Comparative assessment of the scar after organ-sparing surgery for placenta increta


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Abstract

Objective. To assess the scar after cesarean delivery for placenta increta. Subjects and methods. The outcomes of 17 observations of cesarean delivery for placenta increta were comparatively analyzed. According to the choice of surgical technique, all the patients were divided into two groups: 1) 8 patients in whom standard cesarean section procedures were used; 2) 9 patients who received organ-sparing methods, including bottom cesarean section to extract the fetus, followed by placental removal and metroplasty in the lower uterine segment. Ultrasonography was used to comparatively assess uterine involution; the nature and characteristics of blood flow in the area of a suture on the anterior uterine wall were examined. Eight months later, ultrasonography using elatography was repeated to assess the competence of the formed scar on the anterior uterine wall and to determine tissue stiffness in the scar. Results. The evidence obtained in this investigation suggests that the process of scar formation in patients who have undergone bottom cesarean section, followed by placental removal and metroplasty in the lower uterine segment, occurs with a predominance of elastic muscle fibers. Conclusion. Timely diagnosis of placenta increta makes it possible to prepare for surgery and to use novel technologies. Meticulous hemostasis and tissue matching ensure proper scar formation, vascular microinvasion (angiogenesis), and no ischemia. These processes contribute to the formation of an adequate scar, which is further determined by ultrasound methods.

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About the authors

Yulia Eduardovna Dobrokhotova

N.I. Pirogov Russian National Research Medical University

Email: pr.dobrohotova@mail.ru
MD, professor, head of the Department of Obstetrics and Gynecology

Pavel Vasilievich Kozlov

N.I. Pirogov Russian National Research Medical University

Email: kozlovpv@rambler.ru
MD, Professor of the Department of Obstetrics and Gynecology

Irina Viktorovna Bakhareva

N.I. Pirogov Russian National Research Medical University

Email: iribakhareva@yandex.ru
MD, Professor of the Department of Obstetrics and Gynecology

Pavel Andreevich Kuznetsov

N.I. Pirogov Russian National Research Medical University

Email: poohsmith@mail.ru
Ph.D., Associate Professor of the Department of Obstetrics and Gynecology

Nikolay Y. Ivannikov

Branch, Maternity Hospital One, L.A. Vorokhobov City Clinical Hospital Sixty-Seven, Moscow Healthcare Department

Ph.D., Chief Physician

Anton Sergeevich Olenev

City Clinical Hospital Twenty-Four, Moscow Healthcare Department

Email: felidis@mail.ru
Candidate of Medical Science, Deputy chief doctor of the Branch Two

Elena Anatolievna Zubareva

N.I. Pirogov Russian National Research Medical University

MD, professor of the Department of Hospital Pediatrics

Andrey Ruslanovich Zubarev

N.I. Pirogov Russian National Research Medical University

Email: a.zubarev@yahoo.com
MD, Professor, Head of the Department of Ultrasound Diagnostics

Sofya Alekseevna Zalesskaya

N.I. Pirogov Russian National Research Medical University

Email: sofa.zalesskaya@mail.ru
assistant of the Department of Obstetrics and Gynecology

Denis Nikolaevich Samochatov

L.A. Vorokhobov City Clinical Hospital Sixty-Seven, Moscow Healthcare Department

PhD, Head of the Department of Angiography

Irina Aleksandrovna Aponovich

N.I. Pirogov Russian National Research Medical University

postgraduate student of the Department of Obstetrics and Gynecology

References

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