胎盘植入性疾病的诊疗进展:从病因机制到 临床管理
Advances in the Diagnosis and Management of Placenta Accreta Spectrum Disorders: From Etiological Mechanisms to Clinical Practice
摘要: 胎盘植入性疾病(Placenta Accreta Spectrum, PAS)是产科临床面临的重大挑战之一。随着全球剖宫产率持续攀升及辅助生殖技术的广泛应用,PAS发病率呈显著上升趋势,已成为导致严重产科出血、围产期子宫切除乃至孕产妇死亡的重要原因。本文系统回顾了胎盘植入性疾病的病因机制、产前诊断及临床管理策略的研究进展,旨在为临床实践提供参考。
Abstract: Placenta Accreta Spectrum (PAS) is one of the major challenges in clinical obstetrics. With the continuous rise in global cesarean section rates and the widespread application of assisted reproductive technology, the incidence of PAS has shown a significant upward trend, and it has become an important cause of severe obstetric hemorrhage, peripartum hysterectomy, and even maternal mortality. This article systematically reviews the research progress on the etiological mechanisms, prenatal diagnosis, and clinical management strategies of placenta accreta spectrum disorders, aiming to provide a reference for clinical practice.
文章引用:唐在梅, 余昕烊. 胎盘植入性疾病的诊疗进展:从病因机制到 临床管理[J]. 临床医学进展, 2026, 16(6): 298-307. https://doi.org/10.12677/acm.2026.1662221

参考文献

[1] Hecht, J.L., Baergen, R., Ernst, L.M., Katzman, P.J., Jacques, S.M., Jauniaux, E., et al. (2020) Classification and Reporting Guidelines for the Pathology Diagnosis of Placenta Accreta Spectrum (PAS) Disorders: Recommendations from an Expert Panel. Modern Pathology, 33, 2382-2396. [Google Scholar] [CrossRef] [PubMed]
[2] Matsuzaki, S., Mandelbaum, R.S., Sangara, R.N., McCarthy, L.E., Vestal, N.L., Klar, M., et al. (2021) Trends, Characteristics, and Outcomes of Placenta Accreta Spectrum: A National Study in the United States. American Journal of Obstetrics and Gynecology, 225, 534.e1-534.e38. [Google Scholar] [CrossRef] [PubMed]
[3] Luke, R.K., Sharpe, J.W. and Greene, R.R. (1966) Placenta Accreta: The Adherent or Invasive Placenta. American Journal of Obstetrics and Gynecology, 95, 660-668. [Google Scholar] [CrossRef] [PubMed]
[4] Jauniaux, E., Jurkovic, D., Hussein, A.M. and Burton, G.J. (2022) New Insights into the Etiopathology of Placenta Accreta Spectrum. American Journal of Obstetrics and Gynecology, 227, 384-391. [Google Scholar] [CrossRef] [PubMed]
[5] Ali, H. and Chandraharan, E. (2021) Etiopathogenesis and Risk Factors for Placental Accreta Spectrum Disorders. Best Practice & Research Clinical Obstetrics & Gynaecology, 72, 4-12. [Google Scholar] [CrossRef] [PubMed]
[6] Keag, O.E., Norman, J.E. and Stock, S.J. (2018) Long-Term Risks and Benefits Associated with Cesarean Delivery for Mother, Baby, and Subsequent Pregnancies: Systematic Review and Meta-Analysis. PLOS Medicine, 15, e1002494. [Google Scholar] [CrossRef] [PubMed]
[7] Jauniaux, E.R.M., Alfirevic, Z., Bhide, A., Belfort, M., Burton, G., Collins, S., et al. (2018) Placenta Praevia and Placenta Accreta: Diagnosis and Management. BJOG: An International Journal of Obstetrics & Gynaecology, 126, e1-e48. [Google Scholar] [CrossRef] [PubMed]
[8] Thurn, L., Lindqvist, P.G., Jakobsson, M., Colmorn, L., Klungsoyr, K., Bjarnadóttir, R., et al. (2016) Abnormally Invasive Placenta—Prevalence, Risk Factors and Antenatal Suspicion: Results from a Large Population‐Based Pregnancy Cohort Study in the Nordic Countries. BJOG: An International Journal of Obstetrics & Gynaecology, 123, 1348-1355. [Google Scholar] [CrossRef] [PubMed]
[9] Matsuzaki, S., Nagase, Y., Takiuchi, T., Kakigano, A., Mimura, K., Lee, M., et al. (2021) Antenatal Diagnosis of Placenta Accreta Spectrum after in Vitro Fertilization-Embryo Transfer: A Systematic Review and Meta-Analysis. Scientific Reports, 11, Article No. 9205. [Google Scholar] [CrossRef] [PubMed]
[10] Lai, S., Zhang, L., Luo, Y., Gu, Z., Yan, Z., Zhang, Y., et al. (2024) A Sonographic Endometrial Thickness < 7 mm in Women Undergoing in Vitro Fertilization Increases the Risk of Placenta Accreta Spectrum. American Journal of Obstetrics and Gynecology, 231, 557.e1-557.e18. [Google Scholar] [CrossRef] [PubMed]
[11] Einerson, B.D., Gilner, J.B. and Zuckerwise, L.C. (2023) Placenta Accreta Spectrum. Obstetrics & Gynecology, 142, 31-50. [Google Scholar] [CrossRef] [PubMed]
[12] Calì, G., Timor‐Trisch, I.E., Palacios‐Jaraquemada, J., Monteaugudo, A., Forlani, F., Minneci, G., et al. (2018) Changes in Ultrasonography Indicators of Abnormally Invasive Placenta during Pregnancy. International Journal of Gynecology & Obstetrics, 140, 319-325. [Google Scholar] [CrossRef] [PubMed]
[13] Collins, S.L., Ashcroft, A., Braun, T., Calda, P., Langhoff‐Roos, J., Morel, O., et al. (2016) Proposal for Standardized Ultrasound Descriptors of Abnormally Invasive Placenta (AIP). Ultrasound in Obstetrics & Gynecology, 47, 271-275. [Google Scholar] [CrossRef] [PubMed]
[14] 中华医学会妇产科学分会产科学组, 中国医师协会妇产科分会母胎医学专委会. 胎盘植入性疾病诊断和处理指南(2023) [J]. 中华围产医学杂志, 2023, 26(8): 617-627.
[15] 陈永露, 宋亭, 刘祎, 等. 产前MRI在胎盘植入中的诊断价值[J]. 中国医学影像学杂志, 2015, 23(6): 470-473.
[16] Familiari, A., Liberati, M., Lim, P., Pagani, G., Cali, G., Buca, D., et al. (2018) Diagnostic Accuracy of Magnetic Resonance Imaging in Detecting the Severity of Abnormal Invasive Placenta: A Systematic Review and Meta‐Analysis. Acta Obstetricia et Gynecologica Scandinavica, 97, 507-520. [Google Scholar] [CrossRef] [PubMed]
[17] Berezowsky, A., Pardo, J., Ben-Zion, M., Wiznitzer, A. and Aviram, A. (2019) Second Trimester Biochemical Markers as Possible Predictors of Pathological Placentation: A Retrospective Case-Control Study. Fetal Diagnosis and Therapy, 46, 187-192. [Google Scholar] [CrossRef] [PubMed]
[18] Guo, Z., Yang, H. and Ma, J. (2023) Maternal Circulating Biomarkers Associated with Placenta Accreta Spectrum Disorders. Chinese Medical Journal, 136, 995-997. [Google Scholar] [CrossRef] [PubMed]
[19] Pain, F., Dohan, A., Grange, G., Marcellin, L., Uzan‐Augui, J., Goffinet, F., et al. (2022) Percreta Score to Differentiate between Placenta Accreta and Placenta Percreta with Ultrasound and MR Imaging. Acta Obstetricia et Gynecologica Scandinavica, 101, 1135-1145. [Google Scholar] [CrossRef] [PubMed]
[20] 李萍, 翟俊英, 李宛玲. 血清HCG、AFP水平联合MRI在前置胎盘植入及其分类诊断中的应用[J]. 中国CT和MRI杂志, 2019, 17(2): 84-86.
[21] Allen, L., Jauniaux, E., Hobson, S., Papillon‐Smith, J. and Belfort, M.A. (2018) FIGO Consensus Guidelines on Placenta Accreta Spectrum Disorders: Nonconservative Surgical Management. International Journal of Gynecology & Obstetrics, 140, 281-290. [Google Scholar] [CrossRef] [PubMed]
[22] Yao, R., Nguyen, H.Y., Hong, L., Karagoyzyan, D., Burruss, S., Brar, H., et al. (2023) Regional Multidisciplinary Team Approach to the Management of Placenta Accreta Spectrum Disorder. The Journal of Maternal-Fetal & Neonatal Medicine, 36, Article 2190840. [Google Scholar] [CrossRef] [PubMed]
[23] 刘小晖, 董燕, 刘小玲, 等. 多学科协作诊疗模式在穿透性胎盘植入中的应用[J]. 国际妇产科学杂志, 2020, 47(6): 666-669.
[24] Sentilhes, L., Seco, A., Azria, E., Beucher, G., Bonnet, M., Branger, B., et al. (2022) Conservative Management or Cesarean Hysterectomy for Placenta Accreta Spectrum: The PACCRETA Prospective Study. American Journal of Obstetrics and Gynecology, 226, 839.e1-839.e24. [Google Scholar] [CrossRef] [PubMed]
[25] van Beekhuizen, H.J., Stefanovic, V., Schwickert, A., Henrich, W., Fox, K.A., MHallem Gziri, M., et al. (2021) A Multicenter Observational Survey of Management Strategies in 442 Pregnancies with Suspected Placenta Accreta Spectrum. Acta Obstetricia et Gynecologica Scandinavica, 100, 12-20. [Google Scholar] [CrossRef] [PubMed]
[26] 汪革平, 李莹, 樊敏, 等. 凶险性前置胎盘的诊治新进展[J]. 广西医科大学学报, 2018, 35(9): 1315-1317.
[27] 周颖, 汪燕, 李佳宁, 等. 宫颈内口-子宫下段压迫缝合法用于凶险性前置胎盘伴胎盘植入术中止血的疗效评估[J]. 实用妇产科杂志, 2017, 33(1): 69-71.
[28] Alam, B., Nasir, F., Akbari, A.R., Alali, B. and Khalil, Z. (2023) A Review and Comparison of the Efficacy of Prophylactic Interventional Radiological Arterial Occlusions in Placenta Accreta Spectrum Patients: A Meta-Analysis. Academic Radiology, 30, 1443-1455. [Google Scholar] [CrossRef] [PubMed]
[29] Hawthorn, B.R. and Ratnam, L.A. (2021) Role of Interventional Radiology in Placenta Accreta Spectrum (PAS) Disorders. Best Practice & Research Clinical Obstetrics & Gynaecology, 72, 25-37. [Google Scholar] [CrossRef] [PubMed]
[30] 韩新巍, 王艳丽, 张凯. 胎盘植入剖宫产血管内球囊暂时阻断技术规范中国专家共识[J]. 介入放射学杂志, 2023, 32(5): 415-420.
[31] Yuan, Y., He, X., Liu, P., Pu, D., Shi, Q., Chen, J., et al. (2023) The Effectiveness of Single Ultrasound-Guided High-Intensity Focused Ultrasound (USgHIFU) Ablation in Managing Placenta Accreta Spectrum (PAS) Disorder. Archives of Gynecology and Obstetrics, 307, 1037-1045. [Google Scholar] [CrossRef] [PubMed]
[32] 陈敦金, 杨慧霞. 胎盘植入诊治指南(2015) [J]. 中华产科急救电子杂志, 2016, 5(1): 26-31.
[33] Javinani, A., Qaderi, S., Hessami, K., Shainker, S.A., Shamshirsaz, A.A., Fox, K.A., et al. (2024) Delivery Outcomes in the Subsequent Pregnancy Following the Conservative Management of Placenta Accreta Spectrum Disorder: A Systematic Review and Meta-Analysis. American Journal of Obstetrics and Gynecology, 230, 485-492.e7. [Google Scholar] [CrossRef] [PubMed]
[34] Casey, S.R., Goulding, A.N., Reed, C.C., Shamshirsaz, A.A., Lombaard, H.A., Belfort, M.A., et al. (2024) Perinatal Mental Healthcare Utilization among Patients with Placenta Accreta Spectrum. American Journal of Obstetrics & Gynecology MFM, 6, Article 101405. [Google Scholar] [CrossRef] [PubMed]