凶险性前置胎盘诊治进展

doi:10.3760/cma.j.issn.1007-1245.2023.15.005

摘要/Abstract

摘要：

凶险性前置胎盘是一种产科危急疾病，通常伴有胎盘植入，易造成术中大出血。对于凶险性前置胎盘的产妇应做好早期诊断，完善围手术期准备，通过多学科会诊选择合适的手术方式来减少术中出血、术后并发症。本文结合近年来国内外最新诊疗方案，对凶险性前置胎盘的诊治、手术方式选择、止血方式、血液管理及回收式自体输血的应用进行阐述。

关键词:

凶险性前置胎盘, 胎盘植入, 产前检查, 诊治, 产后出血, 进展

Abstract:

Pernicious placenta previa is a critical obstetric disease, usually accompanied by placenta accreta, which can easily cause massive intraoperative bleeding. For women with pernicious placenta previa, early diagnosis should be made, perioperative preparations should be improved, and appropriate surgical methods should be selected through multidisciplinary consultation to reduce the intraoperative bleeding and postoperative complications. Based on the latest diagnosis and treatment plans at home and abroad in recent years, this article describes the diagnosis and treatment of pernicious placenta previa, selection of surgical methods, hemostasis methods, blood management, and application of salvage autologous blood transfusion.

Key words:

Pernicious placenta previa, Placenta accreta, Prenatal examination, Diagnosis and treatment, Postpartum hemorrhage, Progress

刘瀛张磊磊.

凶险性前置胎盘诊治进展 [J]. 国际医药卫生导报, 2023, 29(15): 2091-2095.

Liu Ying, Zhang Leilei.

Progress in the diagnosis and treatment of pernicious placenta previa [J]. International Medicine and Health Guidance News, 2023, 29(15): 2091-2095.

参考文献

[1] Chattopadhyay SK, Kharif H, Sherbeeni MM. Placenta praevia and accreta after previous caesarean section[J]. Eur J Obstet Gynecol Reprod Biol, 1993, 52(3):151-156. DOI: 10.1016/0028-2243(93)90064-j.
[2] Hecht JL, Baergen R, Ernst LM, et al. Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel[J]. Mod Pathol, 2020, 33(12):2382-2396. DOI: 10.1038/s41379-020- 0569-1.
[3] Li P, Tang Y, Jiang Y, et al. Analysis of clinical features of 231 cases with pernicious placenta previa: a retrospective cohort study[J]. Medicine (Baltimore), 2021, 100(11):e25023. DOI: 10.1097/MD.0000000000025023.
[4] Silver RM, Branch DW. Placenta accreta spectrum[J]. N Engl J Med, 2018, 378(16):1529-1536. DOI: 10.1056/NEJMcp1709324.
[5] Tadevosyan M, Ghazaryan A, Harutyunyan A, et al. Factors contributing to rapidly increasing rates of cesarean section in Armenia: a partially mixed concurrent quantitative-qualitative equal status study[J]. BMC Pregnancy Childbirth, 2019, 19(1):2. DOI: 10.1186/s12884-018-2158-6.
[6] Jauniaux E, Burton GJ. Pathophysiology of placenta accreta spectrum disorders: a review of current findings[J]. Clin Obstet Gynecol, 2018, 61(4):743-754. DOI: 10.1097/GRF.0000000000000392.
[7] Jauniaux E, Moffett A, Burton GJ. Placental implantation disorders[J]. Obstet Gynecol Clin North Am, 2020, 47(1):117-132. DOI: 10.1016/j.ogc.2019.10.002.
[8] Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries[J]. Obstet Gynecol, 2006, 107(6):1226-1232. DOI: 10.1097/01.AOG.0000219750.79480.84.
[9] Jauniaux E, Alfirevic Z, Bhide AG, et al. Placenta praevia and placenta accreta: diagnosis and management: green-top guideline No. 27a[J]. BJOG, 2019, 126(1):e1-e48. DOI: 10.1111/1471-0528.15306.
[10] 郭文玲,马建林,陈雪梅,等.宫腔镜在剖宫产术后子宫瘢痕妊娠中对并发症及β-HCG恢复时间的影响[J].国际医药卫生导报,2021,27(6):885-887. DOI:10.3760/cma.j.issn.1007-1245.2021.06.025.
[11] Maheux-Lacroix S, Li F, Bujold E, et al. Cesarean scar pregnancies: a systematic review of treatment options[J]. J Minim Invasive Gynecol, 2017, 24(6):915-925. DOI: 10.1016/j.jmig.2017.05.019.
[12] Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging[J]. Am J Obstet Gynecol, 2018, 218(1):75-87. DOI: 10.1016/j.ajog.2017.05.067.
[13] D'Antonio F, Bhide A. Ultrasound in placental disorders[J]. Best Pract Res Clin Obstet Gynaecol, 2014, 28(3):429-442. DOI: 10.1016/j.bpobgyn.2014.01.001.
[14] Petpichetchian C, Pranpanus S, Suntharasaj T, et al. Comparison of transabdominal and transvaginal sonography in the diagnosis of placenta previa[J]. J Clin Ultrasound, 2018, 46(6):386-390. DOI: 10.1002/jcu.22600.
[15] Garofalo A, Pilloni E, Alemanno MG, et al. Ultrasound accuracy in prenatal diagnosis of abnormal placentation of posterior placenta previa[J]. Eur J Obstet Gynecol Reprod Biol, 2019, 242:86-91. DOI: 10.1016/j.ejogrb.2019.09.021.
[16] Haidar ZA, Papanna R, Sibai BM, et al. Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa? [J]. Am J Obstet Gynecol, 2017, 217(2):202.e1-202.e13. DOI: 10.1016/j.ajog.2017.04.005.
[17] 种轶文,张爱青,王妍,等.超声评分系统预测胎盘植入凶险程度的价值[J].中华围产医学杂志,2016,19(9):705-709. DOI:10.3760/cma.j.issn.1007-9408.2016.09.014.
[18] 巫恒平,仲建全,冯浩,等.磁共振成像在凶险性前置胎盘诊断中的价值研究[J].重庆医学,2020,49(16):2740-2743. DOI:10.3969/j.issn.1671-8348.2020.16.030.
[19] Familiari A, Liberati M, Lim P, et al. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis[J]. Acta Obstet Gynecol Scand, 2018, 97(5):507-520. DOI: 10.1111/aogs.13258.
[20] 周华,金玉华,赵爱娥,等.孕晚期彩超联合血清学指标诊断凶险性前置胎盘合并胎盘植入价值[J].中国计划生育学杂志,2021,29(4):819-822,封3. DOI:10.3969/j.issn.1004- 8189.2021.04.042.
[21] Sentilhes L, Kayem G, Chandraharan E, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management[J]. Int J Gynaecol Obstet, 2018, 140(3):291-298. DOI: 10.1002/ijgo.12410.
[22] 中华医学会妇产科学分会产科学组.前置胎盘的诊断与处理指南(2020)[J].中华妇产科杂志,2020,55(1):3-8. DOI:10.3760/cma.j.issn.0529-567X.2020.01.002.
[23] Selman AE. Caesarean hysterectomy for placenta praevia/accreta using an approach via the pouch of Douglas[J]. BJOG, 2016, 123(5):815-819. DOI: 10.1111/1471-0528. 13762.
[24] Belfort MA, Shamshirsaz AA, Fox KA. A technique to positively identify the vaginal fornices during complicated postpartum hysterectomy[J]. Am J Obstet Gynecol, 2017, 217(2):222.e1-222.e3. DOI: 10.1016/j.ajog.2017.05.001.
[25] Sentilhes L, Ambroselli C, Kayem G, et al. Maternal outcome after conservative treatment of placenta accreta[J]. Obstet Gynecol, 2010, 115(3):526-534. DOI: 10.1097/AOG.0b013e3181d066d4.
[26] Piñas-Carrillo A, Chandraharan E. Conservative surgical approach: the Triple P procedure[J]. Best Pract Res Clin Obstet Gynaecol, 2021, 72:67-74. DOI: 10.1016/j.bpobgyn.2020.07.009.
[27] Peng X, Chen D, Xu J, et al. Parallel transverse uterine incisions, a novel approach for managing heavy hemorrhage and preserving the uterus: a retrospective cohort study for patients with anterior placenta previa and accreta[J]. Medicine (Baltimore), 2019, 98(44):e17742. DOI: 10.1097/MD.0000000000017742.
[28] WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial[J]. Lancet, 2017, 389(10084):2105-2116. DOI: 10.1016/S0140-6736(17)30638-4.
[29] 曹成群,马红云,段丽娜,等.氨甲环酸剖宫产后即刻输注对凶险性前置胎盘患者凝血功能及并发症的影响[J].临床和实验医学杂志,2020,19(23):2555-2558. DOI:10.3969/j.issn.1671-4695.2020.23.026.
[30] Wei Y, Luo J, Luo D. Comparison of efficacy between internal iliac artery and abdominal aorta balloon occlusions in pernicious placenta previa patients with placenta accrete[J]. Gynecol Obstet Invest, 2019, 84(4):343-349. DOI: 10.1159/000494493.
[31] Peng Y, Jiang L, Peng C, et al. The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study[J]. BMC Pregnancy Childbirth, 2020, 20(1):349. DOI: 10.1186/s12884-020-03041-4.
[32] 郭浪涛,张诗茂,敬怀波.超声引导和X射线监测下腹主动脉球囊封堵治疗凶险性前置胎盘临床结局的比较[J].四川医学,2022,43(6):525-529. DOI:10.16252/j.cnki.issn1004- 0501-2022.06.001.
[33] Liu C, Yang DD, Qu HB, et al. Efficacy and safety of prophylactic abdominal aortic balloon occlusion versus internal iliac arterial balloon occlusion for placenta accreta spectrum disorder: a systematic review and meta-analysis[J]. Clin Imaging, 2021, 78:250-255. DOI: 10.1016/j.clinimag.2021.06.020.
[34] Kondoh E, Ueda A, Mogami H. Rethinking uterine compression suture for atonic postpartum hemorrhage[J]. Acta Obstet Gynecol Scand, 2021, 100(1):5-6. DOI: 10.1111/aogs.14035.
[35] Fu M, Bu H, Fang Y, et al. Parallel loop binding compression suture, a modified procedure for pernicious placenta previa complicated with placenta increta[J]. Front Surg, 2021, 8:786497. DOI: 10.3389/fsurg.2021. 786497.
[36] Said Ali A, Faraag E, Mohammed M, et al. The safety and effectiveness of Bakri balloon in the management of postpartum hemorrhage: a systematic review[J]. J Matern Fetal Neonatal Med, 2021, 34(2):300-307. DOI: 10.1080/14767058.2019.1605349.
[37] Wang R, Luo T, Liu Z, et al. Intraoperative cell salvage is associated with reduced allogeneic blood requirements and has no significant impairment on coagulation function in patients undergoing cesarean delivery: a retrospective study[J]. Arch Gynecol Obstet, 2020, 301(5):1173-1180. DOI: 10.1007/s00404-020-05500-x.
[38] Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions[J]. Curr Opin Anaesthesiol, 2019, 32(3):278-284. DOI: 10.1097/ACO.0000000000000717.
[39] 中国输血协会临床输血学专业委员会.产后出血患者血液管理专家共识(2022年版)[J].中国临床新医学,2022,15(1):1-5. DOI:10.3969/j.issn.1674-3806.2022.01.01.