BACKGROUND & AIMS: OBJECTIVE:Patients with suspected placenta accreta have improved outcomes with scheduled delivery. Our objective was to identify risk factors for unscheduled delivery in patients with suspected placenta accreta. STUDY DESIGN:This was a cohort study of women with antenatally suspected placenta accreta. Women who delivered prior to a planned delivery date were compared with women who had a scheduled delivery. Data were analyzed using a Student t test, χ(2), logistic regression, and survival analyses. Variables included in the analyses were episodes of antenatal vaginal bleeding, preterm premature rupture of membranes (PPROM), uterine contractions, prior cesarean deliveries, interpregnancy interval, parity, and patient demographic factors. A value of P < .05 was considered significant. RESULTS:Seventy-seven women with antenatal suspicion for placenta accreta were identified. Thirty-eight (49.4%) had an unscheduled delivery. Demographics were similar between groups. Unscheduled patients delivered earlier (mean 32.3 vs 35.7 weeks, P < .001) and were significantly more likely to have had vaginal bleeding (86.8% vs 35.9%, P < .001) and uterine activity (47.4% vs 2.6%, P < .001). Each episode of antenatal vaginal bleeding was associated with an increased risk of unscheduled delivery (adjusted odds ratio, 3.8; 95% confidence interval, 1.8-7.8). Risk of earlier delivery was even greater when associated with PPROM (P < .001). CONCLUSION:Among women with suspected placenta accreta, those with antenatal vaginal bleeding were more likely to require unscheduled delivery. This risk increases further in the setting of PPROM and/or uterine contractions. These clinical factors should be considered when determining the optimal delivery gestational age for women with placental accreta.

背景与目标：

BACKGROUND & AIMS: :The placental clearance of selected water-soluble molecules and antipyrine was evaluated using a dual perfusion of human placental lobules in vitro. When graded according to decreasing clearance, the sequence of the molecules was as follows: water = antipyrine greater than urea greater than p-aminohippuric acid greater than inulin greater than dextran 20 greater than dextran 70. A close correlation was obtained between the clearance and the free diffusion coefficient of these molecules. However, no restricted diffusion was observed in the molecular range studied. These results suggest an equivalent pore size larger than 90 A for the human placental membrane in vitro.

背景与目标： : 使用体外人胎盘小叶的双重灌注评估了所选水溶性分子和安替比林的胎盘清除率。当根据清除率的降低进行分级时，分子的顺序如下: 水 = 安替比林大于尿素大于对氨基马尿酸大于菊粉大于葡聚糖20大于葡聚糖70。在这些分子的间隙和自由扩散系数之间获得了密切的相关性。然而，在所研究的分子范围内未观察到限制扩散。这些结果表明，体外人胎盘膜的等效孔径大于90 A。

BACKGROUND & AIMS: Effects of exogenous cytokines on replication of vesicular stomatitis virus (VSV) in amniotic membrane and placental organ cultures (OC) were studied. We compared the effects observed in OC and established human carcinoma cell linesA549 and HEp-2. Recombinant human tumor necrosis factor alpha (rHuTNF-alpha), added to amniotic membrane, villous, or decidual OC at concentrations of 30 to 3000 U/ml, potentiated VSV replication by 10-1000 fold. Addition of 5 to 10000 U/ml of recombinant human interleukin 6 (rHuIL-6) to OC from 5 placentas was without effect on VSV growth, except one culture in which enhanced VSV replication has been observed. rHuTNF-alpha was found to have no effect on VSV growth in HEp-2 and A549 cell cultures.

In contrast, the placental OC were sensitive to antiviral activity of natural interferons (IFNs)alpha, beta and recombinant IFN-gamma, although A549 cells were 5 to 10 fold more responsive to the cytokines.

背景与目标： 研究了外源性细胞因子对羊膜和胎盘器官培养物 (OC) 中水泡性口炎病毒 (VSV) 复制的影响。我们比较了在OC和建立的人癌细胞线a549和HEp-2中观察到的效果。以30至3000 U/ml的浓度添加到羊膜，绒毛或蜕膜OC中的重组人肿瘤坏死因子 α (rHuTNF-α) 可使VSV复制增强10-1000倍。从5个胎盘向OC中添加5至10000 U/ml的重组人白细胞介素6 (rHuIL-6) 对VSV生长没有影响，除了一个已经观察到增强的VSV复制的培养物。发现rHuTNF-α 对HEp-2和A549细胞培养物中的VSV生长没有影响。
相反，胎盘OC对天然干扰素 (IFN) α，β 和重组IFN-γ 的抗病毒活性敏感，尽管A549细胞对细胞因子的反应要高5到10倍。

BACKGROUND & AIMS: In several species, placenta has been found to express GH-related proteins. In the ovine placenta, such a protein, ovine chorionic somatommamotropin, has been described, but its involvement in the fetal/placental growth process is not clearly established. The aim of this study was to investigate the occurrence of another GH-related peptide in the ovine placenta. Placental extracts (days 30-140 of pregnancy) showed GH immunoreactivity between days 35-70. SDS-PAGE analysis of these extracts indicated that this immunoreactivity corresponded to 22- and 28-kDa proteins. GH-like immunoreactivity was localized on cotyledonary frozen sections in the syncytium and the trophectoderm. Northern blot analysis of placental RNA showed the expression of GH-hybridizing transcripts migrating to the same position as that of GH pituitary messenger RNA (mRNA). Those transcripts were highly expressed between days 40 and 50. Their sequence analysis showed the existence of three GH mRNA (GHP1, GHP2, and GHP3). GHP1 is identical to pituitary GH mRNA and probably codes for the 22-kDa protein. GHP2 and GHP3 encode the same protein, which differs from GHP1 by four amino acids. This study establishes the expression of GH gene and GH-immunoreactive proteins in the ovine placenta.

背景与目标： 在几个物种中，胎盘被发现表达GH相关蛋白。在绵羊胎盘中，已经描述了这种蛋白质，即绵羊绒毛膜生长激素，但尚未明确其参与胎儿/胎盘生长过程。这项研究的目的是调查绵羊胎盘中另一种GH相关肽的发生。胎盘提取物 (妊娠第30-140天) 在第35-70天之间显示出GH免疫反应性。这些提取物的sdds-PAGE分析表明，该免疫反应性对应于22-和28-kDa蛋白。GH样免疫反应性位于合胞体和滋养外胚层的子叶冷冻切片上。胎盘RNA的Northern印迹分析显示，GH杂交转录本的表达迁移到与GH垂体信使RNA (mRNA) 相同的位置。这些成绩单在第40至50天之间高度表达。他们的序列分析显示存在三种GH mRNA (GHP1，GHP2和GHP3)。GHP1与垂体GH mRNA相同，可能编码22-kda蛋白。GHP2和GHP3编码相同的蛋白质，与GHP1的不同之处在于四个氨基酸。本研究建立了GH基因和GH免疫反应蛋白在绵羊胎盘中的表达。

BACKGROUND & AIMS: :To better understand the role of human equilibrative (hENTs) and concentrative (hCNTs) nucleoside transporters in physiology and pharmacology, we investigated the regional, cellular, and spatial distribution of two hCNTs (hCNT1 and hCNT2) and two hENTs (hENT1 and hENT2) in four human tissues. Using in situ hybridization and immunohistochemical techniques, we found that the duodenum expressed hCNT1 and hCNT2 mRNAs in enterocytes and hENT1 and hENT2 mRNAs in crypt cells. In these cells, the hCNT and hENT proteins were predominantly localized in the apical and lateral membrane, respectively. Hepatocytes expressed higher levels of mRNAs of hENT1, hCNT1, and hENT2 than of hCNT2 and expressed all these proteins at hepatocyte cell borders and in the cytoplasm. While the kidney expressed hCNT1 and hCNT2 mRNAs in the proximal tubules, hENT1 and hENT2 mRNAs were present in the distal tubules, glomeruli, endothelial cells, and vascular smooth muscle cells. Proximal tubules adjacent to corticomedullary junctions expressed hENT1, hCNT1, and hCNT2 mRNA. Immunolocalization studies revealed predominant localization of hCNTs in the brush-border membrane of the proximal tubular epithelial cells and hENTs in the basolateral membrane of the distal tubular epithelial cells. Chorionic villi sections of human term placenta expressed mRNAs and proteins for hENT1 and hENT2 but only mRNA for hCNT2. Immunolocalization studies showed presence of hENT1 in the brush-border membrane of the syncytiotrophoblasts. These data are critical for a better understanding of the role of nucleoside transporters in the physiological and pharmacological effects of nucleosides and nucleoside drugs, respectively.

背景与目标： : 为了更好地了解人类平衡 (hENTs) 和集中 (hCNTs) 核苷转运蛋白在生理学和药理学中的作用，我们研究了两个hcnt (hCNT1和hCNT2) 和两个hENTs (hENT1和hENT2) 在四个人类组织中的区域，细胞和空间分布。使用原位杂交和免疫组织化学技术，我们发现十二指肠在肠细胞中表达hCNT1和hCNT2 mrna，在隐窝细胞中表达hENT1和hENT2 mrna。在这些细胞中，hCNT和hENT蛋白分别主要位于顶膜和侧膜中。肝细胞表达hENT1，hCNT1和hENT2的mrna水平高于hCNT2，并在肝细胞边界和细胞质中表达所有这些蛋白。虽然肾脏在近端小管中表达hCNT1和hCNT2 mrna，但hENT1和hENT2 mrna存在于远端小管，肾小球，内皮细胞和血管平滑肌细胞中。邻近皮质髓连接处的近端小管表达hENT1，hCNT1和hCNT2 mRNA。免疫定位研究表明，hCNTs在近端肾小管上皮细胞的刷状缘膜和远端肾小管上皮细胞的基底外侧膜中的主要定位。人足月胎盘的绒毛膜绒毛切片表达hENT1和hENT2的mRNA和蛋白，但仅表达hcnt2的mRNA。免疫定位研究表明，合胞体滋养细胞的刷状缘膜中存在hENT1。这些数据对于更好地理解核苷转运蛋白在核苷和核苷药物的生理和药理作用中的作用至关重要。

BACKGROUND & AIMS: :We recently identified the presence of two distinct triacylglycerol hydrolases with pH optima of 6.0 and 8.0 in human placental microvillous membranes (MVM). The TAG hydrolase with a pH optimum of 8.0 has properties similar to lipoprotein lipase, whereas TAG hydrolase with a pH optimum of 6.0 still to be fully characterized. In order to understand the functional and structural relationships between these two TAG hydrolases of MVM we have further investigated their biochemical and molecular properties. The presence of oleic acid inhibited TAG hydrolase activity with a pH optimum of 8.0 by 60 per cent whilst it had very little effect on the pH 6.0 TAG hydrolase activity. K(m)values for TAG hydrolases at pH 6.0 and pH 8. 0 optima were 170.6 and 9.83 nmol triolein, respectively, whereas the corresponding V(max)values were 0.32 and 0.037 nmol oleic acid/min mg/protein. Treatment of MVM with phenylmethylsulphonofluoride or protamine had no effect on TAG hydrolase at pH 6.0 whereas both decreased activity at pH 8.0, by 70 per cent and 52 per cent, respectively (P< 0.05), compared with control. p-Chloromercuribenzoate inhibited both TAG hydrolase activities by 25-30 per cent whereas iodoacetate inhibited TAG hydrolase activity with optimum pH 8.0 by 74 per cent and the activity at pH 6.0 by 28 per cent. Unlike the TAG hydrolase activity at pH 8.0, the activity at pH 6.0 was not affected by heparin. TAG hydrolase activity at pH 6.0 was significantly decreased compared with that of pH 8.0 optimum TAG hydrolase activity in smokers placenta. A threefold increase in pH 6.0 TAG hydrolase activity was observed following differentiation, whereas membrane associated TAG hydrolase activity with optimum pH 8.0 did not change. The TAG hydrolase with optimum pH 6.0 was subsequently purified from MVM to almost 1000-fold enrichment of the activity over the starting material. The final preparation however, still contained three distinct protein bands (90, 70 and 45 kDa). When extracted from non-denaturing polyacrylamide gels, the 70 kDa protein was the only protein to have TAG hydrolysing activity and had a pH optimum of 6.0. Labelling of samples with [(14)C]tetrahydrolipstatin also confirmed that the TAG hydrolase active protein was a 70 kDa protein. In conclusion, we report that there is a 70 kDa TAG hydrolase with optimum pH 6.0 in human placental MVM which is quite distinct from placental lipoprotein lipase.

背景与目标： : 我们最近发现在人胎盘微绒毛膜 (MVM) 中存在两种不同的三酰甘油水解酶，其最适pH为6.0和8.0。最适pH为8.0的TAG水解酶具有类似于脂蛋白脂肪酶的性质，而最适pH为6.0的TAG水解酶仍有待完全表征。为了了解MVM的这两种TAG水解酶之间的功能和结构关系，我们进一步研究了它们的生化和分子特性。油酸的存在以8.0最适pH抑制TAG水解酶活性60%，而对pH 6.0 TAG水解酶活性影响很小。在pH 6.0和pH 8下TAG水解酶的K(m) 值。0最适分别为170.6和9.83 nmol三油精，而相应的V(max) 值为0.32和0.037 nmol油酸/min mg/蛋白质。用苯基甲基磺酰氟或鱼精蛋白处理MVM在pH 6.0时对TAG水解酶没有影响，而与对照相比，两者在pH 8.0时活性分别降低了70% 和52% (P< 0.05)。对氯甲苯甲酸对TAG水解酶活性均抑制了25-30%，而碘乙酸盐在最佳pH下抑制了TAG水解酶活性，8.0了74%，在pH下6.0了28%。与pH 8.0时的TAG水解酶活性不同，pH 6.0时的活性不受肝素的影响。在吸烟者胎盘中，与pH 8.0最佳TAG水解酶活性相比，pH 6.0下的TAG水解酶活性显着降低。在分化后观察到pH 6.0 TAG水解酶活性增加了三倍，而具有最佳pH 8.0的膜相关TAG水解酶活性没有改变。随后从MVM纯化具有最佳pH 6.0的TAG水解酶，使活性在起始材料上的富集几乎1000倍。然而，最终制剂仍包含三个不同的蛋白质带 (90、70和45 kDa)。当从非变性聚丙烯酰胺凝胶中提取时，70 kda蛋白是唯一具有TAG水解活性且最适pH为6.0的蛋白。用 [(14)C] 四氢脂质抑制素标记样品也证实了TAG水解酶活性蛋白是70 kDa蛋白。总之，我们报告在人胎盘MVM中存在具有最佳pH 6.0的70 kDa TAG水解酶，这与胎盘脂蛋白脂酶完全不同。

BACKGROUND & AIMS: :Prolonged retained placenta causing a delayed postpartum hemorrhage is a relatively common occurrence. However, there is a dearth of medical literature describing fertility-preserving treatments when standard therapy fails. We present two cases in which protracted retained placenta due to placenta accreta was successfully treated by hysteroscopic resection. Two nulliparous women had spontaneous vaginal deliveries requiring manual placental extraction. Both experienced delayed postpartum hemorrhage and underwent suction curettage with ultrasound guidance. Both patients were found to have persistent products of conception with imaging consistent with placenta accreta. Both patients failed expectant management and subsequently underwent hysteroscopic resection with complete resolution of their symptoms. We conclude that hysteroscopic resection is a conservative therapeutic option for placenta accreta in stable patients.

背景与目标： : 胎盘长期滞留导致产后出血是一种相对常见的情况。然而，当标准疗法失败时，缺乏描述保留生育能力的治疗的医学文献。我们介绍了两例通过宫腔镜切除术成功治疗了因胎盘植入而导致的长期滞留胎盘的病例。两名未产妇女自发阴道分娩，需要人工拔除胎盘。两人都经历了产后出血的延迟，并在超声引导下进行了刮宫术。发现两名患者均具有持续性受孕产物，影像学与胎盘植入一致。两名患者均未能通过预期治疗，随后接受宫腔镜切除术，症状完全缓解。我们得出的结论是，宫腔镜切除术是稳定患者胎盘植入的保守治疗选择。

BACKGROUND & AIMS: OBJECTIVE:To present our experience in hysteroscopic removal of abnormally invasive placenta (AIP) residuals using bipolar energy. DESIGN:Case series. SETTING:University hospital. POPULATION:Sixteen patients with AIP residuals after 17 pregnancies. METHODS:Cases were identified by ultrasound, treated with hysteroscopic bipolar electrosurgery and oral contraceptives, and followed up by ultrasound or hysteroscopy. Nine subsequent pregnancies were described. MAIN OUTCOME MEASURES AND RESULTS:Complete removal of AIP residuals was achieved by hysteroscopic bipolar electrosurgery in all cases except one. No perioperative complications occurred. AIP residual recurred in one patient after a subsequent pregnancy and was successfully treated using the same procedure. CONCLUSIONS:AIP residual is a rare condition. Management by hysteroscopic resection using bipolar energy is safe and feasible.

背景与目标：

BACKGROUND & AIMS: :Macrophage colony-stimulating factor (M-CSF) induces proliferation of monocyte/macrophage progenitor cells and can also activate some functions of mature cells including fetally derived placental cells. To study the role of M-CSF in the pregnant female reproductive tract, the expression of M-CSF mRNA and its receptor, c-fms proto-oncogene, in human placenta and decidua was identified. M-CSF and c-fms mRNAs, 4.7Kb and 3.9Kb respectively, were detected by Northern blotting in the early stage placenta and subsequently increased during pregnancy. These mRNAs were not detected in the nonpregnant endometrium but were strongly induced in maternal decidua with the same mRNA size as in the placenta. Northern blot hybridization on the endometrium of a pseudopregnant uterus revealed that the expression of endometrial M-CSF and c-fms mRNAs is regulated by synergistic action of female sex steroid hormones. These findings indicate that, in an autocrine and/or paracrine manner, M-CSF is deeply involved in the local proliferation and differentiation of cells at the materno-fetal interface, and support the placental immunotrophism hypothesis.

背景与目标： 巨噬细胞集落刺激因子 (m-csf) 诱导单核/巨噬细胞祖细胞增殖，还可以激活成熟细胞 (包括胎儿来源的胎盘细胞) 的某些功能。为了研究m-csf在孕妇生殖道中的作用，鉴定了m-csf mRNA及其受体c-fms原癌基因在人胎盘和蜕膜中的表达。在胎盘早期通过Northern印迹法检测到m-csf和c-fms mrna分别为4.7Kb和3.9Kb，随后在怀孕期间增加。这些mRNA未在未怀孕的子宫内膜中检测到，但在与胎盘相同的mRNA大小的母体蜕膜中被强烈诱导。假孕子宫子宫内膜上的Northern印迹杂交表明，子宫内膜m-csf和c-fms mrna的表达受女性性类固醇激素的协同作用调节。这些发现表明，m-csf以自分泌和/或旁分泌的方式深度参与了胎儿-胎儿界面细胞的局部增殖和分化，并支持胎盘免疫营养假说。

BACKGROUND & AIMS: PROBLEM:Systemic maternal inflammation is associated with adverse neonatal sequelae. We tested the hypothesis that IL-1β is a key inflammatory regulator of adverse pregnancy outcomes. METHOD OF STUDY:Pregnant mice were treated with intraperitoneal injections of IL-1β (0, 0.1, 0.5, or 1 μg) from embryonic day (E)14 to E17. Placenta and fetal brains were harvested and analyzed for morphologic changes and IL-1β signaling markers. RESULTS:As compared with non-treated dams, maternal injections with IL-1β resulted in increased p-NF-κB and caspase-1 in placentas and fetal brains, but not consistently in spleens, suggesting induction of intrinsic IL-1β production. These findings were confirmed by increased levels of IL-1β in the placentas of the IL-1β-treated dams. Systemic treatment of dams with IL-1β suppressed Stat1 signaling. Maternal inflammation caused by IL-1β treatment reduced fetal viability to 80.6% and 58.9%, in dams treated with either 0.5 or 1 μg of IL-1β, respectively. In the placentas, there was an IL-1β dose-dependent distortion of the labyrinth structure, decreased numbers of mononuclear trophoblast giant cells, and reduced proportions of endothelial cells as compared to placentas from control dams. In fetal brains collected at E17, there was an IL-1β dose-dependent reduction in cortical neuronal morphology. CONCLUSION:This work demonstrates that systemic IL-1β injection causes dose-dependent structural and functional changes in the placenta and fetal brain.

背景与目标：

BACKGROUND & AIMS: :Although early rupture of the uterus is rare, that does not mean that it should not be considered. The case reported here was of a patient in her third pregnancy who suddenly presented with internal haemorrhage requiring immediate laparotomy at the 22nd week of pregnancy. When a broad rupture at the fundus was discovered total hysterectomy had to be carried out. Immediately afterwards the patient collapsed and this required a further operation which showed that one of the cervico-vaginal pedicles had slipped away from its ligature. After this, recovery was uncomplicated. Histological examination made it clear that the cause of the rupture was a placenta increta which had grown on the fundus which itself contained a fibroid. Early ruptures of the uterus are very rare and usually occur in a uterus that has been weakened by an anterior scar, or an abnormal development during the pregnancy or a malformation of the uterus. It is rare for placenta increta to be the cause. We have reviewed the clinical and histological material. Hysterectomy is carried out in order to ensure haemostasis and the procedure is discussed.

背景与目标： : 尽管子宫早期破裂很少见，但这并不意味着不应考虑。此处报道的病例是一名第三次怀孕的患者，她突然出现内出血，需要在怀孕第22周立即进行剖腹手术。当发现眼底大破裂时，必须进行全子宫切除术。此后，患者立即晕倒，这需要进一步的手术，表明其中一根宫颈阴道蒂已从其结扎中滑落。此后，恢复变得简单。组织学检查清楚地表明，破裂的原因是胎盘植入，该植入生长在眼底，其本身包含肌瘤。子宫早期破裂非常罕见，通常发生在因前瘢痕或怀孕期间发育异常或子宫畸形而减弱的子宫中。胎盘植入是罕见的原因。我们回顾了临床和组织学材料。为了确保止血，进行了子宫切除术，并讨论了该程序。

BACKGROUND & AIMS: BACKGROUND:To evaluate the effectiveness and safety of a newly designed intrauterine double-balloon catheter to arrest postpartum hemorrhage (PPH) following cesarean delivery (CD) for placenta previa. METHODS:We conducted an open-label, multicenter randomized controlled trial in two referral centers and one general hospital. Women with continuous bleeding after placental delivery following CD for placenta previa, who failed to respond to uterotonics, suturing and uterine devascularization, and in the absence of suspected deeply invasive accreta were eligible subjects. Eligible subjects were randomized to receive intrauterine double-balloon catheter (n = 102) or gauze packing (n = 102). The main outcome was the rate of successful hemostasis without the need for additional surgical interventions. The secondary outcomes included the volume of blood loss during and after CD, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, surgical complications, intensive care unit admission, need for re-laparotomy, length of hospital stay, and readmission. RESULTS:The 224 participants were recruited before delivery, with 20 excluded (14 cases bleeding stopped after uterotonics and/or local myometrium sutures and 6 patients with placental increta). Finally, 102 women were assigned in catheter group and 102 others in gauze group. There was no difference in the rate of successful hemostasis in the catheter and gauze groups (93.1% vs 91.2%, P = .80). Compared with those in the gauze group, women in the catheter group showed significantly less blood loss within 24 hours postpartum (895 [612.3-1297.8] vs 1156 [882.5-1453.3] ml, P < .01), lower rate of PPH ≥1000 ml (42.2% vs 63.7%, P < .01). Accordingly, women in the catheter group had significantly less maternal adverse events such as postpartum anemia, puerperal morbidity, and postpartum pain. CONCLUSION:Uterine tamponade using a double-balloon catheter was as effective as gauze packing in hemostasis, and appeared to be superior in reducing postpartum blood loss and pain following CD for placenta previa. Using double-balloon catheter in managing PPH in this situation may be a preferable alternative to minimize maternal morbidity.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To report successful conservative management of advanced cervical ectopic pregnancy with placenta percreta. DESIGN:Case report. SETTING:University tertiary care hospital. PATIENT(S):A 37-year-old woman with second-trimester cervical ectopic pregnancy and placenta percreta. INTERVENTION(S):Ultrasound-guided injection of potassium chloride into the fetal heart followed by multiple systemic methotrexate injections, removal of fetal bones, cervical cerclage suture, and Foley catheter placement for control of hemorrhage. MAIN OUTCOME MEASURE(S):Low maternal morbidity and successful conservative management with preservation of fertility. RESULT(S):The cervical ectopic pregnancy was treated successfully without significant morbidity; the uterus was preserved, and the woman was delivered of a full-term live fetus in the next pregnancy. CONCLUSION(S):Advanced cervical ectopic pregnancy with placenta percreta is associated with high morbidity with surgical intervention. Conservative management with attendant low morbidity and uterus preservation is possible in advanced cervical ectopic pregnancy.

背景与目标：

BACKGROUND & AIMS: :A normotensive pregnant woman who had no historical risk factors for abruption placenta and found to have Breus' mole that indicates the pattern of single or multiple hematoma protrude above the chorionic plate was encountered. The case resembled a large fetal abdominal wall defect coexisting with a singleton live-born fetus at 27 weeks of gestational age is presented. The obstetric ultrasound showed that multiple coiled masses in the amniotic cavity, both the fetus and the placenta were normal. After two courses of tocolysis therapy, a healthy and, 1,400 g live-born infant was delivered through cesarean section due to fetal distress. Apgar scores at 1 and 5 min were 5 and 8, respectively. The infant died on postnatal day 6 due to severe respiratory distress and prematurity. This rare condition probably occurs frequently in missed abortion and the etiology is unknown, but is probably related to circulatory disturbance on maternal site. We report a rare clinical presentation and review the literature of Breus' mole.

背景与目标： : 一名血压正常的孕妇，她没有胎盘早剥的历史危险因素，发现患有breus痣，表明单发或多发血肿在绒毛膜钢板上方突出。该病例类似于胎龄27周时与单胎活产胎儿并存的大胎儿腹壁缺损。产科超声显示羊膜腔内多发盘绕肿块，胎儿和胎盘均正常。经过两个疗程的围产期治疗后，由于胎儿窘迫，通过剖宫产分娩了健康且1,400g的活产婴儿。1分钟和5分钟的Apgar得分分别为5和8。由于严重的呼吸窘迫和早产，婴儿在出生后第6天死亡。这种罕见的情况可能经常发生在错过的流产中，病因尚不清楚，但可能与母体部位的循环障碍有关。我们报告了罕见的临床表现，并回顾了breus痣的文献。

BACKGROUND & AIMS: OBJECTIVE:The aim of the study was to evaluate our results in the management of placenta accreta. STUDY DESIGN:In a retrospective study we reviewed cases of placenta accreta diagnosed in two university teaching hospitals between 1993 and 2003. For a subgroup of patients a conservative approach was attempted. In this procedure placenta was left in place until spontaneous resorption. RESULTS:Fifty cases (0.12%) of placenta accreta were observed in 41, 119 deliveries during the study period. Of the 50 cases, 24 patients (48%) were managed by the standard approach and 26 patients (52%) underwent conservative treatment. Additional surgical or medical treatment was performed in 35 of the 50 patients (70%). There was no maternal death. Overall hysterectomy rate was 40%, 10 patients were transferred to intensive care unit (20%), 7 had fever (14%), 5 had endometritis (10%) and 19 patients had blood transfusion (38%). Conservative treatment did not lead to hysterectomy in 21 cases (80.7%) and failed in 5 (19.3%). During the follow-up period, 3 women had successful pregnancy. CONCLUSION:Analysis of management of placenta accreta shows that for a subgroup of selected patients a conservative approach could preserve subsequent fertility without evident increase in morbidity.

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