胎盘植入是影响妊娠结局的灾难性疾病，目前我国在胎盘植入的处理已取得长足的进步。本视频讲者结合自身丰富的临床经验和相关文献，讨论了胎盘植入处理中的热点问题。首先阐述胎盘植入患者孕期管理关键问题，包括孕期严重并发症、高危因素、早期诊断、终止妊娠的时机及妊娠风险评估等；其次讨论了胎盘植入术中不同止血措施的效果评价与思考，包括动脉球囊阻断、动脉介入栓塞等；最后总结了胎盘植入处理的基本准则，有助于临床医生在临床实践中灵活运用、规范处理。
For the interventional radiology of postpartum hemorrhage in placenta accrete spectrum, the prenatal risk assessment of placental implantation should be done well, the indications should be understood, a multidisciplinary team should be established and procedures should be standardized, effective surgical hemostasis methods should be combined, and complications should be paid attention to and prevented, so as to make this technology more suitable for application.
Objective:To explore the risk and management approach of re-pregnancy and delivery after partial hysterectomy.Methods:Retrospective analysis was made on the patients who underwent partial hysterectomy to retain the uterus for PAS in the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2015 to December 31, 2018.Following up the pregnancy process and outcomes of 12 re-pregnancy cases after the operation, the recurrence of placenta previa and/or PAS, intraoperative blood loss, uterine condition, delivery gestational weeks, complications, delivery mode, neonatal condition and puerperal recovery of these cases were analyzed.Results:1.Among the 12 cases, there are 1 scar pregnancy and 11 intrauterine pregnancies.Most of them had a good early embryo development(including 1 scar pregnancy) except for 1 embryo damage, and there was no embryonic dysplasia.2.Four women chose induced abortion at the first trimester(terminated at 6-8 gestational weeks, including 1 case of scar pregnancy). One woman chose induced labor in the second trimester (terminated at 13+ weeks).3.There were 7 live births (delivered at 36-38 gestational weeks, the mode of delivery was cesarean section, among which 1 case of central placenta previa combined with placenta increta underwent total hysterectomy). All the above operations were successful, the hemodynamics were stable, and no one was transferred to the ICU afterward. There was no obvious abnormality in their newborns, and the postoperative recovery was good.Conclusions:1.Women with PAS who underwent partial hysterectomy to preserve their reproductive function can have a chance of normal pregnancy afterward. 2.There are risks of scar pregnancy, placental abnormities and uterine rupture in the pregnancies after partial hysterectomy. If these pregnancies were to continue, they should undergo close observation by doctors during the entire gestation and delivery.
The role of prophylactic interventional radiology in the treatment of placenta accrete spectrum diseases has been paid more and more attention and has become one of the alternative methods to reduce severe postpartum hemorrhage in the treatment of placenta accreta. However, there is a lack of clinical operation guidelines, and there is still no uniform standard for technical indications, selection of different interventional methods, operation procedures, precautions, and prevention of complications. The Maternal and Fetal Medicine Special Committee of Obstetrics and Gynecology Branch of Chinese Medical Doctor Association and Critical Care Subgroup, Chinese Society of Perinatal Medicine, Chinese Medical Association have organized experts to discuss and refer to both domestic and international literature to formulate this consensus, which aims to provide a certain basis and guideline for the application of prophylactic interventional radiology in placenta accreta diseases.
Placenta accreta spectrum (PAS) is one of the leading causes of obstetric emergencies, characterized by abnormal invasion of trophoblasts into the uterus and adjacent organs. The incidence of PAS is increasing all around world in recent years. Histopathological examination can accurately diagnose PAS, providing a basis for subsequent treatment. Additionally, histopathological examination also contributes to understand the pathogenesis and improve the management of PAS.
