St George's Hospital University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom.
Best Pract Res Clin Obstet Gynaecol. 2021 Apr;72:25-37. doi: 10.1016/j.bpobgyn.2021.01.007. Epub 2021 Feb 5.
Placenta accreta spectrum (PAS) disorders are rare but potentially life-threatening obstetric conditions, which can result in severe post-partum haemorrhage (PPH). Traditional management necessitates peripartum hysterectomy, but this carries high rates of morbidity and mortality. More recently, interventional radiology techniques have been developed in order to reduce morbidity and preserve fertility. This article summarises and compares the various reported interventional radiology techniques. Arterial embolisation performed to treat PPH is the therapeutic option which is supported by the highest degree of evidence. The role of preventative procedures, such as temporary balloon occlusion of the internal iliac arteries or distal aorta, continues to be debated due to conflicting outcome data and concerns regarding associated morbidity. The choice of which, if any, interventional radiological technique is utilised is determined by local expertise, available resources and the planned obstetric approach. The most complex patients are likely to benefit from multidisciplinary management in high-volume centres.
胎盘植入谱系（PAS）疾病较为罕见，但可能危及生命，可导致严重的产后出血（PPH）。传统的治疗方法需要在围产期进行子宫切除术，但这会带来较高的发病率和死亡率。最近，介入放射学技术已经发展起来，以降低发病率并保留生育能力。本文总结并比较了各种已报道的介入放射学技术。动脉栓塞术是治疗 PPH 的治疗方法，其疗效得到了最高程度的证据支持。预防性手术（如暂时性髂内动脉或腹主动脉下段球囊闭塞）的作用仍存在争议，这是由于存在相互矛盾的数据和对相关发病率的担忧。是否使用任何介入放射学技术，这取决于当地的专业知识、可用资源和计划的产科方法。最复杂的患者可能受益于在高容量中心进行多学科管理。
