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已发表论文
凶险型前置胎盘合并胎盘植入剖宫产术中发生危及生命的大量出血患者的成功复苏：一例报告
Authors Zhi B , Zhang J , Wu H
Received 16 May 2025
Accepted for publication 11 November 2025
Published 12 December 2025 Volume 2025:18 Pages 1605—1610
DOI https://doi.org/10.2147/IMCRJ.S540788
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Gates Colbert
Bingqian Zhi,1 Jingli Zhang,2 Haiying Wu2
1Obstetrical Department, People’s Hospital of Henan University, Henan, People’s Republic of China; 2Obstetrical Department, Henan Provincial People’s Hospital, Henan, People’s Republic of China
Correspondence: Haiying Wu, Obstetrical Department, Henan Provincial People’s Hospital, Henan, People’s Republic of China, Email rustin9dedraav@outlook.com
Abstract: Pernicious placenta previa (PPP) complicated by placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with significant maternal morbidity and mortality, primarily due to severe hemorrhage during cesarean section. The 2018 FIGO Guidelines defines placenta accreta spectrum (PASDs) as a group of pathologic disorders. Depending on the depth of placental villous invasion into the uterine wall, PASDs are divided into placenta accreta (grade I), placenta increta (grade II), and placenta percreta (grade III). A 28-year-old gravida 4, para 2 woman with a history of two previous cesarean sections (Pfannenstiel scar) and one scar pregnancy presented with vaginal bleeding and abdominal discomfort at 34+3 weeks gestation. Prenatal ultrasound and magnetic resonance imaging (MRI) confirmed severe PPP with placenta accreta, involving extensive placental invasion into the bladder, cervix, vagina, and parametrial tissues. A multidisciplinary team performed preoperative abdominal aortic balloon occlusion (AABO) to reduce hemorrhage risk, followed by cesarean section under general anesthesia. Despite preventive measures, massive intraoperative hemorrhage (~6000 mL) led to hemorrhagic shock, necessitating aggressive resuscitation and massive transfusion therapy. The patient was successfully resuscitated with stable vital signs. Postoperative management included intrauterine balloon tamponade for hemostasis, prophylactic antibiotics, as well as additional blood transfusions, albumin, and nutritional support. The patient was discharged after showing improvement. This case highlights the importance of early and accurate prenatal diagnosis, rigorous multidisciplinary collaboration, and individualized surgical and resuscitative strategies in managing severe PPP complicated by PAS. Future research should focus on refining diagnostic techniques, preventive interventions, and comprehensive perioperative care protocols to minimize complications and optimize maternal and neonatal outcomes.
Keywords: pernicious placenta previa, placenta accreta spectrum, massive hemorrhage, multidisciplinary management, abdominal aortic balloon occlusion, fertility preservation
1Obstetrical Department, People’s Hospital of Henan University, Henan, People’s Republic of China; 2Obstetrical Department, Henan Provincial People’s Hospital, Henan, People’s Republic of China
Correspondence: Haiying Wu, Obstetrical Department, Henan Provincial People’s Hospital, Henan, People’s Republic of China, Email rustin9dedraav@outlook.com
Abstract: Pernicious placenta previa (PPP) complicated by placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with significant maternal morbidity and mortality, primarily due to severe hemorrhage during cesarean section. The 2018 FIGO Guidelines defines placenta accreta spectrum (PASDs) as a group of pathologic disorders. Depending on the depth of placental villous invasion into the uterine wall, PASDs are divided into placenta accreta (grade I), placenta increta (grade II), and placenta percreta (grade III). A 28-year-old gravida 4, para 2 woman with a history of two previous cesarean sections (Pfannenstiel scar) and one scar pregnancy presented with vaginal bleeding and abdominal discomfort at 34+3 weeks gestation. Prenatal ultrasound and magnetic resonance imaging (MRI) confirmed severe PPP with placenta accreta, involving extensive placental invasion into the bladder, cervix, vagina, and parametrial tissues. A multidisciplinary team performed preoperative abdominal aortic balloon occlusion (AABO) to reduce hemorrhage risk, followed by cesarean section under general anesthesia. Despite preventive measures, massive intraoperative hemorrhage (~6000 mL) led to hemorrhagic shock, necessitating aggressive resuscitation and massive transfusion therapy. The patient was successfully resuscitated with stable vital signs. Postoperative management included intrauterine balloon tamponade for hemostasis, prophylactic antibiotics, as well as additional blood transfusions, albumin, and nutritional support. The patient was discharged after showing improvement. This case highlights the importance of early and accurate prenatal diagnosis, rigorous multidisciplinary collaboration, and individualized surgical and resuscitative strategies in managing severe PPP complicated by PAS. Future research should focus on refining diagnostic techniques, preventive interventions, and comprehensive perioperative care protocols to minimize complications and optimize maternal and neonatal outcomes.
Keywords: pernicious placenta previa, placenta accreta spectrum, massive hemorrhage, multidisciplinary management, abdominal aortic balloon occlusion, fertility preservation