The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study.
The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study.
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DOI：
10.1111/1471-0528.12405
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Knight M
中科院分区：
文献类型：
--
作者：
Fitzpatrick KE;Sellers S;Spark P;Kurinczuk JJ;Brocklehurst P;Knight M
目的 描述英国植入性胎盘、植入性胎盘和植入性胎盘的处理和结果。设计 一项基于人群的描述性研究，使用英国产科监护系统(UKOS)。设置 所有221家英国医院都设有产科医生主导的产科病房。Popular 在2010年5月至2011年4月期间，英国所有被诊断为植入性胎盘、植入性胎盘和植入性胎盘的女性。方法通过英国疾病控制与预防中心每月邮寄的方式进行 意向病例鉴定。主要观察指标 估计失血量、输血量的中位数。结果 A队列中发现植入胎盘、植入物或胎盘：50%(66/133)的孕妇产前怀疑有胎盘植入、植入物或植入物。在最终诊断为植入性胎盘或排泄物的女性中，产前诊断与出血量减少(中位数估计失血量2750vs6100 ml，P = 0.008)和输血需求减少(59vs94%，P = 0.014)相关，可能是因为产前确诊的女性更有可能对出血采取预防性治疗(74vs52%，P = 0.007)，并且不太可能尝试取出胎盘(59vs93%，P <； 0.001)。为了保全子宫或在子宫切除前不尝试移除任何胎盘，与出血量减少(中位数估计失血量分别为1750vs3700 ml，P = 0.001)和输血需求减少(57%vs86%，P <； 0.001)相关。结论 有植入性胎盘、植入性胎盘或植入性胎盘的妇女，如果为了保全子宫或在子宫切除术前不试图摘除任何胎盘，则出血减少，输血需求减少，支持这一做法的建议。
Objective To describe the management and outcomes of placenta accreta, increta, and percreta in the UK. Design A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). Setting All 221 UK hospitals with obstetrician-led maternity units. Population All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011. Methods Prospective case identification through the monthly mailing of UKOSS. Main outcome measures Median estimated blood loss, transfusion requirements. Results A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001). Conclusions Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.
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