目的:本研究的目的是说明黎巴嫩三个主要中心管理的异常侵袭性胎盘(AIP)病例的结局。
方法:我们进行了一项回顾性多中心队列研究。保守治疗(剖宫产成功胎盘分离)或彻底治疗(剖宫产子宫切除术)的患者被纳入研究。数据包括患者特征,手术结果(失血,手术时间,输血,膀胱部分切除术),产妇结局(死亡,逗留时间,入住ICU,术后血红蛋白水平)和新生儿结局(Apgar评分,新生儿体重,入住新生儿重症监护室,新生儿死亡)。
结果:该研究包括189名患者。在根治性治疗亚组(141/189)中,患者为第3段,平均在344/7周分娩,放血1.5L,并输入三个红细胞,手术时间平均160分钟。尽管有19%的病例进行了部分膀胱切除术,但总共有36%的患者被送入ICU,患者平均停留了1周。计划外的彻底分娩发生在较低的胎龄,与更多的失血有关,更高的输血率和输血量,以及孕产妇和新生儿死亡的风险。此外,以计划外方式分娩的患者膀胱部分切除术率较高,干预时间较长.在保守治疗亚组中,患者平均为第2段,并在36周时分娩,平均出血800mL,输血率(35%)和ICU入院率(22.9%)较低。关于新生儿结局,激进亚组新生儿出生体重平均为2.4kg,保守亚组新生儿出生体重平均为2.5kg.需要根治性治疗的病例中有5.4%的新生儿死亡,而保守治疗的患者中有2%的新生儿死亡。
结论:通过他们的多学科方法,这三个中心表明,黎巴嫩AIP的管理取得了良好的结果,在预定的根治性治疗中没有发生孕产妇死亡.通过三个领导中心的比较,确定并解决了每个中心的陷阱。
OBJECTIVE: The aim of the present study was to illustrate the outcomes of abnormally invasive placenta (AIP) cases managed in three leading centers in Lebanon.
METHODS: We conducted a retrospective multicenter cohort study. Patients managed conservatively (cesarean delivery with successful placental separation) or radically (cesarean hysterectomy) were included in the study. Data included patient characteristics, surgical outcomes (blood loss, operative time, transfusion, partial bladder resection), maternal outcomes (death, length of stay, ICU admission, postoperative hemoglobin level) and neonatal outcomes (Apgar score, neonatal weight, admission to neonatal intensive care unit, neonatal death).
RESULTS: The study included 189 patients. In the radical treatment subgroup (141/189), patients were para 3 and delivered at 34 4/7 weeks in average, bled 1.5 L and were transfused with three packed red blood cells, with operative time averaging 160 min. A total of 36% were admitted to the ICU and patients stayed on average for 1 week despite partial bladder resection in 19% of cases. Unscheduled radical delivery occurred at a lower gestational age, was associated with more blood loss, higher rate and volume of transfusion, and risk of maternal and neonatal death. In addition, patients delivered in an unscheduled fashion experienced higher rates of partial bladder resection and longer interventions. In the conservative treatment subgroup, on average patients were para 2 and delivered at 36 weeks, bled 800 mL on average with low rates of transfusion (35%) and ICU admission (22.9%). With regard to neonatal outcomes, the average neonatal birth weight was 2.4 kg in the radical subgroup and 2.5 kg in the conservative subgroup. Neonatal death occurred in 5.4% of cases requiring radical management while it occurred in 2% of patients treated conservatively.
CONCLUSIONS: Through their multidisciplinary approach, the three centers demonstrated that management of AIP in Lebanon has led to excellent outcomes with no maternal mortality occurring in scheduled radical treatment. By comparison of the three leading centers, pitfalls in each center were identified and addressed.