUSIONS
The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling.
TRIAL REGISTRATION
Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .
背景
胎盘植入谱系（PAS）疾病的发病率、发病率和死亡率不断上升，已成为严重威胁生命的问题。多项研究试图确定 PAS 疾病的危险因素。PAS 疾病的理想治疗方法仍存在争议。本研究的目的是评估 PAS 疾病的发生率和危险因素，并在埃及米尼亚的一家三级转诊医院比较不同的治疗策略。
方法
本前瞻性研究纳入了 2017 年 1 月至 2018 年 8 月期间在埃及米尼亚妇产医院因 PAS 疾病入院的 102 名妇女。这些病例根据治疗方法分为三组：A 组（n=38）行剖宫产子宫切除术；B 组（n=48）行剖宫产术（CS），宫颈反转，双侧子宫动脉结扎；C 组（n=16）：胎盘保留。
结果
研究期间 PAS 疾病的发生率为 9/1000 例产妇（0.91%）。病例的平均年龄为 32.4±4.2 岁，60%的产妇有≥3 次分娩，82%的产妇有≥2 次剖宫产史。此外，1/3 的患者有胎盘前置史。A 组的估计失血量（EBL）和输血明显高于其他组。C 组的平均住院时间较长。A 组的并发症发生率明显较高。
结论
PAS 疾病的发生率为 0.91%。产妇年龄>32 岁、既往剖宫产史（≥2 次）、多胎妊娠（≥3 次）和既往胎盘前置史是危险因素。PAS 疾病的治疗应个体化。对于已完成生育的 PAS 疾病患者，应行剖宫产子宫切除术。对于有局灶性胎盘植入且有生育要求的低产次患者，将宫颈作为填塞物联合双侧子宫动脉结扎似乎是一种安全的替代子宫切除术的方法。对于有弥漫性胎盘植入且希望保留子宫的患者，可以在适当咨询后选择保留胎盘，以达到保守治疗的目的。
试验注册
2015 年 10 月 28 日注册，ClinicalTrials.gov NCT02590484。
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