胎盘植入性疾病的精细化管理

Refined Management of Placenta Accreta Spectrum Disorders

针对胎盘植入性疾病产前漏诊率高、产时并发症发生率高、医疗资源配置不合理以及非本院建档患者就诊困难等难点,从开通胎盘植入性疾病转诊绿色通道,落实风险评估、早期预警,实施门诊和住院多学科协作管理,执行围手术期量化评估、分层管理,改进手术策略等方面,对胎盘植入性疾病进行精细化管理。精细化管理使胎盘植入性疾病患者术前平均住院日缩短,平均术中出血量、子宫切除率降低。下一步,对于胎盘植入超声评分系统的各项指标权重需进一步校正,并将超声和MRI同时应用于胎盘植入性疾病患者术前评估中,还需进一步帮扶指导基层医疗机构对胎盘植入风险进行初步准确评估。

For the problems among patient with Placenta Accreta Spectrum Disorders(PAS)on high rate of prenatal missed diagnosis,high intrapartum complication rate,unreasonable medical resources allocation,and difficulty of treatment without registration,the refined management of PAS was explored by measures on establishment of referral green channel,carrying out the risk assessment and early warning,implementation of outpatient and inpatient multidisciplinary collaborative management,carrying out the perioperative quantitative evaluation and hierarchical management,and improving surgical strategies.The refined management of PAS can shorten the average preoperative hospital stay,decrease the average intraoperative blood loss and hysterectomy rate.In the next step,the weights of all indicators of the ultrasound scoring system for placenta accreta should be further corrected,and ultrasound and MRI should be applied simultaneously in the preoperative evaluation of PAS patients.Further help and guidance should be given to primary medical institutions to conduct a preliminary accurate assessment of the risk of placenta accreta.