胎盘植入发病机制的研究进展

Research progress on pathogenesis of placenta accreta spectrum

胎盘植入是指胎盘滋养层细胞直接侵入子宫肌层的情况,是产科极为凶险的并发症之一。近年来,胎盘植入发病率不断增高,已成为目前导致产后出血、围产期紧急子宫切除及孕产妇死亡的重要原因。然而,胎盘植入的发病机制仍不清楚。目前研究认为,胎盘植入的发生与蜕膜缺失、滋养细胞侵袭力增强、子宫螺旋动脉重铸异常有关,这三方面互相作用、互相影响,共同导致胎盘植入的形成。本文将对这三方面内容进行综述,总结胎盘植入发生的病生理基础。

Placenta accreta spectrum(PAS)refers to the condition that placental trophoblast cells directly invade the myometrium,which is one of the most dangerous complications in obstetrics,but the pathogenesis has not been clarified.In recent years,the incidence of PAS was increasing,which has become the major reason leading to postpartum hemorrhage,perinatal emergency hysterectomy and maternal death.Available studies suggested that the occurrence of PAS was related to the following three interconnected factors:the loss of decidual membrane,enhanced trophoblast invasiveness and abnormal recasting of uterine spiral artery.This review focused on these three factors and tried to illustrate the pathophysiology of PAS.