Department of Obstetrics and Gynecology, First affiliated hospital of Zhengzhou University, School of International Education, Zhengzhou University, Zhengzhou, China; Obstetric Emergency and Critical Care Medicine of Henan Province, Zhengzhou, China (Dr H Zhao, Ms Liu, and Dr X Zhao).
Department of Obstetrics and Gynecology, First affiliated hospital of Zhengzhou University, School of International Education, Zhengzhou University, Zhengzhou, China.
Am J Obstet Gynecol MFM. 2023 Dec;5(12):101189. doi: 10.1016/j.ajogmf.2023.101189. Epub 2023 Oct 12.
Placenta accreta spectrum can lead to uncontrollable massive hemorrhage in the perinatal period. Currently, the first-line treatment for placenta accreta spectrum recommended worldwide is hysterectomy. However, adverse outcomes after hysterectomy, including surgical complications, such as difficulty in performing the procedure, and sequelae, such as infertility and psychological issues, cannot be ignored. Several surgical approaches for conservative treatment have been proposed. There are few reports on the effectiveness, safety, and long-term complications of conservative treatments, especially subsequent pregnancy outcomes.
This study aimed to investigate the clinical outcomes and identify risk factors of subsequent pregnancies among patients with placenta accreta spectrum who had undergone conservative surgery.
This was a retrospective cohort study of subsequent pregnancy cases after cesarean delivery with conservative treatment for placenta accreta spectrum from 2011 to 2019 at The First Affiliated Hospital of Zhengzhou University to identify clinical outcomes of subsequent pregnancies and the risk factors of adverse pregnancy outcomes.
A total of 883 patients undergoing conservative surgery were included in this study, among which 604 (68.4%) were successfully followed up. There were 75 successful pregnancies in 72 patients, including 22 full-term or near-term deliveries, 1 induced labor in the second trimester of pregnancy, 6 cesarean scar pregnancies (8.0%), 2 ectopic pregnancies, and 44 first-trimester pregnancies (3 miscarriages and 41 elective abortions and 12 medical abortions and 32 vacuum aspirations). All newborns survived in the 22 full-term or near-term deliveries. Moreover, 5 placenta accreta spectrum cases (22.7%) and 6 placenta previa cases were observed. Postpartum hemorrhage was observed in 2 cases, with an incidence rate of 9.1%. All parameters, including age at subsequent pregnancy, gravidity, number of cesarean deliveries, type of previous placenta accreta spectrum, gestational week of pregnancy termination, interpregnancy interval, and the use of vascular occlusion techniques, were not found to be associated with recurrent placenta accreta spectrum and cesarean scar pregnancy.
Our findings show that treatment for placenta accreta spectrum does not automatically preclude a subsequent pregnancy. However, patients should be fully informed about the risk of recurrent placenta accreta spectrum, scar pregnancy, and postpartum hemorrhage.
胎盘植入谱系疾病可导致围产期不可控制的大出血。目前，全球范围内推荐的胎盘植入谱系疾病的一线治疗方法是子宫切除术。然而，子宫切除术后的不良结局，包括手术并发症，如手术难度增加，以及后遗症，如不孕和心理问题，不容忽视。已经提出了几种保守治疗的手术方法。关于保守治疗的有效性、安全性和长期并发症的报道很少，特别是后续妊娠结局。
本研究旨在探讨胎盘植入谱系疾病患者行保守手术后的临床结局，并确定其后续妊娠的相关风险因素。
这是一项回顾性队列研究，纳入了 2011 年至 2019 年在郑州大学第一附属医院行剖宫产术并接受胎盘植入谱系疾病保守治疗的后续妊娠病例，以明确后续妊娠结局及不良妊娠结局的相关风险因素。
本研究共纳入 883 例行保守手术的患者，其中 604 例（68.4%）成功随访。72 例患者中有 75 例成功妊娠，包括 22 例足月或近足月分娩、1 例妊娠中期引产、6 例剖宫产瘢痕妊娠（8.0%）、2 例异位妊娠和 44 例孕早期妊娠（3 例流产和 41 例选择性流产和 12 例药物流产和 32 例真空抽吸）。在 22 例足月或近足月分娩中，所有新生儿均存活。此外，还观察到 5 例（22.7%）胎盘植入谱系疾病和 6 例胎盘前置。有 2 例发生产后出血，发生率为 9.1%。后续妊娠年龄、孕次、剖宫产次数、既往胎盘植入谱系疾病类型、终止妊娠孕周、两次妊娠间隔时间以及血管闭塞技术的使用等参数均与再次胎盘植入谱系疾病和剖宫产瘢痕妊娠无关。
我们的研究结果表明，胎盘植入谱系疾病的治疗并不自动排除后续妊娠。然而，应充分告知患者再次发生胎盘植入谱系疾病、瘢痕妊娠和产后出血的风险。
