INVASION OF PLACENTA PREVIA IN PATIENTS WITH A UTERINE SCAR AFTER CESAREAN SECTION: CLINICAL AND MORPHOLOGICAL SECTIONS


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Objective. To compare clinical data and pathomorphological characteristics in patients with a uterine scar concurrent with placental presentation. Subjects and methods. The retrospective investigation enrolled 104 patients with a uterine scar, placental presentation, and a pathomorphologically verified diagnosis of placenta accreta. Results. Out of the 104 women, 51 (49%), 36 (34.7%), 15 (14.4%), and 2 (1.9%) had a scar after 1, 2, 3, and 4 cesarean sections, respectively. After fetal extraction for hemostasis, 45 (43.3%) patients underwent uterine artery embolization; temporary balloon occlusion of the common iliac arteries was carried out in 22 (21.2%), ligation of internal iliac arteries was done in 2 (1.9%). Sutures applied to the placental bed on the side of the uterine cavity were used in 35 (33.6%) patients with an insignificant extent of abnormal placental presentation. The thinning or absent of decidual tissue is a main pathomorphological sign of placental invasion. The wall of the uterus on its side has a scalloped surface, the shape of which is similar to that of placenta accreta. An incompetent uterine scar due to its dehiscence is represented by the fibrous tissue covered by the peritoneum adjoined by chorionic villi. A pronounced commissural process between the wall of uterus and the posterior wall of the bladder and the gestational rearrangement of the vessels of the latter imitate placenta percreta. Conclusion. Invasion of placenta previa into cicatrical tissue after cesarean section is different from that into uterine muscle. It is impossible to reveal the penetration of chorionic villi to the thickness of a uterine scar and the wall of the bladder.

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作者简介

C. SAVELYEVA

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Academician of the Russian Academy of Sciences, MD, PhD, Head of Department of Obstetrics and Gynecology, Faculty of Pediatrics Moscow 117997, Ostrovitianova str. 1, Russia

M. KURTSER

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: m.kurtser@mcclinics.ru
Corresponding Member of the Russian Academy of Sciences, MD, PhD, Professor of Department of Obstetrics and Gynecology, Faculty of Pediatrics Moscow 117997, Ostrovitianova str. 1, Russia

I. BRESLAV

Perinatal Medical Center

Email: irina_breslav@mail.ru
PhD, Head of the Department of Pathology of pregnancy Moscow 111720, Sevastopol pr. 24/1, Russia

O. PANINA

M.V. Lomonosov Moscow State University

MD, PhD, Professor of Department of Obstetrics and Gynecology, Faculty of Fundamental Medicine Moscow 119192, Lomonosovskiy pr. 31/5, Russia

A. ANDREEV

Center for Family Planning and Reproduction, Moscow Healthcare Department

Email: andreevxxx@mail.ru
PhD, Head of the Department of Histopathology Moscow 117209, Sevastopolskyi pr. 24a, Russia

O. BARYKINA

Perinatal Medical Center

Email: medslovar@mail.ru
Head of the Department of Histopathology Moscow 111720, Sevastopol pr. 24/1, Russia

O. LATYSHKEVICH

Center for Family Planning and Reproduction, Moscow Healthcare Department

Chief of the Center Moscow 117209, Sevastopolskyi pr. 24a, Russia

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