Jie Ou1, Ping Peng2, Lirong Teng3, Chunying Li4, Xinyan Liu5. 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China. Electronic address: cristinaO@163.com. 2. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China. Electronic address: Pengping2164@sina.com. 3. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China. Electronic address: tenglirong@sina.com. 4. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China. Electronic address: lcy2008yaya@126.com. 5. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China. Electronic address: cristinaO@126.com.
Abstract
PURPOSE: To analyse the management of patients with placenta accreta spectrum (PAS) disorders who underwent 2nd trimester pregnancy terminations. METHOD: The records of patients with PAS disorders who underwent 2nd trimester pregnancy terminations were collected and analysed. RESULTS: Twenty-eight patients were included; 8 (28.6%) patients received prenatal diagnoses and 20 (71.4%) patients received postnatal diagnoses. In the prenatal diagnosis group, scheduling hysterotomy and placenta removal were performed in 5 patients with complete placenta previa and previous caesarean delivery without hysterectomy or postpartum haemorrhage, and medical termination was performed in 3 patients, 2 of whom retained the placenta in situ. In the postnatal diagnosis group, the placenta remained in situ in 11 patients, and in 13 (46.4%) patients overall, adjuvant treatments were applied to the patients, and the abnormally implanted placenta was passed 43.5 (range: 7-102) days after termination. A complication associated with the placenta left in situ included intrauterine infection in one case. Uterus preservation was achieved in all the patients. CONCLUSIONS: For patients with PAS disorders with complete placenta previa and previous caesarean delivery, hysterotomy is a safe choice for terminating a 2nd trimester pregnancy. When it is impossible to manually remove the placenta, leaving the placenta in situ with the administration of adjuvant treatment is a good choice for uterus preservation.
PURPOSE: To analyse the management of patients with placenta accreta spectrum (PAS) disorders who underwent 2nd trimester pregnancy terminations. METHOD: The records of patients with PAS disorders who underwent 2nd trimester pregnancy terminations were collected and analysed. RESULTS: Twenty-eight patients were included; 8 (28.6%) patients received prenatal diagnoses and 20 (71.4%) patients received postnatal diagnoses. In the prenatal diagnosis group, scheduling hysterotomy and placenta removal were performed in 5 patients with complete placenta previa and previous caesarean delivery without hysterectomy or postpartum haemorrhage, and medical termination was performed in 3 patients, 2 of whom retained the placenta in situ. In the postnatal diagnosis group, the placenta remained in situ in 11 patients, and in 13 (46.4%) patients overall, adjuvant treatments were applied to the patients, and the abnormally implanted placenta was passed 43.5 (range: 7-102) days after termination. A complication associated with the placenta left in situ included intrauterine infection in one case. Uterus preservation was achieved in all the patients. CONCLUSIONS: For patients with PAS disorders with complete placenta previa and previous caesarean delivery, hysterotomy is a safe choice for terminating a 2nd trimester pregnancy. When it is impossible to manually remove the placenta, leaving the placenta in situ with the administration of adjuvant treatment is a good choice for uterus preservation.