About placental implantation

  Implantation is an abnormal placental implantation due to dysplasia of the metaplasia of the uterine fundus and invasion or penetration of the placental villi into the myometrium.  The clinical features are: non-detachment or partial detachment of the placenta after delivery of the fetus, embryonic arrest during pregnancy or spontaneous uterine perforation, which may result in fatal haemorrhage. Or recurrent vaginal bleeding after miscarriage with ultrasound findings of intrauterine residuals and abundant blood flow signal.  There are three types of placenta according to the depth of placenta invasion into the myometrium: ① Adherent placenta: the placenta is adhered very tightly to the uterine wall and cannot be dislodged by itself. It is the most common.  (2) Implantation placenta: the placental villi invade the myometrium.  (3) Penetrating placenta: placental villi penetrate the myometrial wall and reach the plasma membrane surface, which may cause uterine rupture. It is the most rare and the most dangerous, accounting for about 5%.  Diagnosis: Ultrasonography: Placental implantation is of great value for prenatal diagnosis, but the diagnostic rate is lower postnatal diagnosis is higher. Features: placental echogenic dark areas greater than 1 cm in thickness, containing multiple small dark areas (i.e. blood pools), surrounded by thin or even no normal muscular echogenicity.  In recent years, due to the increase in the rate of miscarriage and cesarean section, the incidence has gradually increased. Implantation of placenta, once the symptoms appear, is rapid and dangerous, and 85% of them require hysterectomy. Surgical treatment can effectively reduce the risk of postpartum hemorrhage, but hysterectomy can cause serious physical and psychological damage to young mothers and patients with childbearing requirements. Conservative surgery is relatively less invasive, but the complications of surgery should not be ignored.  Hysteroscopic electroporation of implanted placenta: those with large intrauterine placental implants, patients shortly after delivery especially after cesarean section, high serum β-HCG, abundant blood flow around the residue and heavy vaginal bleeding are not suitable for immediate hysteroscopic electroporation. Common complications: cervical injury, bleeding, uterine perforation, infection, etc.  There is no uniform treatment plan for conservative drug treatment. Foreign literature reports that the longest expulsion time of retained placenta can be up to six months with conservative treatment with MTX and mifepristone.  In Chinese medicine, blood stasis is the main cause, and the main treatment is to activate blood circulation and remove blood stasis. Therefore, there are books on “resting the cell”, “incomplete meconium”, “abdominal pain after childbirth”, “postpartum hemorrhage”, and “blood stasis after childbirth”. “postpartum hemorrhage” and so on.  Advantages of Chinese medicine treatment: promote the natural discharge of placental tissue and reduce the rate of purging; reduce the number of MTX injections; accelerate the decline of serum HCG; shorten the time of vaginal bleeding; anti-infection. However, sometimes the treatment time is long clinically, and the bleeding is still high in individual cases during the treatment, so dynamic observation and symptomatic and timely treatment are needed.