目的:胎盘植入谱(PAS)障碍最常见的治疗方法是计划性剖宫产子宫切除术。然而,其他管理策略可能会改善结果和/或允许保留生育力.这项研究的目的是描述通过将胎盘留在原位来管理PAS患者的过程和结果。
方法:这是2015年至2022年在美国的一个学术中心通过将胎盘留在原位来管理的11例PAS患者。所描述的方法包括通过剖宫产分娩胎儿,没有试图去除胎盘,关闭子宫切开术,预防性静脉注射抗生素长达1周,结束门诊随访直至子宫排空.
结果:子宫成功保存了六个(55%),4例(36%)进行了微创子宫切除术,1例(9%)进行腹式子宫切除术。剖宫产期间,中位估计失血量为650mL(范围:200~1,000mL).大多数患者分娩后几周没有阴道分泌物,接着是棕色或血腥的分泌物,间歇性轻度至中度抽筋.成功保存子宫的患者的PAS消退的中位时间为18周(范围:5-25周)。子宫切除术的适应症包括出血(n=1),凝血病(n=1),子宫内膜炎(n=2),和疼痛(n=1),这些发生在产后5周的中位数(范围:1-25周)。四名患者随后怀孕,其中三名是活产或近足月,一名是19周时的自然流产。
结论:对于一些精心选择和咨询的PAS患者,将胎盘原位放置可能是一种合适的管理策略。
结论:·总体而言,55%有子宫保存(6/11)。.·80%的子宫切除术的微创方法(4/5)。.·患者,67%的子宫保存者随后怀孕(4/6)。.
The most common treatment for placenta accreta spectrum (PAS) disorders is planned primary cesarean hysterectomy. However, other management strategies may improve outcomes and/or allow fertility preservation. The objective of this study was to describe the course and outcomes of patients with PAS managed by leaving the placenta in situ.
This is a series of 11 patients with PAS managed by leaving the placenta in situ at a single academic center in the United States from 2015 to 2022. The approach described involves delivery of the fetus via cesarean, no attempt at placental removal, closure of the hysterotomy, prophylactic intravenous antibiotics for up to 1 week, and close outpatient follow-up until the uterus is empty.
The uterus was successfully preserved in six (55%), minimally invasive hysterectomy was performed in four (36%), and abdominal hysterectomy was performed in 1 (9%). During cesarean delivery, the median estimated blood loss was 650mL (range: 200-1,000mL). The majority of patients had no vaginal discharge for several weeks after delivery, followed by brown or bloody discharge, and intermittent mild-to-moderate cramping. The median time to resolution of PAS was 18 weeks in patients with successful uterine preservation (range: 5-25 weeks). Indications for hysterectomy included hemorrhage (n=1), coagulopathy (n=1), endomyometritis (n=2), and pain (n=1), and these occurred at a median of 5 weeks postpartum (range: 1-25 weeks). Four patients had subsequent pregnancies of whom three were live births at or near term and one was a spontaneous abortion at 19 weeks.
Leaving the placenta in situ may be an appropriate management strategy for some carefully selected and counseled patients with PAS.
· Overall, 55% had uterine preservation (6/11).. · Minimally invasive approach in 80% of hysterectomies (4/5).. · Of patients, 67% with uterine preservation had subsequent pregnancies (4/6)..