保守治疗病态附着性胎盘的顺序手术步骤:病例系列

A. B. A. Mitwaly, A. Abbas
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引用次数: 6

摘要

目的:剖宫产率随着前置胎盘和前置胎盘的增加而增加。胎盘增生是产妇发病和死亡的主要原因。我们的目的是评估一种新的联合手术步骤来处理病态附着性胎盘(MAP)的新方法,以面对其负担,心理和婚姻破裂,如果在我们的低设施子宫切除术管理。材料和方法:在本病例系列中,我们评估了2014年6月至12月在埃及Assiut妇女健康医院使用顺序手术步骤保守治疗20例MAP的术中和术后结果。顺序步骤从膀胱完美解剖开始,然后分娩胎儿,然后取出子宫,在子宫和卵巢血管上应用4个环钳。试验取胎盘后在子宫腔内敷两条毛巾止血。双低位双侧子宫动脉结扎术。最后,在移除毛巾后,将易碎的子宫下段从子宫前壁涂抹。结果:患者平均年龄29.95±4.8岁。所有病例既往均有子宫瘢痕及前置胎盘。增生性胎盘10例(50%),增生性胎盘8例(40%),异生性胎盘2例(2例)。我们的手术是连续的所有18例胎盘增生和增量,但最后2例胎盘percreta需要子宫切除术。所有病例均无产后出血。没有产妇死亡。讨论:这种新方法有利于MAP的治疗,降低了增生性胎盘和增量性胎盘的子宫切除术发生率。
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Sequential surgical steps for conservative management of Morbidly Adherent Placenta: Case series
Objective: Cesarean section rates are increasing with associated increase in placenta previa and accreta. Placenta accreta is a major cause of maternal morbidity and mortality. Our objective was to evaluate of a new method of combined surgical steps in management of morbidly adherent placenta (MAP) to face its burden, psychological and marital disintegration if managed by hysterectomy in our low facilities. Materials and Methods: In this case series, we evaluated the use of sequential surgical steps for conservative management of 20 cases of MAP as regard the intra-operative and post-operative outcomes in Assiut Women Health Hospital, Egypt from June to December 2014. The sequential steps started by perfect dissection of urinary bladder, then delivery of the fetus followed by exteriorization of the uterus and application of 4 ring forceps on both uterine and ovarian vessels. Trial of placenta removal followed by application of two towels in the uterine cavity to achieve hemostasis. Ligation of uterine artery bilaterally at double low level. Finally, plication of the friable lower uterine segment from anterior wall after removal of towels. Results: The mean age of the included women was 29.95±4.8 years. All cases had previous uterine scar and placenta previa. Ten cases (50%) had placenta accreta, 8 cases (40%) had placenta increta and 2 cases had placenta percreta. Our procedure was successive in all 18 cases of placenta accreta and increta but the last 2 cases of placenta percreta required hysterectomy. No post partum hemorrhage in all cases. There were no maternal deaths. Discussion: This new method was favorable in the management of MAP and decreased the incidence of hysterectomy in cases of placenta accreta and increta.
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来源期刊
Thai Journal of Obstetrics and Gynaecology
Thai Journal of Obstetrics and Gynaecology Medicine-Obstetrics and Gynecology
CiteScore
0.40
自引率
0.00%
发文量
3
审稿时长
24 weeks
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