Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Al-Zahraa Hospital University Medical Center, Lebanese University, Beirut, Lebanon.
Placenta. 2020 Jun;95:44-52. doi: 10.1016/j.placenta.2020.04.005. Epub 2020 Apr 26.
Placenta accreta spectrum (PAS) is a major obstetrical problem whose incidence is rising. Current guidelines recommend screening of all women with placenta previa and risk factors for PAS between 20 and 24 weeks. Risk factors, diagnosis, and management of previa PAS are well established, but an apparently normal location of the placenta does not exclude PAS. Literature data are scarce on uterine body PAS, which carries a high risk of maternal and neonatal adverse outcome, but is still easily missed on prenatal ultrasound. We conducted a comprehensive review to identify possible risk factors, clinical presentations, and diagnostic modalities of uterine PAS. A total of 133 cases were found during a 70-year period (1949-2019). The vast majority of them presented with signs of uterine rupture, even prior to the viability threshold of 24 weeks (up to 45%). Major risk factors included previous cesarean delivery, uterine curettage, uterine surgery, Asherman's syndrome, manual removal of the placenta, endometritis, high parity, young maternal age, in vitro fertilization, radiotherapy, uterine artery embolization, and uterine leiomyoma. Diagnosis was pre-symptomatic in only 3% of cases. Future studies should differentiate between previa PAS and uterine body PAS.
胎盘植入谱系疾病（PAS）是一种主要的产科问题，其发病率正在上升。目前的指南建议在 20 至 24 周时对所有前置胎盘和 PAS 危险因素的妇女进行筛查。前置胎盘 PAS 的危险因素、诊断和管理已经得到很好的确立，但胎盘的位置正常并不排除 PAS。关于胎盘位于子宫体部的 PAS 的文献数据很少，它会使产妇和新生儿的不良结局风险很高，但在产前超声检查中仍然很容易被忽视。我们进行了全面的综述，以确定 PAS 子宫体部的可能危险因素、临床表现和诊断方式。在 70 年的时间里（1949 年至 2019 年）共发现了 133 例 PAS 子宫体部。其中绝大多数表现为子宫破裂的迹象，甚至在 24 周的存活阈值之前（高达 45%）。主要的危险因素包括剖宫产史、刮宫术、子宫手术、Asherman 综合征、人工胎盘剥离、子宫内膜炎、多胎妊娠、产妇年龄较小、体外受精、放疗、子宫动脉栓塞和子宫肌瘤。只有 3%的病例是在出现症状前诊断的。未来的研究应区分前置胎盘 PAS 和 PAS 子宫体部。
