经皮冠状动脉介入术后4个月妊娠伴穿透性胎盘植入围手术期管理一例

Perioperative management of placenta percreta in a woman four months after percutaneous coronary intervention

本文报告了1例经皮冠状动脉介入治疗术后穿透性胎盘植入病例。该患者在经皮冠状动脉介入术后4个月发现妊娠,超声提示“中央性前置胎盘,穿透性胎盘植入”。因担心射线及药物对胎儿的不良影响,患者强烈要求终止妊娠。经多学科会诊,术前使用替罗非班替代双联抗血小板药物并放置腹主动脉球囊,术中将穿透达浆膜的胎盘去除并行子宫修复成形术,术后予预防感染、抗凝及过渡抗血小板药物等治疗。患者于术后第6天出院。

A patient was pregnant four months after the percutaneous coronary intervention,and the ultrasound indicated a complete placenta previa and a placenta percreta.Concerned about radiation and drugs exposure on the fetus,the patient chose to terminate the pregnancy.After multidisciplinary consultation,tirofiban was used for antithrombotic therapy in substitution for dual antiplatelet drugs,and an abdominal aortic balloon was inserted preoperatively.The placenta that penetrated the serous membrane and uterine wall at laparotomy was resected,and the uterus was reconstructed.Prophylactic antibiotics,anticoagulation,and transitional antiplatelet therapy with tirofiban were given after the operation.The patient was discharged on day six postoperatively.