国际妇产科学杂志 ›› 2018, Vol. 45 ›› Issue (6): 676-680.

• 综述 • 上一篇    下一篇

胎盘植入的风险评估与诊治策略

邵明昱,冯炜炜   

  1. 200025  上海交通大学医学院附属瑞金医院
  • 收稿日期:2018-07-05 修回日期:2018-09-16 出版日期:2018-12-15 发布日期:2018-12-15
  • 通讯作者: 冯炜炜,E-mail:fww12066@rjh.com.cn E-mail:fww12066@rjh.com.cn
  • 基金资助:
    上海市科学技术委员会科研计划项目(17411950504)

Placenta Accreta: Risk Assessment and Strategy of Diagnosis and Management

SHAO Ming-yu,FENG Wei-wei   

  1. Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China
  • Received:2018-07-05 Revised:2018-09-16 Published:2018-12-15 Online:2018-12-15
  • Contact: FENG Wei-wei,E-mail:fww12066@rjh.com.cn E-mail:fww12066@rjh.com.cn

摘要: 底蜕膜受损或缺失时绒毛膜绒毛直接接触或侵入子宫肌层形成胎盘植入。这种胎盘异常附着的状态根据侵入的深度分为粘连型、植入型和穿透型,可导致不良围生结局,如大量产后出血、输血和凝血障碍,严重时需子宫切除甚至危及生命。胎盘植入的诊断与风险评估主要依靠超声,磁共振检查是重要的补充检查方法。建立胎盘植入风险分级评估标准,有利于个体化围生期治疗方案的制定。对于植入型及穿透型胎盘植入患者,需要依靠多学科支持。术中选择合适入路、压迫子宫、阻断血管和胎盘原位保留等方式减少出血可有效避免子宫切除,保留生育功能。但为了保证母亲安全,条件不允许时则应果断切除子宫。

关键词: 胎盘, 侵入性, 产后出血, 超声检查, 产前, 磁共振成像

Abstract: Placenta accreta occurs when a defect in the decidua basalis allows the chorionic villi to attach directly to or invade into the myometrium. The morbidly adherent placenta including placenta accreta, increta, percreta based on the depth of invasion and may cause reverse maternal outcome including excessive postpartum hemorrhage, transfusion, coagulopathy, emergency peripartum hysterectomy or death. Ultrasound complement with magnetic resonance imaging is the main method of antenatal diagnosis of placenta accreta. It is necessary to establish a scoring system to evaluate the risk of placenta accreta and improve the peripartum care. A multidisciplinary team is required in placenta increta or percreta. To preserve the future fertility, peripartum hysterectomy could be avoided by appropriate incision, compression sutures, devascularization and leaving placenta in situ. Hysterectomy remains the definitive surgical treatment when lack of sufficient supports for maternal safety.

Key words: Placenta accreta, Postpartum hemorrhage, Ultrasonography, prenatal, Magnetic resonance imaging

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