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胎盘植入谱系疾病——产科的灾难性情况。

Placenta accreta spectrum-a catastrophic situation in obstetrics.

作者信息

Pegu Bhabani, Thiagaraju Chitra, Nayak Deepthi, Subbaiah Murali

机构信息

Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

出版信息

Obstet Gynecol Sci. 2021 May;64(3):239-247. doi: 10.5468/ogs.20345. Epub 2021 Mar 24.

Abstract

Placenta accreta is a significant obstetric complication in which the placenta is completely or focally adherent to the myometrium. The worldwide incidence of placenta accreta spectrum (PAS) is increasing day by day, mostly due to the increasing trends in cesarean section rates. The accurate and timely diagnosis of placenta accreta is important to improve the feto-maternal outcome. Although standard ultrasound is a reliable and primary tool for the diagnosis of placenta accreta, the absence of ultrasound findings does not preclude the diagnosis of placenta accreta. Therefore, clinical evaluation of risk factors is equally essential for the prediction of abnormal placental invasion. Pregnant women with a high impression or established diagnosis of placenta accreta should be managed by a multidisciplinary team in a specialist center. Traditionally, PAS has been managed by an emergency obstetric hysterectomy. Previously, few studies suggested a satisfactory success rate of conservative management in well-chosen cases, whereas few studies recommended delayed hysterectomy to reduce the amount of bleeding. The continuously increasing trends of PAS and the challenges for its routine management are the main motives behind this literature review.

摘要

胎盘植入是一种严重的产科并发症,胎盘全部或部分粘连于子宫肌层。全球范围内胎盘植入谱系疾病(PAS)的发病率日益上升,主要原因是剖宫产率呈上升趋势。准确及时地诊断胎盘植入对于改善母婴结局至关重要。虽然标准超声是诊断胎盘植入的可靠且主要的工具,但超声检查未发现异常表现并不能排除胎盘植入的诊断。因此,对危险因素进行临床评估对于预测胎盘异常植入同样至关重要。高度怀疑或已确诊胎盘植入的孕妇应由专科中心的多学科团队进行管理。传统上,PAS的治疗方式是急诊产科子宫切除术。此前,少数研究表明,在精心挑选的病例中,保守治疗有令人满意的成功率,而少数研究则建议延迟子宫切除术以减少出血量。PAS发病率的持续上升趋势及其常规管理面临的挑战是本次文献综述的主要动机。

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