凶险性前置胎盘一例诊治体会

Experience of diagnosis and treatment of pernicious placenta previa: a case report

随着剖宫产率的增加,凶险性前置胎盘合并胎盘植入的几率也随之增加,由于产时胎盘剥离困难,导致产后大出血,是产科严重的并发症之一。该文报道1例既往有剖宫产史患者,此次妊娠为前置胎盘,孕晚期出现无痛性阴道大量流血,急诊行剖宫产手术,胎盘剥离处大量出血,出现失血性休克及DIC,术中止血均不能奏效,实施多学科协助抢救,最终切除子宫,术后转入ICU。术后病理检查提示子宫胎盘粘连并胎盘植入改变。虽然最终母女平安,但是患者却因此切除了子宫,丧失了再生育能力。因此,对有高危因素的产妇,临床医师应提高警惕性,可由经验丰富的医师进行反复多方位检查,做到早期诊断,减少漏诊及误诊率。

The risk of pernicious placenta previa complicated with placenta accreta has been elevated along with the increase of cesarean section rate.Due to the difficulty of placental stripping,postpartum hemorrhage is one of the serious complications of obstetrics.In this article,we reported one case of placenta previa with a medical history of cesarean section.The patient presented with painless and massive vaginal bleeding during the late stage of pregnancy.She underwent emergent cesarean section.Intraoperatively,she suffered from massive bleeding,hemorrhagic shock and disseminated intravascular coagulation.Intraoperative massive bleeding could not be controled after multidisciplinary emergent treatment.Eventually,she had to undergo hysterectomy and was transferred to the intensive care unit.Postoperative pathological examination prompted the coexistence of placental adhesion and placenta accreta.The mother and infant were both safe.However,she lost the reproduction capability due to uterine removal.Consequently,extensive attention and comprehensive examinations should be performed by experienced obstetricians to make early diagnosis and reduce the missing and misdiagnosis rate of pernicious placenta pevia.