Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica ›› 2010, Vol. 32 ›› Issue (5): 501-504.doi: 10.3881/j.issn.1000-503X.2010.05.006

• Original Article • Previous Articles     Next Articles

Diagnosis and Treatment of Placenta Accreta in the Second Trimester of Pregnancy

YU Mei1, LIU Xin-yan1, DAI Qing2, CUI Quan-cai3, JIN Zheng-yu4, LANG Jing-he1   

  1. 1Department of Obstetrics and Gynecology, 2Department of Ultrasound, 3Department of Pathology, 4Department of Radiology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
  • Received:2010-07-23 Online:2010-11-04 Published:2010-11-04
  • Contact: LIU Xin-yan

Abstract: Objective To summarize our experiences in the diagnosis and treatment of placenta accreta in the second trimester of pregnancy. Methods We retrospectively analyzed the clinical data of 31 patients were admitted to Peking Union Medical College Hospital with placenta accreta in the second trimester of pregnancy from January 2002 to January 2010. ResultsAmong 31 cases, one case (3.2%) was suspected to be with placenta accreta by ultrasound examination and 30 cases (96.8%) were normal before delivery. Placenta accreta was identified during follow-up in 12 cases (38.7%) after delivery. Fourteen patients underwent curettage again after delivery, which was effective in 6 patients (42.9%) and failed in 8 patients, in whom uterine artery embolization (UAE) was further applied. Thirteen patients underwent UAE without curettage. In total, 21 cases underwent UAE, which was effective in 19 patients (90.5%); one patient with abnormal β-human chorionic gonadotropin (β-HCG) 5 months after embolization underwent lesion resection and one case with slightly increased β-HCG were lost to follow-up. Hysteroscopy was effective in 3 patients, of whom two patients underwent lesion resection by hysteroscopy and one case who was suspected to be with trophoblastic disease by ultrasonography before surgery and confirmed to be placenta accreta during hysteroscopy examination underwent lesion resection. One case experienced hemorrhagic shock during vaginal delivery and underwent emergency laparotomy. Among all these 31 patients, massive hemorrhage occurred in 13 cases during delivery and hemorrhagic shock in 2 cases. Three cases had postpartum hemorrhage and stopped bleeding after UAE. None needed hysterectomy. ConclusionsPlacenta accreta in the second trimester of pregnancy is usually diagnosed after childbirth, which may be delayed in some cases. Therefore, special attention should be paid to this disease during follow-up. Conservative treatment was the main therapy of placenta accreta in the second trimester of pregnancy. UAE is effective in stopping bleeding.

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