Placenta accreta

第一次看到Placenta accreta，VS雖然之前有預料到，可是C/S時口中還是直唸「這跟我想的不一樣」。寶寶出來之後血一直流，VS拉出胎盤後一直綁，可是還是緩不濟急，BP降到60/30，麻醉科血袋狂叫，幸好有8個R在場，有空的人手一包開始擠。後來VS決定hysterectomy，不過似乎吃到Serosa（幸好沒吃到膀胱），切完以後還是一直冒血，光綁就綁掉了四包一號半，最後總算止住。整個手術過程VS超冷靜也超有耐心，一個點一個點綁住，止血止得很漂亮，最後母子均安，手術時間共三個半小時，Blood loss 13600...真的好恐怖。

UpToDate:

-Placenta accreta refers to an abnormal placental implantation in which the anchoring placental villi attach to the myometrium, rather than being contained by decidual cells. This results in a placenta that is abnormally adherent to the uterus. Related, but more severe abnormalities of placental implantation include placenta increta(in to myometrium) and precreta(to peripheral organ).
-The most important risk factor for placenta accreta is previous uterine surgery and the most common setting is placenta previa after a prior pregnancy delivered by cesarean.

* Unscarred uterus, 1 to 5 percent

* One previous cesarean birth, 11 to 25 percent

* Two previous cesarean births, 35 to 47 percent

* Three previous cesarean births, 40 percent

* Four or more previous cesarean births, 50 to 67 percent

-The most useful modalities for evaluating placental position and implantation are transabdominal and transvaginal ultrasonography. The sensitivity and specificity of ultrasound for detection of placenta accreta are approximately 0.80 and 0.95, respectively.