Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Arch Gynecol Obstet. 2021 Jun;303(6):1451-1460. doi: 10.1007/s00404-020-05875-x. Epub 2020 Dec 7.
Placenta accreta spectrum (PAS) disorders can cause major intrapartum haemorrhage. The optimal management approach is not yet defined. We analysed available cases from a tertiary perinatal centre to compare the outcome of different individual management strategies.
A monocentric retrospective analysis was performed in patients with clinically confirmed diagnosis of PAS between 07/2012 and 12/2019. Electronic patient and ultrasound databases were examined for perinatal findings, peripartum morbidity including blood loss and management approaches such as (1) vaginal delivery and curettage, (2) caesarean section with placental removal versus left in situ and (3) planned, immediate or delayed hysterectomy.
46 cases were identified with an incidence of 2.49 per 1000 births. Median diagnosis of placenta accreta (56%), increta (39%) or percreta (4%) was made in 35 weeks of gestation. Prenatal detection rate was 33% for all cases and 78% for placenta increta. 33% showed an association with placenta praevia, 41% with previous caesarean section and 52% with previous curettage. Caesarean section rate was 65% and hysterectomy rate 39%. In 9% of the cases, the placenta primarily remained in situ. 54% of patients required blood transfusion. Blood loss did not differ between cases with versus without prenatal diagnosis (p = 0.327). In known cases, an attempt to remove the placenta did not show impact on blood loss (p = 0.417).
PAS should be managed in an optimal setting and with a well-coordinated team. Experience with different approaches should be proven in prospective multicentre studies to prepare recommendations for expected and unexpected need for management.
胎盘植入谱系（PAS）疾病可导致严重的分娩期出血。目前尚未明确最佳的管理方法。我们分析了一家三级围产中心的现有病例，以比较不同个体化管理策略的结局。
对 2012 年 7 月至 2019 年 12 月期间临床确诊为 PAS 的患者进行单中心回顾性分析。对电子患者和超声数据库进行检查，以获取围产期发现、围产期发病率（包括失血量）以及管理方法（1）阴道分娩和刮宫，（2）剖宫产伴胎盘去除与原位保留，（3）计划性、即刻或延迟子宫切除术。
共确定 46 例 PAS 患者，发病率为每 1000 例分娩 2.49 例。中位胎盘植入（56%）、胎盘侵入（39%）或胎盘穿透（4%）诊断时间为 35 孕周。所有病例的产前检出率为 33%，胎盘侵入的检出率为 78%。33%的病例与胎盘前置有关，41%的病例与既往剖宫产史有关，52%的病例与既往刮宫史有关。剖宫产率为 65%，子宫切除术率为 39%。9%的病例胎盘主要原位保留。54%的患者需要输血。有产前诊断与无产前诊断的病例之间的失血量无差异（p=0.327）。在已知病例中，试图去除胎盘并未对失血量产生影响（p=0.417）。
PAS 应在最佳环境下并由协调良好的团队进行管理。需要在预期和意外需要管理的前瞻性多中心研究中证明不同方法的经验，以制定相关建议。
