(3)前置癒着胎盤の実態と当院における治療の変遷(<特集>第61回学術講演会シンポジウム1「産科出血と胎盤異常」)

概要

論文の詳細を見る
Placenta accreta is an abnormally firm attachment of placental villi to the uterine wall, which may cause postpartum hemorrhage resulting in maternal morbidity and mortality. The purpose of this study was to clarify the incidence, clinical background and prognosis of placenta previa accreta treated with different modalities in Japan. Research 1) Questionnaire survey for all obstetric institutions (188 institutions in 2002 and 170 in 2007) in Aichi prefecture was conducted. The rate of cesarean section (CS) deliveries was 15.2% in 2002 and 18.8% in 2007 and the incidence of placenta previa was 1/350 deliveries in 2002 and 1/280 deliveries in 2007. Research 2) Medical records of cases with placenta previa in 11 tertiary centers between January 1994 and December 2008 were reviewed. Among the total of 94,968 deliveries, 867 cases were diagnosed as placenta previa (0.91%), 14 of these being placenta accreta vera, 25 placenta increta and 12 placenta percreta. Only 0.81% of cases of placenta previa without previous CS were accreta, in contrast to 37.8% of placenta previa after previous CS (p<0.01, odds ratio=72.3). Median intra-operation blood loss was 4,792mL (accreta vera), 3,605mL (increta) and 3,853mL (percreta). One patient with placenta previa percreta died of hemorrhage. Stepwise treatment (cesarean section without separation of the placenta, arterial embolization and hysterectomy) was applied for 6 cases, which had the least blood loss. We carried out to survey the relationship between the two methods of uterine closure (continuous vs interrupted) at previous CS and the incidence of placenta accreta. 76 patients with lower transverse incision and closure by absorbable material were included for this study. In this sample, 31 patients had been diagnosed as placenta previa accreta pathologically. 31 patients had single-layer closure include 7 with continuous suture (2 placenta accreta) and 24 with interrupted suture (10 placenta accreta). 45 patients had double-layer closure include 17 with continuous suture (12 placenta acreeta) and 28 with interrupted suture (7 placenta accreta). We record that placenta accreta occurred in the patients with single-layer is 39% and 42% of double-layer group, which showed no significant difference (p=0.76). However, placenta accreta occurred in 52% of the patients with continuous group and 26% of interrupted group, which showed a significant difference with p=0.034. When limited to double-layer closure, placenta accreta occurred in 71% of continuous group and in 25% of interrupted group, which showed strong difference (p<0.01). In addition, multivariable logistic regression analysis adjusted for confounder (gravid, history of induced abortion, placental location, number of previous CS) also showed significant difference (p=0.023, odds ratio=8.15). In conclusion, we showed the data that the rate of CS delivery, the incidence of placenta previa/placenta accreta increased in central area of Japan. We also presented the possibility that continuous suture for the closure of uterine incision at previous CS could be a risk factor for accreta in placenta previa with history of CS.
社団法人日本産科婦人科学会の論文
2009-09-01

(3)前置癒着胎盤の実態と当院における治療の変遷(<特集>第61回学術講演会シンポジウム1「産科出血と胎盤異常」)

スポンサーリンク

概要

著者

関連論文

スポンサーリンク