Department of obstetrics and Gynecology, ASST Bergamo Est, Seriate (BG), Italy.
Department of obstetrics and Gynecology, ASST Bergamo Est, Seriate (BG), Italy.
Eur J Obstet Gynecol Reprod Biol. 2023 Aug;287:148-154. doi: 10.1016/j.ejogrb.2023.06.012. Epub 2023 Jun 14.
Placenta Accreta Spectrum disorders (PASd) refer to the range of pathologic adherence of placenta associated with high maternal morbidity and mortality due to severe and sometimes life-threatening hemorrhage at the time of delivery. The aim of this study is to describe the surgical technique of extraperitoneal retrograde hysterectomy, which has allowed a reduction of blood transfusions compared to patients who underwent classical post-partum hysterectomy.
We collected data from twelve patients with antenatal diagnosis of PASd treated between 2018 and 2021 with an extra-peritoneal hysterectomy using a posterior retrograde approach and we compared them to patients who underwent classical hysterectomy for suspected PASd, treated between 2007 and 2017.
The classical hysterectomy group presented a higher frequency of blood and plasma transfusion compared to the extraperitoneal hysterectomy group. In particular, classical hysterectomy resulted in an independent risk factor for transfusion, with an increment of 6.6 times of risk.
Even if future studies are required, we think that extraperitoneal hysterectomy could be a safe option in case of PASd, considering that classical hysterectomy compared to this approach increases, in our population, the risk of blood and plasma transfusion.
胎盘植入谱系疾病（PASd）是指胎盘与母体发病率和死亡率高相关的一系列病理性附着，由于分娩时严重且有时危及生命的出血，导致发病率和死亡率高。本研究旨在描述腹膜外逆行子宫切除术的手术技术，与行经典产后子宫切除术的患者相比，该技术可减少输血。
我们收集了 2018 年至 2021 年间，12 例产前诊断为 PASd 的患者的资料，这些患者采用后向逆行腹膜外子宫切除术治疗，并与 2007 年至 2017 年间疑似 PASd 行经典子宫切除术治疗的患者进行比较。
与腹膜外子宫切除术组相比，经典子宫切除术组的输血和血浆输血频率更高。特别是，经典子宫切除术是输血的独立危险因素，风险增加 6.6 倍。
尽管需要进一步研究，但我们认为在 PASd 情况下，腹膜外子宫切除术可能是一种安全的选择，因为与该方法相比，在我们的人群中，经典子宫切除术增加了输血和血浆输血的风险。
