妊娠晚期剖宫产切口瘢痕胎盘植入9例分析

Placenta accreta on the postoperative scar after previous caesarean section in late pregnancy:an analysis of 9 cases

目的:探讨妊娠晚期剖宫产切口瘢痕胎盘植入的诊治。方法:对2000年1月至2010年7月收治的9例妊娠晚期剖宫产切口瘢痕胎盘植入的临床诊治资料进行回顾性分析。结果:5例经保守治疗后于孕32～35周手术终止妊娠,4例在充分术前准备下行剖宫产术;9例均出现产后出血,1例粘连型胎盘植入者行子宫动脉结扎术,6例植入型和2例穿透型胎盘植入者均行子宫切除术;无孕产妇病死;早产5例,足月产2例,围生儿病死2例。结论:积极准确的诊断和有效的治疗是治疗晚期妊娠剖宫产切口瘢痕胎盘植入患者的关键。

Objective： To evaluate the diagnosis and treatment of the placenta accreta on the postoperative scar after previous caesarean section in late pregnancy. Methods：A retrospective study was conducted in 9 cases with placenta accreta on the postoperative sear after previous caesarean section in late pregnancy from Jan. 2000 to Jul. 2010. Results： Five cases were performed termination of pregnancy after conservative treatment during 32 - 35 weeks pregnancy and 4 cases were performed cesarean section after adequate preoperative preparation. All the 9 cases suffered from postpartum hemorrhage. One case with placental adherence underwent uterine artery ligation, and the other 6 cases with placenta accreta and 2 cases with placenta percreta received hysterectomy. No death occurred in the pregnant or lying-in women. Premature birth was observed in 5 infants and full term birth in 2 infants ; perinatal deaths occurred in 2 infants. Conclusions：Accurate diagnosis and effective therapeutic procedure are essential for treatment of placenta accreta on the postoperative scar after previous caesarean section in late pregnancy.