Wang P H, Chao H T, Yuan C C, Linn J J, Yen M S
Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Feb;61(2):116-20.
Conservative treatment for placenta accreta has recently been popularly accepted even though serious postpartum hemorrhage, resulting in maternal death, may occur. We report a case of placenta previa accreta with cervical involvement resulting in tenacious postpartum hemorrhage. A 28-year-old pregnant woman, gravida-2 para-1, who had undergone a previous cesarean section, was scheduled for a repeat cesarean section because of complete placenta previa associated with placenta accreta. The patient underwent cesarean section and delivered a 3,700 g, male infant. Manual removal of the placenta was performed with some difficulty and redundant placental tissue remained adhered to the uterine wall. Oxytocin, ergometrine, uterine arterial ligation and packing of the lower uterine segment were used to control bleeding; the wound was closed as usual after achieving adequate hemostasis. While closing the abdominal wall, vaginal bleeding was noted. After conservative treatment, shock progressively emerged due to persistent vaginal bleeding. Emergency laparotomy found active bleeding from the cervix and total abdominal hysterectomy was performed without hesitation. Careful evaluation is mandatory to preserve the uterus. In the case of cervical involvement, aggressive treatment such as hysterectomy should be undertaken promptly to decrease the risks of both morbidity and mortality.
尽管胎盘植入的保守治疗可能会导致严重的产后出血甚至产妇死亡，但最近已被广泛接受。我们报告一例伴有宫颈受累的前置胎盘植入病例，该病例导致了顽固性产后出血。一名28岁、孕2产1的孕妇，曾行剖宫产术，因完全性前置胎盘合并胎盘植入而计划行再次剖宫产术。患者接受了剖宫产，娩出一名3700g男婴。徒手剥离胎盘有一定困难，仍有多余的胎盘组织附着于子宫壁。使用缩宫素、麦角新碱、子宫动脉结扎及子宫下段填塞来控制出血；在充分止血后按常规关闭伤口。在关闭腹壁时，发现阴道出血。保守治疗后，由于持续的阴道出血，休克逐渐出现。急诊剖腹探查发现宫颈有活动性出血，毫不犹豫地实施了全子宫切除术。必须进行仔细评估以保留子宫。对于宫颈受累的情况，应迅速采取积极治疗措施，如子宫切除术，以降低发病和死亡风险。
