背景:胎盘植入谱可导致围产期无法控制的大出血。目前,全球推荐的胎盘植入频谱的一线治疗是子宫切除术.然而,子宫切除术后的不良结局,包括手术并发症,如执行手术困难和后遗症,如不孕症和心理问题不容忽视。已经提出了几种用于保守治疗的手术方法。关于有效性的报告很少,安全,保守治疗的长期并发症,尤其是随后的妊娠结局。
目的:本研究旨在调查接受保守性手术的胎盘植入患者的临床结局并确定后续妊娠的危险因素。
方法:本研究对郑州大学第一附属医院2011年至2019年剖宫产合并胎盘植入谱保守治疗后再次妊娠病例进行回顾性队列研究,以确定再次妊娠的临床结局及不良妊娠结局的危险因素。
结果:(1)本研究共纳入883例保守性手术患者,其中604例(68.4%)成功随访。(2)72例成功妊娠75例,包括22个短期或短期交付,1个引产在孕中期,6例(8%)剖宫产瘢痕妊娠,2例异位妊娠,和44例早孕(3例流产和41例选择性流产,12次医疗流产和32次真空抽吸)。(3)在22个完整或近期分娩中,所有新生儿均存活。5例(22.7%)胎盘植入谱,6例前置胎盘病例。产后出血2例,发病率为9.1%。(4)所有参数,包括以后怀孕的年龄,妊娠,剖宫产次数,以前胎盘植入光谱的类型,终止妊娠的孕周,妊娠间隔,未发现使用血管闭塞技术与复发性PAS和剖宫产瘢痕妊娠相关。
结论:基于这些发现,该研究的结论是,对胎盘植入谱的保守治疗不会自动排除随后的妊娠。然而,患者应充分了解PAS复发的风险,疤痕妊娠,产后出血。
Placenta accreta spectrum can lead to uncontrollable massive hemorrhage in the perinatal period. Currently, the first-line treatment for placenta accreta spectrum recommended worldwide is hysterectomy. However, adverse outcomes after hysterectomy, including surgical complications, such as difficulty in performing the procedure, and sequelae, such as infertility and psychological issues, cannot be ignored. Several surgical approaches for conservative treatment have been proposed. There are few reports on the effectiveness, safety, and long-term complications of conservative treatments, especially subsequent pregnancy outcomes.
This
study aimed to investigate the clinical outcomes and identify risk factors of subsequent pregnancies among patients with placenta accreta spectrum who had undergone conservative surgery.
This was a retrospective cohort
study of subsequent pregnancy cases after cesarean delivery with conservative treatment for placenta accreta spectrum from 2011 to 2019 at The First Affiliated Hospital of Zhengzhou University to identify clinical outcomes of subsequent pregnancies and the risk factors of adverse pregnancy outcomes.
A total of 883 patients undergoing conservative surgery were included in this
study, among which 604 (68.4%) were successfully followed up. There were 75 successful pregnancies in 72 patients, including 22 full-term or near-term deliveries, 1 induced labor in the second trimester of pregnancy, 6 cesarean scar pregnancies (8.0%), 2 ectopic pregnancies, and 44 first-trimester pregnancies (3 miscarriages and 41 elective abortions and 12 medical abortions and 32 vacuum aspirations). All newborns survived in the 22 full-term or near-term deliveries. Moreover, 5 placenta accreta spectrum cases (22.7%) and 6 placenta previa cases were observed. Postpartum hemorrhage was observed in 2 cases, with an incidence rate of 9.1%. All parameters, including age at subsequent pregnancy, gravidity, number of cesarean deliveries, type of previous placenta accreta spectrum, gestational week of pregnancy termination, interpregnancy interval, and the use of vascular occlusion techniques, were not found to be associated with recurrent placenta accreta spectrum and cesarean scar pregnancy.
Our findings show that treatment for placenta accreta spectrum does not automatically preclude a subsequent pregnancy. However, patients should be fully informed about the risk of recurrent placenta accreta spectrum, scar pregnancy, and postpartum hemorrhage.