早孕胎盤絨毛植入

1、 婦科常見英語單詞婦產(chǎn)科：Gynecology and obstetric 葡萄胎：Hydatidiform moleHCG：human chorionic gonadotropinHPV:human papilloma virusGTD：gestational trophoblastic diseaseGTT：gestational trophoblastic tumorCC:choriocarcinoma侵蝕性葡萄胎：invasive molePSTT：placental site trophoblastic tumor胎物殘留： placental remnantCIS：cancinom

2、a in situCIN:cervical intraepithelial neoplasia病例一病例二病例三病例四中山市博愛醫(yī)院婦科顏友良早孕絨毛植入 placenta accreta implantation of early pregnancy病例特點一患者覃xx，女，30歲，已婚人流術(shù)后17天，檢查發(fā)現(xiàn)宮內(nèi)異常1天，于3月3日入院17天前在外院因“早孕”行人流術(shù)，組織物未送病檢，過程順利?；颊咴陆?jīng)規(guī)則，末次月經(jīng)2010-12-30。G1P0A1。心肺腹部無異常婦科檢查：宮頸光滑，無舉痛，子宮前位，增大如孕2月大小，質(zhì)軟，無壓痛，雙附件未及包塊，無壓痛。 病歷特點二3月2日（入院前一天

3、）：血-HCG129,351mIU/ml，B超：子宮增大，宮內(nèi)異常回聲3633，考慮滋養(yǎng)細胞疾病？組織殘留物？血常規(guī)、凝血功能、白帶常規(guī)+BV、心電圖、胸片無異常。肝功示ALT 64U/L，余正常，腎功無異常入院診斷：滋養(yǎng)細胞疾??？依據(jù)：已婚育齡女性，人流術(shù)后17天，檢查宮內(nèi)異常。子宮增大如孕2月。血-HCG12,9351mIU/ml，B超檢查示：子宮增大，宮內(nèi)異?；芈?633，考慮滋養(yǎng)細胞疾?。拷M織殘留物？ 鑒別診斷 胎物殘留？ 侵蝕葡萄胎？ 絨毛膜癌？ 宮腔鏡檢查(3月4日)： 宮深11cm，宮頸管光滑，宮腔形態(tài)不規(guī)則，宮腔右側(cè)見黃色組織物及粘連帶如網(wǎng)狀。 右側(cè)輸卵管開口可見，左側(cè)輸卵管開

4、口未見，鏡下診斷：1、宮腔粘連 2、胎物殘留？診刮術(shù)，刮出組織物15g，見絨毛樣組織物，術(shù)中出血10ml。治療經(jīng)過第三天(3月6日)： 1.血-HCG79,290mIU/ml。 2.病理：送檢絨毛組織物，少數(shù)絨毛水腫變性，滋養(yǎng)葉細胞未見明顯增生， 3.陰道三維彩超：子宮增大，宮底后壁類圓形稍高混合回聲4031mm，內(nèi)見豐富彩流信號 考慮滋養(yǎng)細胞疾病累及肌壁？組織物殘留植入肌壁？診療經(jīng)過 術(shù)后患者陰道流血少，無腹痛。生命體征平穩(wěn)，腹軟，無壓痛及反跳痛。入院第六天: 血-HCG 45,406mIU/ml。 入院第十天: 血-HCG 33,747mIU/ml。 診斷：考慮早孕胎盤植入可能性大，建議患

5、者行介入動脈灌注治療.介入治療（入院第12天） 雙側(cè)子宮動脈管徑增粗，迂曲顯影（左側(cè)優(yōu)勢） 子宮體左側(cè)可見團狀血管染色，大小約3.0*3.0cm，邊緣欠清，未見明顯動靜脈瘺及血管畸形 微導管分別插至雙側(cè)子宮動脈主干后，分別注入氨甲喋呤（總量為100mg）后，以慶大霉素混合明膠海綿顆粒（直徑約710-1400um）適量栓塞，再次腹主動脈下段造影顯示雙側(cè)栓塞范圍及程度滿意，雙側(cè)子宮動脈未顯影。3月17日（術(shù)后第2天） -HCG 3799mIU/ml3月22日（術(shù)后第7天） -HCG 609.43mIU/ml 陰道彩超：子宮底部偏左側(cè)實性略強回聲團（栓塞術(shù)后）3024mm：結(jié)合病史考慮胎物浸潤肌層可

6、能，周邊見少許點狀血流信號。術(shù)后情況時間子宮大?。╩m）內(nèi)膜厚度（mm）宮底包快大?。╩m）-HCG(mIu/ml)E2(pg/ml)2011.3.1754*38*538.233*22 混合性37992011.3.2256*44*64730*24 實性609.432011.3.301502011.4.1428.382011.4.2550*40*54325*22 實性16.052011.6.2345*32*42412*11 混合性52011.7.2547*37*38315*16 混合性1.2320778.142012.2.2354*34*535.68*7 混合性2012.6.

7、2750*41*489消失0.78416.62問題1、診斷？2、處理能否更加完善些？3、如何預防？1.病理基礎(chǔ)：子宮粘膜缺乏或缺陷2.所有子宮內(nèi)膜疾病都容易發(fā)生胎盤植入3.粘膜下子宮肌瘤、子宮瘢痕、子宮肌瘤剔除術(shù)后或殘角子宮切除術(shù)后及有刮宮、徒手剝離胎盤、子宮內(nèi)膜炎病史胎盤絨毛植入的病因胎盤絨毛植入的臨床特點1.剖宮產(chǎn)史：2.停經(jīng)后陰道出血：3.刮宮術(shù)時出現(xiàn)難以控制的大出血：4.子宮穿破、腹腔內(nèi)出血：1.子宮切除術(shù) 胎盤植入可發(fā)生致命性大出血，多需子宮切除術(shù)才能奏效 2.子宮動脈栓塞術(shù)胎盤絨毛植入的處理方法 早孕絨毛植入誤診1 例吉林省臨江林業(yè)局職工醫(yī)院婦產(chǎn)科宮青1臨床資料 一般情況: 患者,

8、 女, 28 歲, 因停經(jīng)45 d, 在當?shù)匦l(wèi)生院行人工流產(chǎn)術(shù)后持續(xù)流血半個月, 又行消炎、促進宮縮、刮宮治療, 觀察1 周仍有陰道流血, 色暗, 又行第二次刮宮, 陰道持續(xù)流血1 個月, 不伴有腹痛, 術(shù)后HCG 定性持續(xù)陽性, 轉(zhuǎn)入本院。發(fā)病以來無明顯消瘦及咳嗽等癥狀。既往曾做過2 次人工流產(chǎn), 足月分娩一胎。入院查體: 一般情況良好。婦科檢查: 子宮增大約孕50 d 大小, 質(zhì)軟, 無明顯結(jié)節(jié)及壓痛。HCG 定量3 次分別為386、226 和202 IU L- 1 ( 正常值為120 IUL- 1) 。彩色B 型超聲: 子宮7. 3 cm6. 4 cm 5. 5 cm , 邊界欠清, 中

9、央有強光團, 附件正常。B 型超聲: 人工流產(chǎn)不全, 絨毛膜癌待排出。遂入院后行清宮術(shù), 術(shù)中探及宮腔8 cm, 宮腔壁無明顯突起, 刮出少許組織物。病理報告: 增殖期子宮內(nèi)膜。臨床擬診絨毛膜癌, 征得家屬同意行手術(shù)治療。剖腹探查術(shù): 術(shù)中發(fā)現(xiàn)子宮增大約孕50 d 大小, 左宮角突起呈紫藍色結(jié)節(jié), 約5 cm3 cm, 漿膜完整。雙附件正常, 流血不明顯, 切開紫色結(jié)節(jié), 內(nèi)部為均勻壞死織。行子宮次全切除加左附件切除術(shù)。病理報告: 左宮角絨毛植入。術(shù)后8 d 痊愈出院。，（ ，）【】 ， ； _ ， ， 【】Int J Crit Illn Inj Sci.2013 Jul;3(3):183-9

10、. doi: 10.4103/2229-5151.119197.Contemporary issues in the management of abnormal placentation duringpregnancyin developing nations: An Indian perspective.Bajwa SK1,Singh A1,Bajwa SJ2.Abstract The gap between the developed and developing nations with regards to maternal mortality and morbidity may h

11、ave narrowed but still a lot of dedicated work is required to bridge these differences. Obstetrical haemorrhage is the leading cause of maternal deaths in these developing nations especially in India. The most common causes of this fatal haemorrhage are the placental abnormalities which rarely get d

12、etected before delivery. Numerous factors have been incremental in the causation of this abnormal placentalimplantationwith resultant complications. The present article is an attempt to review possible predictors of abnormal placentalimplantation. Also, a genuine attempt has been made to enumerate p

13、ossible measures to identify the predictors of abnormal placentation duringearly pregnancyand their suitable prevention and management.KEYWORDS:Abnormal placentation, haemorrhage, maternal mortality,placenta accreta,placentaincreta,placentapercreta,placentapreviaBJOG.2014 Jan;121(2):171-81; discussi

14、on 181-2. doi: 10.1111/1471-0528.12557.The antenatal diagnosis ofplacenta accreta.Comstock CH1,Bronsteen RA.AbstractThe incidence of placental attachment disorders continues to increase with rising caesarean section rates. Antenatal diagnosis helps in the planning of location, timing and staffing of

15、 delivery. In at-risk women grey-scale ultrasound is quite sensitive, although colour ultrasound is the most predictive. Magnetic resonance imaging can add information in some limited instances. Patients who have had a previous caesarean section could benefit fromearly(before 10 weeks) visualisation

16、 of theimplantationsite. Current data refer only to placentas implanted in the lower anterior uterine segment, usually over a caesarean section scar. 2013 Royal College of Obstetricians and Gynaecologists.KEYWORDS:Caesarean hysterectomy, caesarean section, colour Doppler ultrasound, magnetic resonan

17、ce imaging,placenta,placenta accreta,placentaincreta,placentapercreta, scarpregnancy, three-dimensional colour Doppler ultrasound, ultrasoundJ Ultrasound Med.2012 Nov;31(11):1835-41.Identifying sonographic markers forplacenta accretain the first trimester.Ballas J1,Pretorius D,Hull AD,Resnik R,Ramos

18、 GA.Author informationAbstractOur study attempted to identify whether sonographic markers forplacenta accretamay be present asearlyas the first trimester. We reviewed 10 cases with pathologically provenaccretaand retrospectively analyzed their first-trimester images. The gestational ages ranged from 8 weeks 4 days to 14 weeks 2 days. Sonographic findings included anechoic placental areas (9 of 10), lowimplantationof the gestational sac (9 of 10), an irregular placental-myometrial in