Fujishima Risa, Kawasaki Kaoru, Moriuchi Kaori, Shiro Reona, Yo Yoshie, Matsumura Noriomi
Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Osaka, Japan.
Healthcare (Basel). 2023 Jan 5;11(2):168. doi: 10.3390/healthcare11020168.
This retrospective study aims to compare the early manual removal of placenta (MROP) and conservative management of retained products of conception (RPOC) after 34 weeks of gestation. Nineteen cases underwent MROP within 24 h of delivery, of which nine patients had no symptoms requiring emergent treatment. These 9 patients (group M) were compared with 22 patients who were treated conservatively (group C). Massive bleeding was observed in 5 (56%) patients in group M and 11 (50%) patients in group C, with no significant difference in frequency. However, the lowest hemoglobin level within 72 h after massive bleeding was lower in group M (median: 6.7 vs. 7.7 g/dL, = 0.029), suggesting that massive bleeding occurred in a short period of time. On the other hand, a retained placenta was observed in four patients in group M after the MROP; however, the placenta disappeared more quickly than in group C (median; 1.0 vs. 99.0 days, = 0.009). In group C, all bleeding and infection occurred within 60 days of delivery, including heavy bleeding in six cases during the placental-extraction trial. Human chorionic gonadotropin in group C fell below the measurable threshold at a median of 67 days postpartum. In conclusion, for RPOC without urgent symptoms, early MROP and conservative treatment have their advantages and disadvantages. Randomized controlled trials are needed to determine which of those treatments is superior.
这项回顾性研究旨在比较妊娠34周后早期人工剥离胎盘（MROP）与对妊娠物残留（RPOC）的保守治疗。19例患者在分娩后24小时内接受了MROP，其中9例患者没有需要紧急治疗的症状。将这9例患者（M组）与22例接受保守治疗的患者（C组）进行比较。M组5例（56%）患者和C组11例（50%）患者出现大出血，发生率无显著差异。然而，M组大出血后72小时内的最低血红蛋白水平较低（中位数：6.7 vs. 7.7 g/dL，P = 0.029），表明大出血在短时间内发生。另一方面，M组4例患者在MROP后观察到胎盘残留；然而，胎盘消失的速度比C组更快（中位数：1.0 vs. 99.0天，P = 0.009）。在C组中，所有出血和感染均发生在分娩后60天内，包括胎盘剥离试验期间6例大出血。C组人绒毛膜促性腺激素在产后中位数67天时降至可测量阈值以下。总之，对于没有紧急症状的RPOC，早期MROP和保守治疗各有优缺点。需要进行随机对照试验来确定哪种治疗方法更优。
