Clinical Analysis Of 40 Cases Of Placenta Increta

Objective:To investigate the diagnosis and therapy of placenta increta treatment scheme selection,in order to find out approaches for the placenta increta both preserve fertility as well as treat effectively.Methods :A retrospective study was carried out in patients who had placenta increta in China Hospital from January 2013 to February 2016. We obtained information about maternal characteristics in detail, compared the uterus retained with hysterectomy difference and studied the related factors of treatment.Results:40 cases of placenta increta were identified and 11 hysterectomy performed(nine hysterectomies were performed following an attempt to remove the placenta),10 cases attempted to remove the invaded tissues in cesarean section and succeed,19 cases the with placenta left in situ(8 cases with mifepristone therapy and uterine curettage, the others with uterine artery embolisation and uterine curettage or lesion resection),all of them without complication. In this study the retention rate of the uterus was 72.5%. A success rate of placenta left in situ was 100%. The retention rate of the uterus was linked with postpartum hemorrhage amount,the gestational age at delivery,parity and delivery way. The difference was statistically signifcant(P < 0.05). The maternal age and gravidity and cesarean section history did not correlate with the risk of hysterectomy. Obstetric hemorrhage amount related with placenta previa, prenatal diagnosis,the difference was statistically signifcant(P < 0.05). Area of placenta increta and obstetric hemorrhage amount affect the therapy of placenta left in situ,the difference was statistically signifcant(P < 0.05). The maternal age, the gestational age at delivery,gravidity, parity, serum β-hCG levels and uterine muscle layer thickness where the placenta increta did not correlate with the treatment with placenta left in situ.Conclusions:1.The retention rate of the uterus was linked with obstetric hemorrhage amount, prenatal diagnosis and delivery way. When obstetric hemorrhage mount more than 3000 ml in patients with placenta increta and still without effective hemostatic,there should be a hysterectomy to rescue patients lives. Obstetric hemorrhage connect with placenta previa. Prenatal diagnosis can reduce the obstetric hemorrhage and increase the retention rate of the uterus. Vaginal delivery had higher retention rate compared with Cesarean. The maternal age, gravidity,gestational age at delivery, parity and cesarean section history did not correlate with the risk of hysterectomy. 2.For placenta left in situ:It can increase the retention rate of the uterus,and area of placenta increta and obstetric hemorrhage amount affect the therapy. When area of placenta increta more 18.04 cm2,select the UAE treatment is better. When late obstetric hemorrhage more than 2000 ml,it should need a lumpectomy. The maternal age, the gestational age at delivery,gravidity, parity, and uterine muscle layer thickness where the placenta increta did not correlate with the treatment with placenta left in situ. The utility of monitoring serum β-hCG may be more suitable for placenta increta which found later postpartum. 3. The uterine curettage is of great significance for the treatment of placenta left in situ.