Maternal Outcome After Conservative Treatment of Placenta Accreta
Maternal Outcome After Conservative Treatment of Placenta Accreta
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DOI：
10.1097/aog.0b013e3181d066d4
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发表时间：
2010-03-01
影响因子：
7.2
通讯作者：
Bretelle, Florence
中科院分区：
文献类型：
--
作者：
Sentilhes, Loic;Ambroselli, Clemence;Bretelle, Florence
目的：评估植入性胎盘保守治疗后的产妇结局。 方法：这项回顾性多中心研究旨在纳入 1993 年至 2007 年间在法国三级大学医院中心接受保守治疗的植入性胎盘的所有女性。保守治疗的定义是产科医生决定将胎盘部分或全部留在原位，而不试图强行去除胎盘。主要结局是保守治疗的成功，即保留子宫。次要结局是严重孕产妇发病率的综合衡量标准，包括败血症、败血性休克、腹膜炎、子宫坏死、瘘管、邻近器官损伤、急性肺水肿、急性肾衰竭、深静脉血栓性静脉炎或肺栓塞或死亡。 结果：在同意参与本研究的 40 家大学医院中，25 家机构至少使用了保守治疗 一次（范围 1-46），总共治疗了 167 名女性。 131 名女性的保守治疗取得了成功（78.4%，95% 置信区间 [CI] 71.4-84.4%）；其余 36 名女性中，18 名接受了初次子宫切除术，18 名接受了延迟子宫切除术（各 10.8%，95% CI 6.5-16.5%）。 10 例发生严重孕产妇发病（6.0%，95% CI 2.9-10.7%）。一名妇女死于与脐内甲氨蝶呤给药相关的骨髓抑制和肾毒性。 116 例中有 87 例发生自发性胎盘吸收（75.0%，95% CI 66.1-82.6%），中位延迟分娩时间为 13.5 周（范围为 4-60 周）。结论：植入性胎盘的保守治疗可以帮助妇女避免子宫切除术，并且在设备和资源充足的中心，严重孕产妇发病率较低。 （妇产科 2010；115：526-34）
OBJECTIVE: To estimate maternal outcome after conservative management of placenta accreta.METHODS: This retrospective multicenter study sought to include all women treated conservatively for placenta accreta in tertiary university hospital centers in France from 1993 to 2007. Conservative management was defined by the obstetrician's decision to leave the placenta in situ, partially or totally, with no attempt to remove it forcibly. The primary outcome was success of conservative treatment, defined by uterine preservation. The secondary outcome was a composite measure of severe maternal morbidity including sepsis, septic shock, peritonitis, uterine necrosis, fistula, injury to adjacent organs, acute pulmonary edema, acute renal failure, deep vein thrombophlebitis or pulmonary embolism, or death.RESULTS: Of the 40 university hospitals that agreed to participate in this study, 25 institutions had used conservative treatment at least once (range 1-46) and had treated a total of 167 women. Conservative treatment was successful for 131 of the women (78.4%, 95% confidence interval [ CI] 71.4-84.4%); of the remaining 36 women, 18 had primary hysterectomy and 18 had delayed hysterectomy (10.8% each, 95% CI 6.5-16.5%). Severe maternal morbidity occurred in 10 cases (6.0%, 95% CI 2.9-10.7%). One woman died of myelosuppression and nephrotoxicity related to intraumbilical methotrexate administration. Spontaneous placental resorption occurred in 87 of 116 cases (75.0%, 95% CI 66.1-82.6%), with a median delay from delivery of 13.5 weeks (range 4-60 weeks).CONCLUSION: Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources. (Obstet Gynecol 2010;115:526-34)