探讨胎盘植入的诊断和治疗方法。

回顾性分析2008年1月至2010年12月本院收治的29例胎盘植入患者的临床病历资料。胎盘植入分度标准参照《诊断病理学》(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准)。

本组29例患者中，在分娩即刻及分娩后确诊为胎盘植入的患者为89.66%(26/29)，仅3例(10.34%)为分娩前确诊。本组Ⅱ°以上胎盘植入患者占72.41%(21/29)，Ⅰ°为27.59%(8/29)。本组仅8例(27.59%)胎盘植入患者根据病史及体征确诊，另外21例(72.41%)借助彩色多普勒超声确诊；3例分娩前确诊断的患者中，2例借助MRI确诊。本组因胎盘植入导致的产后出血(PPH)发生率高达82.76%(24/29)，出血量超过1000 mL为16例(55.17%，16/29)，其中3例(12.50%，3/24)因PPH行急诊子宫切除术，2例(8.33%，2/24)行局灶切除术。24例87.5%(21/24)综合治疗后，87.5%(21/24)植入胎盘组织于产后3个月内排出，另3例在产后3～6月内排出。本组无一例产妇死亡。

彩色多普勒超声联合MRI可提高胎盘植入的分娩前、后确诊率。彩色多普勒超声跟踪观察将有助于动态判断胎盘植入的转归。手术及药物联合治疗有助于提高胎盘植入患者保守治疗的成功率。

To investigate the diagnosis and treatment of placenta accrete.

From January 2008 to December 2010, a total of 29 cases clinical records of women with placenta accreta in Wuxi Materiality and Child Health Hospital Affiliated to Nanjing Medical University were admitted to analysis by retrospective analysis methods. This study was approved by the ethics committee of Wuxi Materiality and Child Health Hospital. The standard of diagnosis and classification of placenta accreta are followed by the guideline of Diagnostic Pathology.

Of 29 patients in this study, 26 cases (89.66%) were diagnosed with placenta accreta during or after delivery, only 3 cases (10.34%) were diagnosed before delivery, 2 cases of them were diagnosed by MRI. Among them 8 cases(8/29) were diagnosed of grade Ⅰ of placenta accreta, while the other majority (21 patients, 72.41%) were diagnosed with grade Ⅱ or Ⅲ. In this study, only 8 cases (27.59%) were diagnosed by medical history and symptoms, the other 21 cases(72.41%) were diagnosed by color Doppler ultrasound.The incidence of postpartum hemorrhage (PPH) caused by placenta accreta was as high as 82.76% (24/29). Of them, blood loss volume of 16 cases (55.17%) was more than 1000 mL, 3 cases (12.50%, 3/24) due to PPH underwent emergency hysterectomy and 2 cases (8.33%, 2/24) were underwent supracervical hysterectomy. After treatment with conservative treatment among 24 cases with placenta accreta , there were 87.5%(21/24)placenta tissues were discharged in 3 months, the others' placenta tissues were discharged between 3 to 6 months. There was no maternal death in this group.

Placenta accreta can be accurately diagnosed by color Doppler ultrasound or MRI. Doppler tracking will help to dynamically determine the outcome of placenta accreta. The combination of surgery and medical therapy can improve the success rate of conservative treatment to patients with placenta accreta.