胎盘积聚谱的预期管理后，后续妊娠中延迟的灾难性子宫破裂
Delayed Catastrophic Uterine Rupture in a Subsequent Pregnancy After Expectant Management of Placenta Accreta Spectrum.
摘要(中文译文)
胎盘植入谱系疾病（placenta accreta spectrum，PAS）是一种严重的产科疾病，涉及胎盘异常附着于子宫壁，并与显著的母体风险相关。尽管剖宫产子宫切除术仍是标准治疗方案，但保守管理方法正逐渐成为替代选择。目前关于保守管理长期并发症的数据十分有限。我们报告一例有保守管理PAS病史的患者，在14年后的再次妊娠中于孕中期发生宫底子宫破裂，凸显了保留子宫方法相关的潜在长期风险。患者为39岁，孕6产5活3，于孕26周就诊，表现为急性腹痛且无胎心活动。其病史值得注意的是既往五次剖宫产，包括在第四次妊娠时因合并PAS而行的古典式剖宫产。在该次妊娠中，她接受了多学科保守管理，包括古典式剖宫产并留置胎盘原位及子宫动脉栓塞术。其术后病程顺利，成功保留了子宫。在第六次妊娠中，因担心子宫破裂，决定紧急行剖宫产术。进入腹腔后，发现其已发生宫底子宫破裂伴胎盘完全剥离。子宫破裂部位得以修补，子宫予以保留。本病例表明，即使在对PAS采取保留子宫的保守管理时进行了仔细的患者选择和多学科规划，不良结局仍可能发生。这凸显了长期监测和进一步研究的必要性，以明确保留生育能力方法的风险、结局及生殖相关影响。
Abstract
Placenta accreta spectrum (PAS) is a serious obstetric disorder involving abnormal placental attachment to the uterine wall and is associated with substantial maternal risk. While cesarean hysterectomy remains the standard treatment, conservative management approaches are emerging as alternatives. Minimal data is currently available regarding the long-term complications of conservative management. We present a case of a patient with a history of conservatively managed PAS who presented 14 years later during a subsequent pregnancy with fundal uterine rupture in the second trimester, highlighting the potential long-term risks associated with uterine sparing approaches. A 39-year-old gravida 6 para 5003 woman presented at 26 weeks of gestation with acute abdominal pain and no fetal cardiac activity. Her history was notable for five prior cesarean deliveries, including a classical cesarean in her G4 pregnancy complicated by PAS. In that pregnancy, she underwent multidisciplinary conservative management, including classical cesarean delivery with the placenta left in situ and uterine artery embolization. Her postoperative course was uncomplicated, with successful uterine preservation. In her G6 pregnancy, due to concern for uterine rupture, decision was made to proceed with stat cesarean section. Upon entry into the abdominal cavity, she had experienced a fundal uterine rupture with complete placental separation. The site of the uterine rupture was able to be repaired, and the uterus was left in situ. This case demonstrates that even when conservative, uterine-sparing management of PAS is pursued with careful patient selection and multidisciplinary planning, adverse outcomes can still occur. It highlights the need for long-term surveillance and further research to clarify the risks, outcomes, and reproductive implications of fertility-preserving approaches.
如何引用
AMA
Nneoma B Edokobi, Tam D Nguyen, Kaitlin A Warta. Delayed Catastrophic Uterine Rupture in a Subsequent Pregnancy After Expectant Management of Placenta Accreta Spectrum.. Cureus. 2026; doi:10.7759/cureus.108494.
APA
Nneoma B Edokobi, Tam D Nguyen, Kaitlin A Warta (2026). Delayed Catastrophic Uterine Rupture in a Subsequent Pregnancy After Expectant Management of Placenta Accreta Spectrum.. Cureus. https://doi.org/10.7759/cureus.108494
GB/T 7714
Nneoma B Edokobi, Tam D Nguyen, Kaitlin A Warta. Delayed Catastrophic Uterine Rupture in a Subsequent Pregnancy After Expectant Management of Placenta Accreta Spectrum.[J]. Cureus, 2026 doi:10.7759/cureus.108494.
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