Sompolinsky Yishai, Yagel Simcha, Hochner-Celniker Drorith, Tal Zion
Obstetrics and Gynecology Department, Hadassah Mt. Scopus Medical Center, Jerusalem, Israel.
Faculty of Medicine, Hebrew University in Jerusalem, Israel.
Harefuah. 2020 Mar;159(3):186-190.
Placenta accrete spectrum (PAS) is a complicated obstetrical condition arising from abnormal implantation of the placenta into the myometrium. The placenta might partially or completely adhere to the myometrium and in rare cases invade adjacent organs (placenta percreta). The abnormal placentation might cause life-threatening hemorrhages during pregnancy and birth, increasing maternal and neonatal mortality and morbidity. Detachment of the placenta after delivery in PAS might be difficult and requires manual removal of the placenta as well as advanced surgical procedures in more serious cases. In the past decades, several studies have demonstrated that removing the uterus while the placenta is still in situ avoided massive hemorrhage. However, in some cases, preserving the uterus and the fertility of the patient is desired and therefore advanced surgical procedures have been developed. Several techniques for uterine preserving procedures have been described: conservative management - closing the uterus while the placenta is still in situ and complementary procedures to remove the placenta, using interventional radiology to reduce the blood supply to the uterus and other surgical approaches to reduce the blood supply to the uterus. In this article we will review the different methods for uterine preserving techniques in treating advanced cases of PAS and propose a surgical protocol for such a method we use in our medical center.
胎盘植入谱系疾病（PAS）是一种由胎盘异常植入子宫肌层引起的复杂产科病症。胎盘可能部分或完全附着于子宫肌层，在极少数情况下会侵入邻近器官（穿透性胎盘植入）。异常胎盘植入可能在妊娠和分娩期间导致危及生命的出血，增加孕产妇和新生儿的死亡率及发病率。PAS患者分娩后胎盘剥离可能困难，在更严重的情况下需要人工剥离胎盘以及采取先进的外科手术。在过去几十年中，多项研究表明，在胎盘仍原位时切除子宫可避免大出血。然而，在某些情况下，患者希望保留子宫和生育能力，因此已开发出先进的外科手术。已经描述了几种保留子宫的手术技术：保守处理——在胎盘仍原位时缝合子宫，并采用辅助手术切除胎盘，利用介入放射学减少子宫血供以及采用其他外科方法减少子宫血供。在本文中，我们将回顾治疗晚期PAS病例时保留子宫技术的不同方法，并提出我们医疗中心使用的此类方法的手术方案。
