Placenta increta. Evolution of knowledge and skills


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Abstract

Objective. To investigate the current possibilities of diagnosis and prognosis of placenta increta and the most effective organ-sparing treatments for this condition according to data from Russian and foreign literature. Materials and methods. The keywords “placenta”, “placenta increta”, “PAS”, “organ-sparing treatment”, “accreta”, “increta”, “percreta” were used to search for literature sources in the Russian and foreign databases: eLibrary, Medline/PubMed, Embase, CINAHL. Forty sources were selected. Results. The pioneering scientists Irving and Hertig defined the term “placenta increta” as “abnormalpartial or complete attachment of the placenta to the uterine wall.” There are presently several grades of placenta accreta spectrum (PAS): 1) placenta adherenta or creta (the tight attachment or fusion of the placenta to the muscle layer); 2) placenta increta (villous invasion into the muscle layer); 3) placenta percreta (placental invasion into all uterine layers). Clinically abnormal attachment of the placenta manifests itself in its inability to separate from the uterine wall (as it normally does). The most significant risk factors for this abnormality include prior uterine surgery, placenta previa, and a history of PAS. For diagnosis, ultrasound and magnetic resonance imaging, which have equal efficiency, are used. Preference for surgical treatment is given to organ-sparing methods that can save not only the life of a mother, but also her reproductive function. Conclusion. Placenta increta is a dangerous pregnancy complication that leads to massive blood loss and high maternal morbidity and mortality rates. To date, a significant number of studies have been conducted to investigate this problem and to elaborate effective management tactics for these patients. The paper identifies the features of terminology, epidemiology, possible risk factors, and molecular markers and attributes of the pathogenesis of this nosological entity. It describes in details the most effective organ-sparing treatments for placenta increta.

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About the authors

Olga I. Lisitsyna

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: o_yazykova@inbox.ru
Resident

Natalia V. Nizyaeva

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: niziaeva@gmail.com
Cand. of Sci. (Med.), Senior Researcher, the 2nd Pathology Department

Alexandra A. Mikheeva

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: shuratora@mail.ru
Graduate student

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