The management of placenta percreta: Conservative and operative strategies
The management of placenta percreta: Conservative and operative strategies
复制标题
DOI：
10.1016/s0002-9378(96)70117-5
复制
发表时间：
1996-12-01
影响因子：
9.8
通讯作者：
Donaldson, ES
中科院分区：
文献类型：
--
作者：
OBrien, JM;Barton, JR;Donaldson, ES
目的：我们的目的是评估偏好的管理胎盘植入，并确定方面的护理有关的改善outcome.Study设计：无论是一个分析的问卷调查的成员，围产期产科医师协会和回顾性研究，在我们的机构被用来获得病历的妇女与胎盘植入在最近3年期间。围产期产科医生协会成员报告的109例病例中有55例（50%）疑似产前。并发症包括子宫破裂（3例）、输血>10单位（44例，40%）、输尿管结扎或瘘形成（各5例，5%）、感染（31例，28%）、围产儿死亡（10例，9%）和孕产妇死亡（8例，7%）。治疗选择包括手术切除子宫和相关组织（101例，93%）和保守治疗，分娩后胎盘留在原位（8例，7%）。围产期产科医师协会的更多成员对我们的调查作出回应，选择保守治疗，如果邻近组织的参与（69%的延伸到膀胱或胃肠道）相比，31%的percreta局限于子宫，p < 0.001。保守治疗也与报告病例中的失血量减少相关（输注红细胞的中位数单位，0 vs 7，p = 0.003）。在我们的机构三例胎盘percreta产前确定，第三例代表第一次报告与产前识别percreta其次是故意保守treatment.CONCLUSIONS：随着周围组织的参与更大，保守治疗是首选血流动力学稳定的患者。如果试图或必须手术切除胎盘，由于产妇发病率和死亡率较高，必须由有盆腔解剖经验的医生参与。
OBJECTIVE: Our purpose was to assess preferences for the management of placenta percreta and identify aspects of care related to an improved outcome.STUDY DESIGN: Both an analysis of a questionnaire issued to members of the Society of Perinatal Obstetricians and a retrospective study at our institution were used to obtain case histories of women with placenta percreta during a recent 3-year period.RESULTS: Fifty-five of the 109 cases (50%) reported by members of the Society of Perinatal Obstetricians were suspected ante partum. Complications associated with this disorder included uterine rupture (3 cases), transfusion of >10 units (44 cases, 40%), ureteral ligation or fistula formation (5 cases each, 5%), infection (31 cases, 28%), perinatal death (10 cases, 9%), and maternal death (8 cases, 7%). Management options included surgical removal of the uterus and involved tissues (101 cases, 93%) and conservative treatment with the placenta left in situ after delivery (8 cases, 7%). More members of the Society of Perinatal Obstetricians responding to our survey opted for conservative management if adjacent tissues were involved (69% with extension into the bladder or gastrointestinal tract) compared with 31% when the percreta was confined to the uterus, p < 0.001. Conservative therapy was also associated with less blood loss in reported cases (median units red blood cells transfused, 0 vs 7, p = 0.003). Two of the three cases of placenta percreta at our institution were identified ante partum, The third case represents the first reported with antepartum identification of percreta followed by deliberate conservative treatment.CONCLUSIONS: With greater involvement of surrounding tissues, conservative treatment was preferred in hemodynamically stable patients. If surgical excision of the placenta is attempted or necessary, physicians experienced in pelvic dissection must be involved because of the frequency of maternal morbidity and mortality.