离开胎盘 in situ 为了管理胎盘合频谱障碍
Farah H Amro1, Edgar A Hernandez-Andrade, Ramesha Papanna
1Division of Maternal Fetal Medicine and the Division of Gynecology Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
Obstetrics and gynecology
|April 24, 2025
概括
留下胎盘 in situ用于胎盘增生谱 (PAS) 管理是切除子宫的可行替代方案,大多数患者可以避免感染或出血等并发症. 这种方法为选定的PAS病例提供了子宫保存选项.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 怀孕并发症的手术管理
背景情况:
- 胎盘增生谱 (PAS) 存在重大风险,往往需要切除子宫.
- 除了立即剖腹产切除外的替代管理策略正在探索PAS.
- 在特定的PAS病例中,留下胎盘 in situ 是一种选择,目的是保护子宫或延迟子宫切除.
研究的目的:
- 在被诊断为PAS的患者中,评估与离开胎盘 in situ相关的母亲结果.
- 基于计划外科治疗的结果进行比较:子宫保存与计划延迟子宫切除.
- 为了评估感染风险,在PAS中预期管理的显著出血,子宫切除和输血率.
主要方法:
- 对180名患有产前PAS诊断的患者进行了回顾性队列研究.
- 分析了50名通过留下胎盘 in situ 管理的患者,按计划程序 (子宫保存或延迟子宫切除) 分类.
- 分析了母亲的结果,包括感染,需要切除子宫的出血,输血率和严重的发病率.
主要成果:
- 在50名患者中,有43人 (86%) 避免了立即切除子宫.
- 在那些留下胎盘在位的患者中,12%的患者经历了需要切除子宫的出血,9%的患者患有子宫内膜炎.
- 成功的子宫保存 (n=13) 与间隔切除子宫切除术 (n=30) 相比,与估计的血液损失和输血率显著降低相关.
结论:
- 在特定的PAS患者中,将胎盘留在现场是剖腹产切除术的可行替代方案,感染率和出血并发症率较低.
- 这种方法可能适用于希望维护子宫的患者或那些患有PAS的患者,即时切除子宫的风险很高.
- 由于样本规模小,结果应谨慎解释,这可能会限制罕见并发症的检测.
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