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目的探讨胎盘植入的相关因素、诊断、预防与治疗。方法对我院剖宫产术中及阴道分娩后确诊的26例胎盘植入患者的临床资料进行回顾性分析。结果 2例产前彩超检查提示疑胎盘植入,行剖宫产术,术中确诊;5例阴道分娩后因胎盘滞留行人工剥离或钳夹胎盘困难而诊断;19例在剖宫产术中发现胎盘植入。21例剖宫产手术患者18例行保守性手术治疗,3例行次全子宫切除术;5例阴道分娩给予米非司酮口服保守治疗,4例7d后行钳刮术,保守治疗成功,1例产后第2d因阴道大出血急诊行次全子宫切除术。结论多次妊娠、流产、剖宫产等既往宫腔操作是胎盘植入形成的主要因素,一旦发生,常导致严重的产后大出血而危及产妇生命。积极预防、早期诊断、及时处理是产妇预后好坏的关键。
Objective To investigate the related factors, diagnosis, prevention and treatment of placenta accreta. Methods The clinical data of 26 cases of placenta accreta diagnosed in our hospital after cesarean section and vaginal delivery were retrospectively analyzed. Results Two prenatal diagnosis of prenatal color Doppler ultrasound revealed placenta accreta, cesarean section, intraoperative diagnosis; 5 cases of vaginal delivery due to manual detachment of placenta accreta or difficult to diagnose placenta accreta; 19 cases in cesarean section Found placenta accreta. 21 cases of cesarean section in 18 patients underwent conservative surgery, 3 cases underwent subtotal hysterectomy; 5 cases of oral delivery of mifepristone oral conservative treatment, 4 cases of clamp curettage after 7d, conservative treatment was successful, One case of postpartum 2d due to vaginal bleeding emergency line subtotal hysterectomy. Conclusions Multiple pregnancies, miscarriage, cesarean section and other previous uterine operations are the main factors in the formation of placenta accreta. Once occurred, severe postpartum hemorrhage often leads to endangering maternal life. Active prevention, early diagnosis, timely treatment is the key to good and bad maternal prognosis.