Objective To study the selection of cesarean section for placenta increta in order to improve the prognosis of mothers and their infants. Methods Clinical data about 9 cases of placenta increta (6 cases in Chinese PLA General Hospital and 3 cases in Third Hospital of Peking University) were retrospectively analyzed. How to select cesarean section for placenta increta was discussed based on a review of the literature. Results Color Doppler ultrasound showed placenta increta or suspicious placenta increta in 8 out of the 9 cases. MR1 identified placenta increta in 3 cases. The diagnosis of placenta increta was established in the 8 cases during surgery or at pathological examination. The mean age of the 9 cases was 35 years. The mean gestational time was 33+4 weeks. The pregnancy was ≥4 times. Six cases had a history of more than 2 times of uterine cavity operation and 5 had a history of cesarean section. Penetrative placenta, implanted placenta and placenta previa were observed in 4,5 and 7 cases, respectively. Of the 9 cases, 3 underwent cesarean section, hysterectomy and bladder repair, 4 underwent cesarean section and hysterectomy, and 2 underwent cesarean section and uterus repair. Postpartum hemorrhage occurred in the 9 cases with a mean blood loss of 5.6 liters and a mean blood transfusion volume of 4.9 liters. Intrauterine fetal death occurred in 3 cases. Conclusion Placenta increta frequently occurs in women at the age of over 35 years. Surgical plan should be made for those with a history of multiparity and uterine cavity operation. Hysterectomy should be performed when conservative treatment fails in order to reduce bleeding.%目的 探讨胎盘植入剖宫产手术方案的选择,以改善母婴预后.方法 回顾分析我院6例、北医三院3例共9例胎盘植入和穿透病例,结合文献探讨剖宫产术前及术中发现胎盘植入时,如何选择制定手术方案.结果 9例中8例术前彩超检查提示为胎盘植入及可疑胎盘植入,3例经MRI检查提示为胎盘植入,8例经手术及病理检杏明确诊断.平均年龄35岁,平均孕周33+4周;8例孕次≥4次,6例有2次以上宫腔手术史,5例有剖宫产史.4例为穿透性胎盘,5例植入性胎盘,共7例合并前置胎盘.3例行剖宫产术+子宫切除术及膀胱修补术,4例行剖官产术+子宫切除术,2例行剖宫产术+子宫修补术.9例患者均发生产后出血,平均出血量5.6L,输血量4.9L;3例发生胎死宫内.结论 胎盘植入多发生于高龄、经产且有宫腔手术史者,术前制订手术预案,术中多科协作,出血多采取保守治疗无效时应及时行子宫切除术以减少出血.
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