Zhao Peng, Zhao Ying, He Jing, Bai Xiao-Xia, Chen Jian
Department of Obstetrics, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China.
Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China.
World J Clin Cases. 2021 Nov 26;9(33):10244-10248. doi: 10.12998/wjcc.v9.i33.10244.
Mifepristone-induced abortion (MIA) has been used worldwide to terminate pregnancies. However, the association between placenta accrete (PA) and MIA has seldom been reported.
A 26-year-old pregnant woman presented with painless vaginal bleeding at 35 wk of gestation. She had a medical abortion (mifepristone followed by misoprostol) 1 year ago at the sixth week of gestation. Her personal history for previous surgery was negative. Abdominal ultrasonography showed a normal foetus with complete placenta previa. The foetal membrane ruptured with massive vaginal bleeding and severe abdominal pain. An emergency Caesarean section was performed, and the newborn was delivered. The placenta failed to expel and manual extraction was carried out. A large defect was noted in the uterine fundus and repair of the uterine rupture was conducted immediately. The postoperative pathology report showed placenta accreta.
The evidence suggests a possible etiologic role of MIA in PA, as the incidence of PA after MIA is much higher than general population. Millions of pregnancies are complicated by PA each year, some of which result in fatality. To prevent subsequent placental complications after MIA, hormonal supplementation might be a promising therapeutic options. However, further studies are needed to identify the high-risk factors and to confirm the effectiveness of estrogen supplement therapy.
米非司酮引产（MIA）已在全球范围内用于终止妊娠。然而，胎盘植入（PA）与MIA之间的关联鲜有报道。
一名26岁孕妇在妊娠35周时出现无痛性阴道出血。她在妊娠六周时于1年前进行了药物流产（米非司酮后加用米索前列醇）。她既往手术史为阴性。腹部超声检查显示胎儿正常，完全性前置胎盘。胎膜破裂，伴有大量阴道出血和严重腹痛。行急诊剖宫产，娩出新生儿。胎盘未能排出，进行了人工剥离。发现子宫底部有一个大的缺损，立即进行了子宫破裂修补术。术后病理报告显示为胎盘植入。
有证据表明MIA在PA中可能起病因作用，因为MIA后PA的发生率远高于一般人群。每年数以百万计的妊娠并发PA，其中一些导致死亡。为预防MIA后的后续胎盘并发症，激素补充可能是一种有前景的治疗选择。然而，需要进一步研究以确定高危因素并证实雌激素补充疗法的有效性。
