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Abordarea diagnostică şi terapeutică a placentei invazive

 Diagnostic and therapeutical approach of the invasive placenta

Natalia Ţurcan, Prof. Dr. Elvira Brătilă, Diana Ioana Voicu, Profesor universitar Claudia Mehedinţu, Roxana-Elena Bohîlţea, Monica Mihaela Cîrstoiu, Oana Bodean, Octavian Munteanu

First published: 15 aprilie 2016

Editorial Group: MEDICHUB MEDIA

Abstract

Adherent placenta incidence has increased in the last 60 years from 1/30000 pregnancies to 1/700 pregnancies. The increased index of the caesarean section supports this pathology. Uncontrollable bleeding due to the invasive placenta is one of the main indications of per partum hysterectomy and a major cause of disseminated intravascular coagulopathy, adult respiratory distress syndrome, kidney failure and maternal mortality. Although ultrasound diagnosis has a sensitivity considered to be 90% and a specificity of 97% with a positive real rate appreciated at 11 and a negative real rate of 0.16, magnetic resonance imaging is widely available and has a high diagnostic accuracy. In current practice prevails an inadvertently and an unreasonably high report between prenatal and the intraoperative diagnosis. Discussing the cases from the last 2 years of experience in a multidisciplinary emergency hospital, we present a broad review of the literature with the purpose of giving a coherent and standardized approach of the patients with risk factors. As well, the current methods for optimal therapeutic approach will be presented.
 

Keywords
adherent placenta, uterine embolization

Rezumat

Incidenţa placentei aderente a crescut în ultimii 60 de ani de la 1/30000 de sarcini la 1/700 de sarcini, creşterea indicelui de cezariană favorizând această patologie. Hemoragia incontrolabilă datorată placentatiei invazive reprezintă una dintre principalele indicaţii ale histerectomiei peripartum şi o cauză majoră de coagulopatie intravasculară diseminată, detresă respiratorie a adultului, insuficienţă renală şi mortalitate maternă. Deşi diagnosticul ecografic are o sensibilitate considerată a fi de 90% şi o specificitate de 97%, cu o rată de real pozitiv apreciată la 11 şi o rată de real negativ de 0,16, deşi rezonanţa magnetică este larg disponibilă şi are acurateţe diagnostică înaltă, practica demonstrează un raport de inadvertenţă nejusticat de mare între diagnosticul prenatal şi cel intraoperator. Discutând experienţa cazurilor ultimilor 2 ani într-un spital pluridisciplinar de urgenţă, prezentăm o largă revizie a literaturii de specialitate în scopul formulării unei abordari coerente şi standardizate a pacientelor cu factori de risc, precum şi a metodelor actuale optime de abordare terapeutică.
 

Cuvinte cheie
adherent placenta placentă aderentă

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