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印度北部一家三级护理中心计划性或急诊分娩后胎盘植入谱系疾病母婴结局的回顾性研究

A Retrospective Study of Maternal and Neonatal Outcome in Placenta Accreta Spectrum After Planned or Emergency Delivery From a Tertiary Care Centre in North India.

作者信息

Birendra Ruchi, Jigyasa Singh

机构信息

Obstetrics and Gynaecology, Institute Of Medical Sciences, Banaras Hindu University, Varanasi, IND.

出版信息

Cureus. 2023 Sep 5;15(9):e44725. doi: 10.7759/cureus.44725. eCollection 2023 Sep.

DOI:10.7759/cureus.44725
PMID:37809253
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10552932/
Abstract

Aim This retrospective study aimed to evaluate the incidence, sociodemographic profile, feto-maternal outcomes, and associated risk factors of placenta accreta spectrum (PAS) among all the deliveries. Methods This retrospective cohort study included all women diagnosed with PAS either preoperatively or intraoperatively. Data on maternal high-risk factors such as previous surgical history, association with placenta praevia, parity and primary outcomes such as the operative procedure carried out, transfusion requirements and ICU admission, as well as neonatal variables such as Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. The study was carried out over a period of 10 months at our centre. Results A cohort of 32 women were identified with placenta accreta, increta, or percreta. The mean maternal age was 31 years. The mean gestational age at the time of diagnosis was 32.75 weeks. Around 50% of patients had risk factors for the abnormally invasive placenta, such as placenta praevia, and 75% had a history of previous caesarean sections. Hysterectomy was done in 28 cases (87.5%). Blood transfusion was done in all the cases. There were two maternal deaths in the study group. The perinatal outcome was better in the antenatally detected cases. Conclusion An increased incidence of PAS has been seen. Early risk factor identification and strategic management improve maternal and foetal outcomes. Our findings demonstrated that PAS pregnancies managed in our centre had maternal and neonatal outcomes comparable to those in developed countries. It is hypothesized that this is because pregnancies with PAS are managed using a multidisciplinary approach.

摘要

目的 本回顾性研究旨在评估所有分娩中胎盘植入谱系(PAS)的发生率、社会人口学特征、母婴结局及相关危险因素。方法 本回顾性队列研究纳入所有术前或术中诊断为PAS的女性。本研究的主要结局包括产妇高危因素(如既往手术史、前置胎盘、产次)及主要结局(如实施的手术操作、输血需求和入住重症监护病房),以及新生儿变量(如阿氏评分、入住新生儿重症监护病房和出生体重)。本研究在我们中心进行了10个月。结果 共识别出32例胎盘植入、穿透性胎盘植入或完全性胎盘植入的女性。产妇平均年龄为31岁。诊断时的平均孕周为32.75周。约50%的患者有异常侵入性胎盘的危险因素,如前置胎盘,75%有既往剖宫产史。28例(87.5%)行子宫切除术。所有病例均进行了输血。研究组有2例产妇死亡。产前诊断病例的围产期结局较好。结论 PAS的发生率有所增加。早期识别危险因素并进行策略性管理可改善母婴结局。我们的研究结果表明,在我们中心管理的PAS妊娠的母婴结局与发达国家相当。据推测,这是因为采用多学科方法管理PAS妊娠。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ba03/10552932/e26ab33b3a05/cureus-0015-00000044725-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ba03/10552932/b51d6173091d/cureus-0015-00000044725-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ba03/10552932/e26ab33b3a05/cureus-0015-00000044725-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ba03/10552932/b51d6173091d/cureus-0015-00000044725-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ba03/10552932/e26ab33b3a05/cureus-0015-00000044725-i02.jpg

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本文引用的文献

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Placenta Accreta Spectrum: Prenatal Diagnosis and Management.胎盘植入谱系疾病:产前诊断与管理。
Obstet Gynecol Clin North Am. 2022 Sep;49(3):423-438. doi: 10.1016/j.ogc.2022.02.004.
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Quality of surgical management of placenta accreta spectrum in a tertiary center in Sri Lanka: baseline study for quality improvement project: problems and solutions.斯里兰卡一家三级中心胎盘植入谱系手术管理质量:质量改进项目的基线研究:问题与解决方案。
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Maternal and fetal outcome in placenta accreta spectrum (PAS) associated with placenta previa: a retrospective analysis from a tertiary center.
胎盘植入谱系疾病(PAS)相关前置胎盘的母婴结局:来自一家三级中心的回顾性分析。
J Med Life. 2021 May-Jun;14(3):367-375. doi: 10.25122/jml-2021-0134.
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A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women.伊朗南部女性剖宫产子宫切除治疗胎盘植入谱系疾病围产期结局的5年经验
BMC Womens Health. 2021 Jun 15;21(1):243. doi: 10.1186/s12905-021-01389-z.
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Lack of experience is a main cause of maternal death in placenta accreta spectrum patients.经验不足是胎盘植入谱系患者产妇死亡的主要原因。
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Epidemiology of placenta previa accreta: a systematic review and meta-analysis.植入性胎盘的流行病学:一项系统评价和荟萃分析。
BMJ Open. 2019 Nov 12;9(11):e031193. doi: 10.1136/bmjopen-2019-031193.
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