中晚孕期胎盘植入32例临床分析

目的探讨中晚孕期胎盘植入的高危因素、诊断、结局与治疗.方法 回顾性分析本院2002年12月至2010年11月32例中晚孕期胎盘植入病例的临床资料.结果 发生率:本院2002年12月至2010年11月的8年间,胎盘植入发生率为0.175%.高危因素:年龄≥35岁占28.1%,有刮宫史者占78.1%,有子宫手术史者占37.5%,前置胎盘者占46.9%.诊断:32例胎盘植入患者中,B超诊断6例、病理诊断19例、临床诊断7例.结局与治疗:32例患者中产后出血20例、失血性休克7例;23例保留子宫,其中9例行子宫动脉栓塞术(UAE)、8例行盆腔动脉结扎术、6例行胎盘植入部分局灶切除术等方式、9例行子宫切除术.结论 胎盘植入的高危因素可能包括高龄、刮宫史、剖宫产史及合并前置胎盘等;对具有高危因素的孕妇产前综合应用彩超、MRI等检查,有可能于分娩前诊断胎盘植入,但目前仍以临床诊断及病理诊断为主;传统治疗方式可选择子宫切除或药物治疗,子宫动脉栓塞术(UAE)是有效治疗胎盘植入的保守性方法.

Clinical analysis of placenta accrete in the second and third trimesters

Objective To investigate the risk factors,diagnosis,outcome and treatments of placenta accrete in the second and third trimesters. Methods A retrospective analysis was made of 32 cases of placenta accreta admitted during December 2002 to November 2010 of the First Affiliated Hospital of Soochow University. Results Among all the patients,the incidence of placenta accreta was 0. 175%. 28. 1% of the cases were no less than 35 years -old,78. 1% of the cases had abortion experiences,37.5% of the cases had uterine opertation experiences, 46. 9% of the cases were found with placenta previa. 6 cases were diagnosed by uhrasonography, 19 cases by biopsy and 7 cases by clinical evidence. Of all the patients, 20 cases had postpartum hemorrhage, 7 cases had uncontrolled hemorrhagic shock. 23 cases were cured by conservative treatment in which 9 cases by uterine artery embolization（UAE） ,8 cases by pelvic artery ligation, 6 cases by focal resection of the placenta increta. 9 cases received cesarean hysterectomy. Conclusions The risk factors of placenta accreta may include advanced age, abortion experiences, uterine opertation experiences and with placenta previa, etc; For those pregnant women who has high risk factors, placenta accreta can possibly be diagnosed by uhrasonography, MRI and so on, but presently placenta accreta is still mainly diagnosed by clinical and pathology; Hysterectomy and drug therapy are traditional methods for treating placenta accreta, uterine artery embolization（UAE） is proved to be an effective conservative method.