中期妊娠合并胎盘植入的临床分析

Clinical analysis of placenta accreta of the second trimester of pregnancy

目的:探讨中期妊娠合并胎盘植入的临床诊治。方法:回顾分析2005年1月至2015年1月深圳市妇幼保健院收治的中期妊娠合并胎盘植入的30例患者的临床资料,其中胎盘植入最大直径<5cm者22例(A组),最大直径≥5cm者8例(B组)。结果:30例患者中,1例通过核磁共振产前确诊(3%),其余均为分娩后确诊。29例行保守性手术治疗,1例因胎盘植入面积大,子宫动脉栓塞术(UAE)后行药物治疗,治疗过程中出现宫内感染、后因突发出血切除子宫。A组患者中:出血量<1000ml 21例,出血量≥1000ml1例,保守手术者,首选UAE 7例,行宫腔镜电切者9例。B组患者中,出血量<1000ml 3例,出血量≥1000ml 5例,保守手术者,首选UAE 8例,行宫腔镜电切者0例,两组比较,差异有统计学意义(P<0.05)。A组患者中,胎盘植入位于子宫前壁16例,后壁5例,宫底1例;B组胎盘植入子宫前壁5例,后壁3例,宫底0例;两组比较差异无统计学意义(P>0.05)。结论:中期妊娠胎盘植入的诊断存在滞后性,发生后可引起严重后果,对有胎盘植入高危因素的妇女,需引起医务人员的足够重视,尽早干预和诊断,减少严重并发症的发生。中期妊娠胎盘植入的治疗应以保守性治疗为主,胎盘的植入面积及出血量可作为治疗方法的选择依据,保守治疗过程中应重视防治宫内感染的发生。

Objective： To investigate diagnosis and therapy of placenta accrete of the second trimester. Methods： The clinical data of 30 cases of placenta accrete in second trimester of pregnancy in the Affiliated Shenzhen Maternity and Child Healthcare Hospital of the South Medical University was analysed retrospectively from 2005 to 2015. Patients of group A（ 22 cases） ： the largest diameter of placenta accreted 〈5cm,Patients of group B（ 8 cases） ： the largest diameter of placenta accreted≥5cm. Results： Only 1 case（ 3%） was confirmed dignosis with magnetic resonance imaging in antepartum,29 cases were confirmed dignosis after delivered. 29 cases were treated with conservative surgery,1 patient after uterine arterial embolization（ UAE）was performed hysterectomy because of severe intraoperative hemorrhage and postoperative infection. Patients of group A,the amount of bleeding was less than 1000 ml in 21 cases and more than 1000 ml in 1 case,in conservative operation 7 cases were preferred treated with UAE,9 cases were treated with hysteroscopy. Patients of group B,the amount of bleeding was less than1000 ml in 3 cases and more than 1000 ml in 5 case,in conservative operation 8 cases were preferred treated with UAE,0 case was treated with hysteroscopy. The difference was statistically significant（ P〈0. 05）. Patients of group A： placenta accrete was located on the anterior uterine wall in 16 cases,on the posterior wall in 5 cases,on the fundus uteri in 1 case; Patients of group B： placenta accrete was located on the anterior uterine wall in 5 cases,on the posterior wall in 3cases. There was no significant difference between them（ P〉0. 05）. Conclusions： Placenta accreta in second trimester of pregnancy could lead to severe complications with hysteretic diagnosis. Individuals with risk factors for placenta accreta should be investigated early in pregnancy.Bleeding volume and area of placenta could serves as basis for the selection of treatment options. Conservative methods were preferred and intrauterine infection should be attach importance in the treatment of placenta accreta in second trimester of pregnancy.