Placenta previa increta/percreta in Japan: A retrospective study of ultrasound findings, management and clinical course
Placenta previa increta/percreta in Japan: A retrospective study of ultrasound findings, management and clinical course
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DOI：
10.1111/j.1447-0756.2007.00619.x
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发表时间：
2007-10-01
影响因子：
1.6
通讯作者：
Kikkawa, Fumitaka
中科院分区：
文献类型：
--
作者：
Sumigama, Seiji;Itakura, Atsuo;Kikkawa, Fumitaka
目的：胎盘植入是胎盘绒毛异常牢固地附着在子宫壁上，可引起产后出血，导致产妇发病和死亡。本研究的目的是澄清的发病率，临床背景和预后的前置胎盘植入/percreta治疗不同models.Methods：病例前置胎盘植入/percreta在8个三级中心1994年1月至2004年12月的病历进行了审查。经病理学证实未实际侵入子宫肌层的植入性胎盘不包括在植入性/渗透性胎盘中。结果：在59008例分娩中，阴道分娩45261例（76.7%），剖宫产13747例（23.3%）。前置胎盘408例（0.69%），其中植入性胎盘18例，穿透性胎盘5例。无剖宫产史的前置胎盘只有1.1%发生植入/植入，而有剖宫产史的前置胎盘为37%。平均术中失血量为3630 +/-2216 g（increta）和12140 +/-8343 g（percreta）。1例前置胎盘植入患者因出血死亡。4例采用不剥离胎盘剖宫产、动脉栓塞及子宫切除等分步治疗，出血量最少。结论：前置胎盘植入/渗漏是一种危及生命的疾病。子宫动脉栓塞后行子宫切除术的患者术中失血量减少，应结合此治疗以降低孕产妇发病率。
Aim: Placenta accreta is an abnormally firm attachment of placental villi to the uterine wall, which may cause postpartum hemorrhage resulting in maternal morbidity and mortality. The purpose of the present study was to clarify the incidence, clinical background and prognosis of placenta previa increta/percreta treated with different modalities in Japan.Methods: Medical records of cases with placenta previa increta/percreta in eight tertiary centers between January 1994 and December 2004 were reviewed. Placenta accreta without actual invasion into the myometrium confirmed by pathology was not included in placenta increta/percreta. Details of obstetric history, maternal background, ultrasonographical findings, the course of delivery, subsequent complications and management were noted.Results: Among the total of 59 008 deliveries, 45 261 were by the vaginal route (76.7%) and 13 747 by cesarean section (23.3%). In this study, 408 cases were diagnosed as placenta previa (0.69%), 18 of these being placenta increta and 5 placenta percreta. Only 1.1% of cases of placenta previa without prior cesarean section were increta/percreta, in contrast to 37% of placenta previa after prior cesarean sections. Mean intraoperation blood loss was 3630 +/- 2216 g (increta) and 12 140 +/- 8343 g (percreta). One patient with placenta previa percreta died of hemorrhage. Stepwise treatment (cesarean section without separation of the placenta, arterial embolization and hysterectomy) was applied for 4 cases, which had the least blood loss.Conclusions: Placenta previa increta/percreta is a life-threatening disease. Patients who undergo hysterectomy after uterine arterial embolization demonstrate reduced intraoperation blood loss, and this treatment should be incorporated to reduce maternal morbidity.