经阴道手术处理中央性胎盘前置状态临床分析

Clinical analysis of central placenta previa percreta successfully treated by the operations through vagina.

目的：探讨持续或反复大量阴道流血的孕中期中央性胎盘前置状态的阴道手术方法。方法：对2例孕中期中央性胎盘前置状态伴持续或反复大量阴道流血患者，分别进行宫颈扩张术、胎盘开窗术、人工破膜术、钳刮术、宫纱填塞术。第1例患者为1胎0产孕20^＋3周～21^＋3周中央性胎盘前置状态，反复大量阴道流血，通过期待治疗8天失败后，采用上述阴道手术，并进行了碎胎术。第2例患者为1胎0产孕26^＋3周-26^＋3周，持续大量阴道流血，抑制宫缩失败，产程发动，宫口开大3cm，行上述阴道手术，并进行了头皮牵引术。结果：成功地完成了上述阴道手术，孕妇术中、术后阴道出血量不多，第1例为200ml，第2例150ml。软产道损伤较轻，第1例3处浅表划痕，第2例宫颈轻度裂伤。结论：对于反复或持续大量阴道流血的孕中期中央性胎盘前置状态的病例，有计划、有准备地经上述阴道手术处理，终止妊娠可能是一种比较安全、有效的治疗方法之一，可避免剖宫手术对孕妇的损伤及诱发再次前置胎盘。

Objective： To determine the operative methods through vagina for the pregnant women with central placenta previa percreta and continual or recurrent and massive vaginal bleeding during the second trimester. Methods： A prospective study was performed on 2 cases of the pregnant women with central placenta previa perereta, who had a continual or recurrent and massive vaginal bleeding during the second trimester, and were operated on a dilatation of cervix, a placenta windowing, an artificial rupture of fetal membranes, a uterine curettage with sponge holding forceps, an intrauterine packing with gauze respectively. The first patients, who was a primigravida between 20 ^＋3 weeks of gestation and 21 ^＋5 weeks of gestation with a recurrent and massive vaginal bleeding and had a failure in a temperization for eight days, was operated on the above operation programs and embryotomy. The second patient, a primigravida between 26 ^＋ 3 weeks of gestation and 26 ^＋4 weeks of gestation with a continual and massive vaginal bleeding and a progress of labor after a failure in inhibiting uterine contraction, was operated on the above operation programs and traction of Willett forceps. Results： The operation through vagina were successfully performed and two patients had a small amount of vaginal bleeding, 200 ml in the first patients and 150 ml in the second one, and a mild damage in the birth canal, superficial streaks of the first patient and the mild damage of the cervix of the second one. Conclusion： For the patients with continual or recurrent and massive vaginal bleeding due to central placenta previa percreta during the second trimester, the operations of termination pregnancy through vagina under the condition of the planned and adequate preparation may be one of safe and effective treatment ways and may avoid the injury and secondary placenta previa induced by cesarean section.