Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta
Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta
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DOI：
10.1016/j.ajog.2018.04.049
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发表时间：
2018-08-01
影响因子：
9.8
通讯作者：
Goffinet, Francois
中科院分区：
文献类型：
--
作者：
Marcellin, Louis;Delorme, Pierre;Goffinet, Francois
背景：异常侵入性胎盘是产科子宫切除术的主要原因，可导致不良甚至灾难性的母体结局。大多数以前关于围产期管理和孕产妇发病率的研究都包括不同比例的重度和轻度病例。目的：这项研究的目的是比较植入胎盘和植入性胎盘的孕产妇发病率。研究设计：这项在巴黎转诊中心进行的回顾性研究包括2003-2017年间所有患有异常侵入性胎盘的妇女。组织学或临床诊断为植入性胎盘和植入性胎盘。当胎盘植入在出生前被怀疑时，由于术中剖宫产的风险，提出了将胎盘留在原位的保守方法。当怀疑植入胎盘时，父母可以选择保守的方法或尝试移除胎盘，如果失败则进行子宫切除术。比较植入胎盘和植入/植入胎盘的产妇结局。主要的预后指标是严重急性孕产妇发病率的综合标准，包括以下至少一项：剖宫产时子宫切除，延迟子宫切除，输注<10U的红细胞，感染性休克，急性肾损伤，心血管衰竭，母亲转入重症监护，或死亡。结果：在纳入的156名妇女中，51名为植入性胎盘，105名为植入性胎盘。排泄物异常侵入性胎盘的发生率是植入物组的近4倍(96.1%[49/51]vs25.7%[27/105]，P
BACKGROUND: Abnormally invasive placentation is the leading cause of obstetric hysterectomy and can cause poor to disastrous maternal outcomes. Most previous studies of peripartum management and maternal morbidity have included variable proportions of severe and less severe cases.OBJECTIVE: The aim of this study was to compare maternal morbidity from placenta percreta and accreta.STUDY DESIGN: This retrospective study at a referral center in Paris includes all women with abnormally invasive placentation from 2003 through 2017. Placenta percreta and accreta were diagnosed histologically or clinically. When placenta percreta was suspected before birth, a conservative approach leaving the placenta in situ was proposed because of the intraoperative risk of cesarean delivery. When placenta accreta was suspected, parents were offered a choice of a conservative approach or an attempt to remove the placenta, to be followed in case of failure by hysterectomy. Maternal outcomes were compared between women with placenta percreta and those with placenta accreta/increta. The primary outcome measure was a composite criterion of severe acute maternal morbidity including at least 1 of the following: hysterectomy during cesarean delivery, delayed hysterectomy, transfusion of >= 10 U of packed red blood cells, septic shock, acute kidney injury, cardiovascular failure, maternal transfer to intensive care, or death.RESULTS: Of the 156 women included, 51 had placenta percreta and 105 placenta accreta. Abnormally invasive placentation was suspected antenatally nearly 4 times more frequently in the percreta than the accreta group (96.1% [49/51] vs 25.7% [27/105], P