Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
Arch Gynecol Obstet. 2021 Jan;303(1):61-68. doi: 10.1007/s00404-020-05721-0. Epub 2020 Aug 18.
Abnormally invasive placenta (AIP) is often associated with high maternal morbidity. In surgical treatment, caesarean hysterectomy or partial uterine resection may lead to high perioperative maternal blood loss. A conservative treatment by leaving the placenta in utero after caesarean delivery of the baby is an option to preserve fertility and to reduce peripartum hysterectomy-related morbidity. Nevertheless, due to increased placental coagulation activity as well as consumption of clotting factors, a disseminated intravascular coagulation (DIC)-like state with secondary late postpartum bleeding can occur.
Systematic review after the presentation of a case of conservative management of placenta percreta with secondary partial uterine wall resection due to vaginal bleeding, complicated by local hyperfibrinolysis and consecutive systemic decrease in fibrinogen levels.
Systematic PubMed database search was done until August 2019 without any restriction of publication date or journal RESULTS: Among 58 publications, a total of 11 reported on DIC-like symptoms in the conservative management of AIP, in the median on day 59 postpartum. In most cases, emergency hysterectomy was performed, which led to an almost immediate normalization of coagulation status but was accompanied with high maternal blood loss. In two cases, fertility-preserving conservative management could be continued after successful medical therapy.
Based on these results, we suggest routinely monitoring of the coagulation parameters next to signs of infection in the postpartum check-ups during conservative management of AIP. Postpartum tranexamic acid oral dosage should be discussed when fibrinogen levels are decreasing and D-Dimers are increasing.
异常侵袭性胎盘（AIP）常伴有较高的产妇发病率。在手术治疗中，剖宫产子宫切除术或部分子宫切除术可能导致围手术期产妇大量失血。在剖宫产分娩婴儿后将胎盘留在子宫内是一种保留生育能力和降低与围产期子宫切除术相关发病率的保守治疗方法。然而，由于胎盘凝血活性增加以及凝血因子消耗，可能会发生弥漫性血管内凝血（DIC）样状态，随后出现产后晚期出血。
在胎盘植入保守管理的病例报告后进行系统回顾，该病例因阴道出血行部分子宫壁切除术，伴有局部纤维蛋白溶解过度和随后的纤维蛋白原水平系统性下降。
对PubMed 数据库进行系统搜索，截至 2019 年 8 月，未对出版物日期或期刊进行任何限制。
在 58 篇出版物中，共有 11 篇报道了 AIP 保守管理中出现 DIC 样症状，中位数发生在产后第 59 天。在大多数情况下，紧急行子宫切除术，这导致凝血状态几乎立即恢复正常，但伴有大量产妇失血。在 2 例中，在成功的药物治疗后可以继续保留生育能力的保守治疗。
基于这些结果，我们建议在 AIP 保守管理的产后检查中，除了感染迹象外，还应常规监测凝血参数。当纤维蛋白原水平下降和 D-二聚体升高时，应讨论产后口服氨甲环酸的剂量。
