■本研究评估了在前置胎盘(PPC)和前置胎盘(PP)患者中,紧急子宫切除术与计划子宫节段切除术的母婴结局。
■接受计划或紧急子宫节段切除术的PP和PPC患者被纳入本研究。人口统计数据,出血性疾病,术中和术后并发症,住院时间,手术时间,并比较围手术期和新生儿发病率。
■本研究共纳入141例PPC和PP病例。25例(17.73%)患者接受了紧急子宫切除术,116例(82.27%)接受了计划的子宫节段切除术。术后血红蛋白的变化,操作次数,输血总量,膀胱损伤,两组间的住院时间无显著差异(分别为P=0.7,P=0.6,P=0.9,P=0.9,P=0.2).胎儿重量,5分钟阿普加得分,两组间新生儿重症监护病房的入院率无显著差异.出现出血的患者分娩时的孕龄低于接受积极分娩并接受择期手术的患者(32周[95%可信区间[CI],26-37周]vs.35周[95%CI,34-35周],P=0.037)。
■使用多学科方法,这项在三级中心进行的研究表明,在急诊和计划的子宫节段切除术中,孕产妇和胎儿的发病率和死亡率没有显著差异.
OBJECTIVE: This study evaluated maternal and fetal outcomes of emergency uterine resection versus planned segmental uterine resection in patients with placenta percreta (PPC) and placenta previa (PP).
METHODS: Patients with PP and PPC who underwent planned or emergency segmental uterine resection were included in this study. Demographic data, hemorrhagic morbidities, intra- and postoperative complications, length of hospital stay, surgical duration, and peri- and neonatal morbidities were compared.
RESULTS: A total of 141 PPC and PP cases were included in this study. Twenty-five patients (17.73%) underwent emergency uterine resection, while 116 (82.27%) underwent planned segmental uterine resections. The postoperative hemoglobin changes, operation times, total blood transfusion, bladder injury, and length of hospital stay did not differ significantly between groups (P=0.7, P=0.6, P=0.9, P=0.9, and P=0.2, respectively). Fetal weights, 5-minute Apgar scores, and neonatal intensive care unit admission rates did not differ significantly between groups. The gestational age at delivery of patients presenting with bleeding was lower than that of patients who were admitted in active labor and underwent elective surgery (32 weeks [95% confidence interval [CI], 26-37] vs. 35 weeks [95% CI, 34-35]; P=0.037).
CONCLUSIONS: Using a multidisciplinary approach, this study performed at a tertiary center showed that maternal and fetal morbidity and mortality did not differ significantly between emergency versus planned segmental uterine resection.