Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal.
Serviço de Ginecologia e Obstetrícia. Hospital de Vila Franca de Xira. Vila Franca de Xira. Portugal.
Acta Med Port. 2021 Mar 31;34(4):266-271. doi: 10.20344/amp.14001. Epub 2021 Apr 1.
Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.
Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.
During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.
Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.
This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.
胎盘植入谱系疾病是导致产妇发病率和死亡率的主要原因之一，其患病率未来可能会增加。在剖宫产瘢痕部位前置胎盘的情况下，胎盘植入谱系疾病的风险最高。葡萄牙很少有研究评估胎盘植入谱系疾病。本研究旨在回顾过去十年在葡萄牙一家三级中心管理的剖宫产瘢痕部位胎盘植入谱系疾病的病例。
回顾性、横断面研究，数据来自医院数据库。仅纳入经组织病理学证实为胎盘植入谱系疾病的病例。
在研究期间，诊断出 15 例剖宫产瘢痕部位胎盘植入谱系疾病（患病率为 0.6/1000）。所有病例均在产前诊断。所有病例均行横向剖宫产术，13 例采用计划多学科方法治疗，2 例需要紧急处理。12 例患者行全子宫切除术或次全子宫切除术。无产妇或新生儿死亡病例。组织病理学评估证实 9 例胎盘植入、3 例胎盘植入和 3 例胎盘穿透。
早期产前诊断对于这些病例的计划性多学科管理非常重要，这可以降低潜在的发病率和死亡率，并确保更好的产科结局。
本剖宫产瘢痕部位胎盘植入谱系疾病的病例系列报告了葡萄牙一家三级围产中心的真实情况，在过去十年中，没有因胎盘植入谱系疾病而导致的产妇或新生儿死亡；这可能归因于产前诊断和协调的多学科团队方法。
