中期引产胎盘植入的诊断与治疗

doi:10.3969/j.issn.1006-7795.2013.04.029

摘要/Abstract

摘要：

胎盘植入是造成产后出血、孕产妇死亡的严重产科合并症,近年来已经成为产后出血子宫切除的主要指征。在中期引产时,胎盘植入同样存在导致产妇出血的风险。本文综述了胎盘植入的流行病学、病因学、诊断和治疗的方法。治疗包括手术治疗及药物治疗。手术治疗包括B超指导下钳刮术、开腹局部病灶切除术、宫腔镜下局部病灶切除术、经导管动脉栓塞术、子宫切除术等。药物治疗包括甲氨蝶呤、米非司酮、5-氟尿嘧啶、依沙吖啶以及中药治疗等,多为保守手术的辅助治疗。由于中期引产的妇女大多数有生育的要求,因此引产前筛查胎盘植入的高危因素,仔细的产前检查和引产时对胎盘植入临床特点的关注,尽早做出胎盘植入的诊断,采取保守的手术及药物治疗方法,尽可能保全妇女的生育能力。

关键词: 胎盘植入, 诊断, 治疗

Abstract:

Placenta accreta is a severe complication of pregnancy that is significant contributor to postpartum hemorrhage and maternal morbidity. It becomes currently the most common indication for peripartum hysterectomy due to massive hemorrhage. Even in the artificial abortion of the second trimester, we face the risk of placenta accreta as well. In this article, we review the epidemiology, etiology, diagnosis and management of placenta accreta, especially the high risk factors and diagnosis. The managements include operations and medications. Operation treatments include B-mode ultrasound guided dilatation and curettage, local resection by laparotomy or hysteroscopy, hysterectomy and transcatheter artery embolization. Medications include methotrexate, mifepristone, 5-fluorouracil(5-Fu), ethacridine, Chinese traditional medicine and so on. On account of the fertility desire of women who need induced abortion in the second trimester, the diagnosis of the placenta accreta should be made as soon as possible according to the screening for predisposing factors and careful examination both in prenatal phase and abortion. Conservative management should be considered first with caution to preserve fertility as far as possible.

Key words: placenta accreta, diagnosis, management

中图分类号:

R714.46⁺2

罗岚蓉, 李坚. 中期引产胎盘植入的诊断与治疗[J]. 首都医科大学学报, 2013, 34(4): 623-628.

LUO Lanrong, LI Jian. Diagnosis and management of placenta accreta in induced abortion of the second trimester[J]. Journal of Capital Medical University, 2013, 34(4): 623-628.

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