Urological Involvement in the Multidisciplinary Management of Placenta Accreta Spectrum in a Centralised, High-Volume Centre: A Retrospective Analysis

B. Kelly, R. Moorhead, D. Wetherell, Tracey Gilchrist, M. Furrer, M. Perera, B. Norris, David H. Wrede, M. Umstad, J. Kearsley, Faris Al-Shammaa
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引用次数: 1

Abstract

Objectives Placenta accreta spectrum (PAS) significantly increases the complexity of childbirth and frequently involves urologic organs. Multidisciplinary team (MDT) care is paramount to ensure optimal outcomes. We aimed to evaluate urologic interventions in patients with PAS at a centralised, tertiary referral centre. Methods An analysis of a prospectively collected data set, consisting of all women presenting with PAS at our institution between November 2013 and June 2019. Patients who required urological intervention were identified, and perioperative details were retrieved. Results Forty-two cases of PAS were identified. The mean maternal age was 35 years, and mean gestational age at delivery was 34 weeks. Thirty-seven cases were managed electively, with 5 cases managed conservatively (no hysterectomy) and 5 requiring emergency management. Fifteen patients (36%) had suspected bladder invasion on MRI. A total of 36 patients (86%) had ureteric catheters inserted, 14 (33%) required bladder repair, and 2 had ureteric injuries (5%). Conclusions PAS frequently requires urological intervention to prevent and repair injury to the urinary bladder and ureter. PAS is a rare condition that is best managed in an MDT setting in a centralised, tertiary, high-volume centre with access to a variety of medical and surgical sub-specialities.
在一个集中的、高容量的中心,泌尿科参与胎盘增生谱的多学科管理:回顾性分析
目的胎盘增生谱(PAS)显著增加了分娩的复杂性,并经常累及泌尿系统器官。多学科团队(MDT)护理对于确保最佳结果至关重要。我们的目的是在一个集中的三级转诊中心评估PAS患者的泌尿系统干预措施。方法对前瞻性收集的数据集进行分析,该数据集包括2013年11月至2019年6月期间在我院就诊的所有患有PAS的女性。确定需要泌尿外科干预的患者,并检索围手术期细节。结果共确诊PAS 42例。产妇的平均年龄为35岁,分娩时的平均胎龄为34周。37例选择治疗,5例保守治疗(不切除子宫),5例需要急诊治疗。15例患者(36%)MRI表现怀疑膀胱侵犯。输尿管置管36例(86%),膀胱修复14例(33%),输尿管损伤2例(5%)。结论PAS经常需要泌尿外科干预以预防和修复膀胱和输尿管损伤。PAS是一种罕见的疾病,最好在集中的三级高容量中心的MDT环境中进行管理,并可获得各种医学和外科专科。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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