經由導管動脈栓塞成功的處理黏著性胎盤合併後腹膜腔血腫及嚴重產後子宮出血病例報告

Successful Management of a Case of Placenta Accreta Complicated with Retroperitoneal Hematoma and Severe Postpartum Hemorrhage by Transcatheter Arterial Embolization

陰道自然產後想要清除子宮內胎盤組織時，有時會發現胎盤組織異常黏著子宮。以子宮搔刮來清除子宮內黏著性胎盤有時可能會造成子宮穿孔、內出血、後腹膜腔血腫或子宮內沾黏後遺症。在本文中我們將討論如何經由導管動脈栓塞成功的處理可能因搔刮子宮內黏著性胎盤造成的後腹膜腔血腫及嚴重子宮出血。經由導管動脈栓塞能容易找到出血點、保留子宮生育能力及避免手術可能造成併發症。經由導管動脈栓塞後兩個月，後腹膜腔血腫及子宮黏著性胎盤完全吸收。三個月後月經週期恢復正常。

Placenta accreta is often encountered when attempting to manually remove the placenta after a vaginal delivery. Removing a placenta accreta by uterine curettage can result in uterus perforation, internal bleeding, retroperitoneal hematoma and intrauterine adhesions (Asherman syndrome). In this report, we discuss the use of transcatheter arterial embolization [TAE] to treat a case of placenta accreta complicated by retroperitoneal hematoma and severe uterine bleeding that may have been caused by uterine curettage. TAE is able to easily identify sources of bleeding, allows preservation of the uterus and the patient’s reproductive capability and helps to prevent surgery related complications. Complete resorption of the retroperitoneal hematoma and placenta accreta was found to have occurred two months after TAE. The patient’s menstrual cycle resumed three months after TAE without any sequelae.