PDF(Pubmed)
Abstract：
A 31-year-old female sought termination of pregnancy due to a fetal body stalk anomaly diagnosed at 18 weeks of gestation. Despite an anterior placenta previa, successful vaginal delivery occurred. However, placental adhesion over a previous cesarean scar occurred, and part of the placenta could not be removed. Immediate postpartum bleeding prompted imaging studies, revealing extravasation from adherent placental remnants. Uterine artery embolization (UAE) provided initial hemostasis, but recurrent bleeding necessitated re-embolization. Although conservative treatment was initially pursued, significant hematuria prompted reevaluation, revealing extensive uterine wall and bladder penetration. Surgical intervention with total hysterectomy and partial bladder resection was performed, leading to the successful recovery of bladder function following surgical repair. While this case achieved a positive outcome, there is a potential for permanent urinary dysfunction if lesions are more extensive. While achieving a conservative cure is ideal, it is essential to assess the timing for opting for surgical intervention.
摘要：
一名31岁的女性因妊娠18周时诊断出胎儿体柄异常而寻求终止妊娠。尽管有前置胎盘,阴道分娩成功。然而,胎盘粘连发生在先前的剖宫产瘢痕上，部分胎盘无法切除。立即产后出血提示影像学检查，从粘附的胎盘残留物中发现外渗。子宫动脉栓塞术（UAE）提供初始止血，但复发性出血需要再次栓塞.虽然最初采取保守治疗，显著血尿提示重新评估，显示广泛的子宫壁和膀胱渗透。进行了全子宫切除术和膀胱部分切除术的手术干预，导致手术修复后膀胱功能的成功恢复。虽然此案取得了积极成果，如果病变更广泛，则有可能发生永久性泌尿功能障碍。虽然实现保守治疗是理想的，评估选择手术干预的时机至关重要。
