背景:胎盘植入谱系障碍(PAS)会导致妊娠的主要并发症。虽然与PAS相关的孕产妇发病率是众所周知的,在这种情况下,关于新生儿发病率的信息较少。这项研究的目的是描述新生儿结局(胎儿畸形,新生儿发病率,双胞胎出生,死产,和新生儿死亡),使用国际多中心PAS病例数据库。
方法:这是一个前瞻性的,基于前瞻性收集病例的多中心队列研究,使用国际PAS协会的国际多中心数据库,2020年1月至2022年6月,由23个有PAS护理经验的中心进行。包括所有PAS病例,无论单胎妊娠还是多胎妊娠,每个中心都根据自己的方案进行管理。数据通过图表审查收集。根据当地政策获得了当地道德委员会的批准和数据使用协议。
结果:有315例妊娠符合纳入条件,有12个双胞胎怀孕,包括329个胎儿/新生儿;2例由于有关胎儿异常的数据不一致而被排除。为了计算新生儿发病率和死亡率,所有选择性终止妊娠均被排除,因此,分析了311例怀孕和323例新生儿。在我们的队列中,3例新生儿(0.93%)死产;在320例新生儿中,新生儿死亡10例(3.13%)。主要先天畸形的患病率为4.64%(15/323新生儿),最常见的是,心血管,中枢神经系统,胃肠道畸形.妊娠合并PAS的主要新生儿发病率为47/311(15.1%)。没有死胎,新生儿死亡,或报告的双胎妊娠胎儿畸形。
结论:尽管在我们的队列中某些结果可能太罕见而无法检测到,并且应谨慎解释数据,我们的观察数据支持PAS患者的新生儿结局令人放心.
BACKGROUND: Placenta accreta spectrum disorders (PAS) lead to major complications in pregnancy. While the maternal morbidity associated with PAS is well known, there is less information regarding neonatal morbidity in this setting. The aim of this study is to describe the neonatal outcomes (fetal malformations, neonatal morbidity, twin births, stillbirth, and neonatal death), using an international multicenter database of PAS cases.
METHODS: This was a prospective, multicenter cohort study based on prospectively collected cases, using the international multicenter database of the International Society for PAS, carried out between January 2020 and June 2022 by 23 centers with experience in PAS care. All PAS cases were included, regardless of whether singleton or multiple pregnancies and were managed in each center according to their own protocols. Data were collected via chart review. Local Ethical Committee approval and Data Use Agreements were obtained according to local policies.
RESULTS: There were 315 pregnancies eligible for inclusion, with 12 twin pregnancies, comprising 329 fetuses/newborns; 2 cases were excluded due to inconsistency of data regarding fetal abnormalities. For the calculation of neonatal morbidity and mortality, all elective pregnancy terminations were excluded, hence 311 pregnancies with 323 newborns were analyzed. In our cohort, 3 neonates (0.93%) were stillborn; of the 320 newborns delivered, there were 10 cases (3.13%) of neonatal death. The prevalence of major congenital malformations was 4.64% (15/323 newborns), most commonly, cardiovascular, central nervous system, and gastrointestinal tract malformations. The overall prevalence of major neonatal morbidity in pregnancies complicated by PAS was 47/311 (15.1%). There were no stillbirths, neonatal deaths, or fetal malformations in reported twin gestations.
CONCLUSIONS: Although some outcomes may be too rare to detect within our cohort and data should be interpreted with caution, our observational data supports reassuring neonatal outcomes for women with PAS.