Nguyen Bianca T, Rodriguez Anthony, Patel Naiya, Rodriguez Diana, Khamvongsa Peter
Obstetrics and Gynecology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Cureus. 2020 Dec 1;12(12):e11832. doi: 10.7759/cureus.11832.
The incidence of abnormal placentation has escalated due to the increase in cesarean sections. Adherent placentas are associated with significant maternal morbidity and mortality and often result in cesarean hysterectomy due to life-threatening hemorrhage. The purpose of these case reports is to describe conservative management of placenta accreta by utilizing a helium plasma device to fulgurate the placental bed. Placenta accreta is associated with a 7% mortality rate and 60% morbidity rate. Conservative treatment for uterine preservation include embolization, placenta left in-situ, uterine balloon tamponade, and methotrexate. Complications of these options include hemorrhage, endometritis, and morbidly adherent placentas (MAP) recurrence in subsequent pregnancies. The helium plasma device utilizes radiofrequency (RF) to ionize helium into a plasma beam capable of coagulating and fulgurating tissue with high precision and minimal thermal spread. This instrument is Food and Drug Administration (FDA) approved for surgical coagulation and fulguration, but has not been evaluated in the treatment of placenta accreta at the time of a cesarean section. The helium plasma device was used to fulgurate the placenta accreta at 40% power 4 L/min gas flow for 30 seconds, providing adequate hemostasis to the 12.76 cc of retained placental bed. Estimated blood loss was 560 cc. The patient remained hemodynamically stable and had no complications at follow up. The device provided efficient management of placenta accreta. This approach offers a safer alternative management of abnormal placentation and avoiding a cesarean hysterectomy. This novel surgical technique allows women with morbidly adherent placentas to maintain reproductive capability.
由于剖宫产率的上升，异常胎盘植入的发生率不断攀升。黏附性胎盘与孕产妇的高发病率和死亡率相关，常因危及生命的出血而导致剖宫产子宫切除术。这些病例报告的目的是描述通过使用氦等离子体设备对胎盘床进行电灼来保守治疗胎盘植入。胎盘植入的死亡率为7%，发病率为60%。保留子宫的保守治疗方法包括栓塞、胎盘原位保留、子宫球囊压迫和甲氨蝶呤。这些方法的并发症包括出血、子宫内膜炎以及后续妊娠中病态黏附胎盘（MAP）复发。氦等离子体设备利用射频（RF）将氦电离成等离子束，能够高精度地凝固和电灼组织，且热扩散最小。该仪器已获得美国食品药品监督管理局（FDA）批准用于手术凝血和电灼，但尚未在剖宫产时治疗胎盘植入方面进行评估。使用氦等离子体设备以40%的功率、4 L/分钟的气体流量对胎盘植入部位进行30秒的电灼，为12.76立方厘米的残留胎盘床提供了充分的止血效果。估计失血量为560毫升。患者血流动力学保持稳定，随访期间无并发症。该设备对胎盘植入进行了有效管理。这种方法为异常胎盘植入提供了一种更安全的替代管理方式，避免了剖宫产子宫切除术。这种新颖的手术技术使患有病态黏附胎盘的女性能够维持生育能力。
