Ekoukou D, Ng Wing Tin L, Nere M B, Bourdet O, Elalaoui Y, Bazin C
Service de Gynécologie-Obstétrique, Centre Hospitalier Général, Hôpital De la Fontaine, Saint-Denis.
J Gynecol Obstet Biol Reprod (Paris). 1995;24(2):189-93.
Placenta membranacea or placenta diffusa is a rare abnormality in which all or most of fetal membranes remain covered by chorionic villi, because the chorion has failed to differenciate into chorion laeve and chorion frondosum. This condition is associated with recurrent antepartum bleeding, abortion in the second trimester of the pregnancy, preterm delivery, fetal death, intra-uterine growth retardation, post partum haemorrhage and placental retention. In this paper, we report our first case of placenta membranacea. A 30-year-old black woman, gravida 3, para 1, was admitted at 23 weeks of gestation for vaginal bleeding. She was placed on complete bed rest. Ultrasonographic examination showed a placenta covering the anterior and posterior uterine walls and the internal cervical os. At 28 weeks and 34 weeks of gestation, ultrasound examination showed the same findings: total placenta previa covering the entire uterine wall and presenting many lacuna. At 38 weeks, she underwent a cesarean section. The placenta adhered firmly to the myometrium. Because the attempts to remove the placenta was unsuccessful, it was performed a total hysterectomy. The total blood loss was 7000 ml. Anatomo-pathologic examination of the placenta led do the diagnosis of placenta membranea, total previa and increta. In the literature, 35 cases of placenta membranacea have been reported; of these, there are ten cases associated with total hysterectomy.
膜状胎盘或弥漫性胎盘是一种罕见的异常情况，即全部或大部分胎膜仍被绒毛膜绒毛覆盖，这是因为绒毛膜未能分化为平滑绒毛膜和叶状绒毛膜。这种情况与产前反复出血、妊娠中期流产、早产、胎儿死亡、宫内生长受限、产后出血和胎盘滞留有关。在本文中，我们报告了首例膜状胎盘病例。一名30岁的黑人女性，孕3产1，妊娠23周因阴道出血入院。她被要求完全卧床休息。超声检查显示胎盘覆盖子宫前壁、后壁及宫颈内口。妊娠28周和34周时，超声检查结果相同：完全性前置胎盘，覆盖整个子宫壁，并出现多个血窦。38周时，她接受了剖宫产。胎盘与子宫肌层紧密粘连。由于试图取出胎盘未成功，遂行全子宫切除术。总失血量为7000毫升。胎盘的解剖病理学检查确诊为膜状胎盘、完全性前置胎盘和植入性胎盘。文献中已报道35例膜状胎盘病例；其中，有10例与全子宫切除术有关。
