凶险型前置胎盘6例临床分析

目的分析植入性凶险型前置胎盘对母婴的危害性,提高对植人性凶险型前置胎盘的认识。方法回顾分析本院6例植入性凶险型前置胎盘患者的『临床资料,总结植入性凶险型前置胎盘处理经验。结果6例患者均术前B超检查以及术中检查明确诊断植入性凶险型前置胎盘,均以剖宫产结束妊娠,均发生产后出血,术中出血约3800～13000ml,平均出血量约6800ml。子宫切除4例,其中1例子宫切除术后10天并发腹腔再次出血,膀胱修补1例,早产儿6例,新生儿窒息4例,其中3例为轻度窒息,1例重度窒息。结论植入性凶险型前置胎盘对母儿危害大,应提高认识,及时识别,做好充分准备（包括介人）以减少母婴并发症。     

凶险性前置胎盘并发胎盘植入的临床分析

目的探讨凶险性前置胎盘并胎盘植入的危险因素、特点、治疗方法和结局。方法将2010-02—2014-10间因胎盘前置入院诊治的36患者纳入做为观察组,抽取同期38例非凶险性前置胎盘患者做为对照组,对比2组患者临床诊疗过程和结局。结果观察组患者的怀孕次数、流产≥3次例数、完全型胎盘位置出现率、子宫瘢痕等各项指标高于对照组。围术期出血量、胎盘植入、胎盘粘连及休克发生率均高于对照组,早产、产后出血以及新生儿窒息等发生率均高于对照组,2组比较,差异均有统计学意义(P0.05)。结论凶险性胎盘前置的危险因素包括孕次、流产次、瘢痕子宫、完全型前置胎盘等。前置胎盘孕产妇孕期出血应高度警惕胎盘植入的可能性,应注重预防,提高分娩前诊断率,及时处理,保证母儿安全。     

剖宫产产后出血的危险因素分析

目的探究剖宫产产后出血的危险因素。方法对本院508例行剖宫产的患者的临床资料进行回顾,分析可能与剖宫产产后出血相关的危险因素。结果 508例剖宫产分娩的产妇中发生产后出血的有45例(8.9%,45/508)。不同病理特征分组的组间分析结果显示:高龄、多胎妊娠、多次流产史、妊娠期高血压、胎盘早剥、前置胎盘和子宫切口撕裂均是产妇行剖宫术分娩后产后出血的重要危险因素。单因素分析和多因素回归分析结果显示:前置胎盘、多胎妊娠、子宫切口撕裂和胎盘早剥是剖宫产产后出血的独立危险因素(P0.05)。结论前置胎盘、多胎妊娠、子宫切口撕裂和胎盘早剥是剖宫产产后出血的独立危险因素。     

剖宫产术中宫颈捆扎加正方形缝合预防中央性前置胎盘产后出血

目的探讨剖宫产术中宫颈捆扎加正方形缝合预防中央性前置胎盘产后出血的效果。方法 研究组中央性前置胎盘34例,在暂时阻断子宫血流下行子宫下段和(/或)宫颈内口局部正方形缝合以预防中央性前置胎盘剖宫产后大出血,必要时加行子宫动脉下行支结扎。26例中央性前置胎盘患者为对照组,采用常规方法预防产后出血。结果研究组在平均出血量、平均手术时间、宫腔填纱率、子宫切除率以及产褥病率方面均明显优于对照组(P0.05或P0.01)。术后56~60 d B超检查两组子宫复旧情况,研究组32例(94.1%)子宫复旧良好,对照组20例(90.0%)恢复正常,组间比较无统计学差异(P0.05)。结论该方法具有安全、止血快、效果可靠、能保留子宫等优点,是预防中央性前置胎盘剖宫产出血的可靠方法。     

前置胎盘所致产后出血病例分析

目的探讨前置胎盘孕妇分娩时产后出血的发生率、处理方法及并发症等。方法回顾性分析2009年1月至2012年6月间在北京协和医院分娩的前置胎盘患者的临床资料。记录患者年龄、孕产史、临床表现、分娩方式、术中出血及发生产后出血的孕妇的高危因素、术中处理及并发症等情况。结果 2009年1月至2012年6月间在北京协和医院分娩9,086例患者,前置胎盘患者共222例,发生率为2.4%,其中边缘性前置胎盘174例,完全性前置胎盘34例,部分性前置胎盘14例。222例前置胎盘患者发生产后出血39例(17.6%),无死亡病例。产后出血患者中12例通过宫缩剂及子宫按摩加强宫缩有效,4例患者通过加强宫缩及局部多点8字缝合止血。其余患者在加强宫缩基础上进行其他操作,11例行宫腔填塞治疗(6例行宫纱宫腔填塞,5例行Bakri球囊宫腔填塞),8例行B-Lynch缝合术,2例行子宫动脉栓塞术,2例行全子宫切除术。发生弥漫性血管内凝血(DIC)者4例,术后发热者2例。前置胎盘产后出血患者术后平均住院日为5.0d。39例产后出血患者中完全性前置胎盘15例,合并胎盘植入或胎盘粘连者13例,前次剖宫产史者5例。结论完全性前置胎盘、合并胎盘植入或胎盘粘连及前次剖宫产史的前置胎盘患者容易发生产后出血,在加强宫缩的基础上行局部缝扎、宫纱宫腔填塞、Bakri球囊宫腔填塞、B-Lynch缝合术、子宫动脉栓塞术及全子宫切除术阶梯性治疗是治疗前置胎盘所致产后出血的有效方法。     

子宫动脉栓塞术治疗凶险性前置胎盘伴胎盘植入临床分析

目的探讨子宫动脉栓塞术治疗凶险性前置胎盘伴胎盘植入的临床效果。方法选取48例凶险性前置胎盘伴胎盘植入患者,根据治疗方法不同分为2组。观察组(30例)行子宫动脉栓塞术治疗,对照组(18例)实施缩宫素、纱布或明胶海绵填塞及按摩子宫等常规止血措施。比较2组的治疗效果。结果 2组患者产后出血量及产褥感染率比较,差异无统计学意义(P0.05)。但观察组术中出血量、子宫切除率均低于对照组,差异有统计学意义(P0.05)。结论子宫动脉栓塞术治疗凶险性前置胎盘伴胎盘植入,可显著控制术中出血量,降低子宫切除率,效果确切。     

前置胎盘、胎盘粘连及胎盘植入与人工流产的关系研究

目的：研究前置胎盘、胎盘粘连及胎盘植入与人工流产的相关性。方法对入我院进行分娩的3280例孕妇资料进行分析,选择其中342例发生胎盘异常孕妇进行研究,包括未经人工流产和人工流产的孕妇前置胎盘、胎盘粘连及胎盘植入的发生率;人工流产的次数与前置胎盘、胎盘粘连及胎盘植入的关系以及围产期感染相关因素的研究。结果未经人工流产孕妇胎盘总的异常率为3.7%,人工流产孕妇胎盘总的异常率为14.3%,两组胎盘异常总发生率比较显著差异（P＜0.05）;流产次数越多,胎盘异常发生率随着次数增高而增高;围产期感染与产前贫血、宫腔感染和产妇营养不良关系密切（P＜0.05）。结论前置胎盘、胎盘粘连及胎盘植入与人工流产的关系密切,多次人工流产易导致胎盘异常情况的发生,又易由于胎盘异常导致产后出血,育龄女性应尽量避免人工流产。     

l例胎盘植入并存晚期产后出血患者的护理

对1例胎盘植入并存晚期产后出血患者进行化疗、输血、对症治疗及护理，结果患者阴道出血减少，各项生化指标恢复正常，宫颈管内坏死组织完全脱落，达到临床治愈。提出加强心理护理和药物治疗及对症护理是治疗成功的关键。     

194例前置胎盘剖宫产手术的麻醉分析

我院于 1995年 1月～ 2 0 0 0年 12月实施剖宫产手术6 310例 ,其中 194例 (3% )为前置胎盘病人。有资料表明[1,2 ] ,对于择期剖宫产手术病人 ,采用硬膜外麻醉 ,术中出血量明显要少于全麻。而手术选择何种方式麻醉尚存有争论[3 ] 。通过回顾性分析 ,认为前置胎盘病人的择期手术适合采用硬膜外麻醉。资料与方法一般资料　 194例前置胎盘剖宫产病人 ,经阴道分娩的低置胎盘和边缘型前置胎盘病人除外 ,所收集到的资料包括孕妇年龄、体重、产次、孕龄、麻醉方式、有无阴道出血、术前血红蛋白浓度、术前出血量、术中出血量、晶体输入量 ,术后血红蛋…     

腹主动脉球囊阻断术在凶险性前置胎盘合并胎盘植入产妇剖宫产术中的应用效果分析

目的 探讨腹主动脉球囊阻断术(IABO)在凶险性前置胎盘合并胎盘植入产妇剖宫产术中的应用效果及安全性.方法 回顾性分析濮阳市妇幼保健院妇产科2017-09—2020-03收治的52例凶险性前置胎盘合并胎盘植入并行剖宫产产妇的临床资料,年龄(31.23±3.81)岁,孕周(37.46±0.48)周.以开始行IABO的时间...     

Laparoscopic-assisted vaginal hysterectomy in a patient with placenta percreta

Placenta percreta is a problem encountered with increasing frequency due to the rising rate of cesarean delivery. Conservative management of this condition is associated with decreased perioperative morbidity. When hysterectomy is necessary, a laparoscopic approach can provide additional benefits. We present the case of a woman with placenta percreta with bladder invasion who was undergoing conservative management and then required delayed hysterectomy. Laparoscopic-assisted vaginal hysterectomy was successfully performed. We review the techniques used to ensure a good outcome and the advantages of a minimally invasive approach to hysterectomy in this patient with placenta percreta.     

Anaesthesia for abnormally invasive placenta: a single-institution case series

BackgroundAbnormally invasive placenta describes a spectrum of disorders resulting in pathological placental implantation. It is associated with the potential for severe maternal haemorrhage and poor fetal outcome. Increasing numbers of women are at risk owing to the rising incidence of uterine surgery and increasing maternal age. We report data over a five-year period describing anaesthetic management of cases of abnormally invasive placenta in a UK tertiary-referral maternity unit and assess how management has developed.MethodsSurgically confirmed cases of abnormally invasive placenta were identified from January 2011 to January 2016. Cases were identified using standard ICD-10 codes and by review of departmental records, with surgically-confirmed cases included following review of medical records.ResultsForty cases of abnormally invasive placenta were identified. Eighteen (40%) women had significant medical co-morbidity. All parturients were delivered by caesarean delivery. Caesarean hysterectomy occurred in 24 (60%) cases, delayed hysterectomy in two (5%) and the uterus was preserved in the remaining 14 (35%). Thirty-eight (95%) caesarean deliveries were commenced under neuraxial anaesthesia with 17 (45%) converted to general anaesthesia intraoperatively. Interventional radiology was undertaken in 23 (58%) cases. Median [range] estimated blood loss was 1700 mL [500–12000 mL]. Intraoperative transfusion of packed red cells occurred in 14 (35%) cases. Intraoperative cell salvage was used in 26 (65%) cases. Four (10%) women were admitted to critical care postoperatively. There were no maternal deaths.ConclusionOur data illustrate the burden on healthcare resources associated with management of abnormally invasive placenta, underlining the continued need for centralised services for treatment of these complex cases. An integrated multidisciplinary approach to case planning, case management and service provision is key to a successful outcome in these cases.     

Pregnant noncommunicating rudimentary uterine horn with placenta percreta.

BACKGROUND: To report a placenta percreta in a 7-week gestational rudimentary noncommunicating uterine horn pregnancy. METHODS: A 28-year-old woman with no complaints presented with a rudimentary uterine horn pregnancy at 7-weeks gestation. The diagnosis was suspected by ultrasonography and diagnosed by laparoscopy. Laparoscopic excision of the rudimentary uterine horn and ipsilateral salpingectomy were performed, as well as biopsy of several peritoneal endometriosis lesions. RESULTS: A 7-week gestation pregnancy with placenta percreta was identified in the rudimentary uterine horn. No communication was found with the right unicornuate uterus. Endometriosis was confirmed. Clinical outcome was favorable. CONCLUSION: Placenta percreta may occur in rudimentary uterine horn pregnancies, but accidents may be avoided by an early diagnosis and surgical management. However, in young women who desire pregnancy, planned laparoscopic resection of a rudimentary uterine horn revealed accidentally should be discussed.     

Sciatic nerve ischaemia after iliac artery occlusion balloon catheter placement for placenta percreta

Placenta percreta is a complex obstetric condition and a cause of life-threatening peripartum haemorrhage. National guidelines advise preoperative placement of internal iliac artery occlusion balloon catheters in such cases to reduce haemorrhage, avoid caesarean hysterectomy and preserve fertility. Maternal complications of prophylactic occlusion balloon catheter insertion include puncture-site complications and arterial thrombosis, the signs of which are usually immediately clinically evident. Presentation of ischaemic nerve injury attributable to iliac artery thrombosis secondary to the presence of an occlusion balloon catheter is as yet unreported. Awareness of this possible complication and local unit guidelines may allow early detection and treatment.     

Multiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta

The incidence of placenta praevia/accreta is increasing, placing women at significant risk of postpartum haemorrhage with associated morbidity and mortality. National guidelines recommend prophylactic placement of internal iliac artery balloon occlusion catheters for women with abnormal placentation. We describe an elective caesarean delivery in a patient with placenta percreta who underwent this technique. She developed bilateral pseudoaneurysms, unilateral arterial rupture and compromised vascular supply to her right leg secondary to thrombus formation, and suffered massive haemorrhage, both despite and as a result of intervention. This is the first case report of multiple complications in an obstetric patient after temporary internal iliac balloon occlusion in an elective setting.     

胎盘粘连98例临床分析

目的探讨引起胎盘粘连的相关因素,总结其预防及处理方法。方法回顾性分析2006年1月～2010年12月在笔者所在保健院住院分娩诊断为胎盘粘连（包括胎盘植入）的98例患者的产科情况。结果胎盘粘连的发生跟刮宫次数呈正相关,其发生可能与子宫内膜损伤、病变有密切关系。结论胎盘粘连可引起产后出血等严重并发症,临床工作者应严格宫腔操作,避免损伤子宫内膜,预防和减少胎盘粘连的发生。     

凶险性前置胎盘合并胎盘植入剖宫产术中腹主动脉远端球囊阻断的临床疗效

目的分析剖宫产术中腹主动脉远端球囊阻断对于治疗凶险性前置胎盘合并胎盘植入的临床疗效。方法回顾性分析72例凶险性前置胎盘合并胎盘植入产妇的资料。其中53例(阻断组)于剖宫产术前预留腹主动脉球囊导管,术中暂时阻断腹主动脉血流;19例(未阻断组)未留置腹主动脉球囊导管,直接行剖宫产手术。比较2组术中、术后情况及新生儿情况。结果球囊阻断组术中出血量、术中输血量、子宫切除率均低于未阻断组(P均0.05),2组间术后转入重症监护室(ICU)的比例及ICU住院时间差异均有统计学意义(P均0.05),手术时间、术后感染发生率及术后住院总时间差异均无统计学意义(P均0.05)。2组间新生儿体质量及出生后5min、10min的Apgar评分差异均无统计学意义(P均0.05)。结论凶险性前置胎盘合并胎盘植入剖宫产术中行腹主动脉远端球囊阻断安全可行,可有效减少术中出血及输血量,降低子宫切除率。