支持方：胎盘植入的保守管理

摘要(中文译文)

胎盘植入谱系疾病的保守管理正日益被视为剖宫产子宫切除术的一种临床上有效、循证医学支持的替代方案，能够降低孕产妇发病率，尤其适用于希望保留生育功能的女性。前瞻性研究表明，与剖宫产子宫切除术相比，保守管理与出血相关发病率显著降低及器官损伤率更低相关。其代价包括延迟性产后出血、较高的感染率和再入院率。保守管理涉及长期的临床和超声随访。其成功需要严格的患者筛选，而安全实施则要求地理位置邻近转诊中心，并具备24小时全天候的多学科团队以处理潜在的急性并发症。

Abstract

Conservative management of placenta accreta spectrum is increasingly recognized as a clinically valid, evidence-based alternative to cesarean hysterectomy, enabling reduction of maternal morbidity, particularly for women desiring fertility preservation. Prospective studies demonstrate that conservative management is associated with substantially reduced hemorrhagic morbidity and lower organ injury rates compared with cesarean hysterectomy. Trade-offs include delayed postpartum hemorrhage, higher infection, and readmission rates. Conservative management involves prolonged clinical and ultrasound follow-up. Its success requires patient selection, and its safe implementation demands geographic proximity to a referral center, and availability of a multidisciplinary team 24/7 to manage potential acute complications.

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