Because of the low incidence of embryo implantation, it is difficult to diagnose early pregnancy, and the placenta can not be peeled off after delivery, which affects uterine contraction and causes a lot of bleeding, and the incidence of postpartum bleeding is high. Early diagnosis of placenta accreta is the key to improve prognosis. Screening high-risk parturient women undergoing uterine operations such as placenta previa and cesarean section, detecting serum CK, AFP, free fetal DNA and other indicators can suggest that placenta implantation is non-invasive, but it lacks specificity; MRI can not only identify the types of implanted placenta, but also predict recent bleeding. The accuracy of prenatal diagnosis of placenta accreta is high, but it is expensive and difficult to be popularized in clinic. Color Doppler ultrasound is of great value in the diagnosis of placenta accreta. Color Doppler ultrasound examination during pregnancy can indicate that the posterior placental space disappears, and there are many fluid dark areas with different sizes and irregular shapes in the placenta, which are rich in blood flow and involve the muscularis, resulting in the loss or even complete interruption of the muscularis in some areas behind the placenta [4]. Although there was no vaginal bleeding during pregnancy, 2 cases in this group were found to be central placenta previa, with multiple blood sinuses in the placenta. Placenta implantation was highly suspected before delivery, and the placenta adhered to the uterine wall during delivery, which was difficult to peel off, resulting in massive bleeding. After hysterectomy, the placenta was confirmed by pathological examination. In addition, if it is difficult to peel off the placenta by hand during delivery, and the peeling surface is not loose, and the placenta penetrates into the myometrium like a branch, the possibility of placenta implantation should be highly suspected [5]. Through the analysis of 25 cases of placenta accreta, it is recognized that pregnant women with a history of cesarean section, multiple induced abortions and multiple pregnancy delivery should be highly valued. As far as possible, 1 color Doppler ultrasound examination should be carried out in the middle and late pregnancy to understand the position of placenta, its relationship with uterine muscle wall and the blood flow of placenta, which is expected to make a diagnosis as soon as possible.
It used to be thought that the principle of placenta implantation was hysterectomy. If the placenta is completely implanted and the implantation degree reaches deep muscular layer or penetrates serosa surface with active bleeding, subtotal hysterectomy should be performed decisively. However, hysterectomy made young women lose their fertility and caused great psychological and physical trauma [5]. 23 cases (92.0%) were treated conservatively, which showed the feasibility of conservative treatment. Placenta is partially implanted, and the degree of implantation only reaches the superficial muscle layer. Those with small implantation area should be treated conservatively as far as possible to preserve the uterus. If there is not much bleeding after vaginal delivery, postpartum can be treated with integrated traditional Chinese and western medicine; During cesarean section, blunt or sharp dissection of placenta is feasible, and the dissection surface is sutured with catgut 8 or continuous suture to stop bleeding. If the bleeding on the peeling surface is rough and it is difficult to suture for a while, hot saline towel can be used to compress the bilateral uterine arteries locally, which can appropriately slow down the bleeding speed and amount, which is beneficial to suture and stop bleeding, and can also ligate the bilateral internal iliac arteries. There were 4 cases of postpartum hemorrhage in this group, and finally the uterus was preserved by this method. Preserving uterus is beneficial to women's physical and mental health. Therefore, for patients with fertility requirements, under the premise of effectively controlling placental bleeding, conservative treatments such as catgut suture, diamond-shaped resection of uterine wall at placenta implantation site and application of chemotherapy drugs should be taken as far as possible.
Embryo implantation is prone to postpartum hemorrhage, infection, and even maternal death due to postpartum hemorrhage. It is of great significance to actively find the risk factors of placenta accreta and prevent them. (1) Strengthen family planning education, give birth to fewer and healthier children, give birth at appropriate age, prevent multiple births, multiple births and multiple intrauterine operations, and reduce endometrial damage. ② Grasp the indications of cesarean section, reduce the rate of cesarean section, and adopt the mode of accompanying delivery to relieve the mental stress and pain of pregnant women during delivery. ③ Improve the technical level, avoid iatrogenic endometrial damage and prevent reproductive tract infection. ④ Avoid rough intrauterine operation and actively treat pregnancy complications.