Trends, characteristics, and outcomes of conservative management for placenta percreta
Trends, characteristics, and outcomes of conservative management for placenta percreta
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穿透性胎盘保守治疗的趋势、特征和结果
DOI：
10.1007/s00404-021-06384-1
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发表时间：
2022
影响因子：
2.6
通讯作者：
Matsuo Koji
中科院分区：
文献类型：
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作者：
Youssefzadeh Ariane C.;Matsuzaki Shinya;Mandelbaum Rachel S.;Sangara Rauvynne N.;Bainvoll Liat;Matsushima Kazuhide;Ouzounian Joseph G.;Matsuo Koji
目的探讨无子宫切除剖宫产(CD)行保守治疗的植入胎盘妇女的趋势、特点和结局。研究人群包括2015年10月10日至2018年12月12日期间接受CD检查的被诊断为植入胎盘的妇女。结果共检查1055例患者，其中790例(74.9%)行CD子宫切除术，265例(25.1%)行保守治疗。在研究期间，CD的子宫切除效果从71.4%增加到93.8%(P<； 0.001)。在多变量分析中，较新的植入性胎盘CD病例不太可能采取保守治疗[调整后的优势比(AOR)/年-季度0.93，95%可信区间(CI)0.89-0.97]。相比之下，中小床位容量(AOR 1.72，95%CI 1.18-2.51)、非城市教学环境(AOR 1.76，95%CI 1.14-2.70)、位于中西部(AOR 2.55，95%CI 1.56-4.17)的医院更倾向于保守治疗CD。较晚的胎龄也与保守治疗的可能性较高相关(中位数胎龄，36周比34周，P<； 0.001)。与剖宫产组相比，保守治疗组入院时手术并发症发生率较低(47.2%比75.9%，AOR 0.35，95%CI 0.26~0.48)。
PurposeTo examine trends, characteristics, and outcomes of women with placenta percreta who had conservative management at cesarean delivery (CD) without hysterectomy.MethodsThis is a retrospective cohort study querying the National Inpatient Sample. The Study population was comprised of women with diagnosis of placenta percreta who underwent CD from 10/2015–12/2018. Characteristics and surgical outcome of women who had hysterectomy at time of CD were compared to those who did not (conservative management) in multivariable analysis.ResultsA total of 1055 cases were examined, of which 790 (74.9%) received hysterectomy at CD and the remaining 265 (25.1%) had conservative management without hysterectomy. During the study period, performance of hysterectomy at CD increased from 71.4% to 93.8% (P< 0.001). In multivariable analysis, more recent cases of CD for placenta percreta were less likely to have conservative management [adjusted-odds ratio (aOR) per year-quarter 0.93, 95% confidence interval (CI) 0.89–0.97]. In contrast, hospitals with small-medium bed capacity (aOR 1.72, 95% CI 1.18–2.51), non-urban teaching setting (aOR 1.76, 95% CI 1.14–2.70), and located in the Midwest (aOR 2.55, 95% CI 1.56–4.17) were more likely to offer conservative management at CD. Later gestational age was also associated with a higher likelihood of conservative management (median gestational age, 36 versus 34 weeks,P< 0.001). Women in the conservative management group experienced lower measured surgical morbidity during the admission compared to those in the cesarean hysterectomy group (47.2% versus 75.9%, aOR 0.35, 95% CI 0.26–0.48).ConclusionThe clinical practice for placenta percreta appears to be shifting to upfront hysterectomy at the time of CD.