Optimization of surgical strategy and blood-conserving technologies for a placenta ingrown into the uterine scar


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Abstract

Objective: To improve delivery strategy in pregnant women with abnormal placentation. Materials and methods: The design of a sampling retrospective study included 54 pregnant women with placenta previa centrala and uterine scar after caesarean section (CS) with histologically confirmed results of placenta increta. The arsenal of used blood-conserving methods involved ligation of three pairs of the main uterine vessels; that of the internal iliac arteries, the complex compression hemostasis proposed by R.G. Shmakov and V.D. Chuprynin; and temporary cleaving of the common iliac arteries. Results: Lower-segment CS was used in 47 (87.0%) of the 54 women. Hysterectomy was performed in 17/54 (31.5%) patients. Metroplasty and organ preservation surgery were carried out in the remaining 37 (68.5%) cases. No relaparotomy was used; no maternal deaths were observed; there were 4 (7.4%) perinatal deaths; forced opening and resection of the bladder were seen in 7 (13.0%) cases; opening of the bladder without resection of its wall was made in 2 (3.7%); near miss cases were noted in 2 clinical episodes; there were no complications associated with temporary cleaving of the common iliac arteries; endometritis (cure after medical treatment) was identified in 2 (3.7%) women. Histological examination revealed placenta accreta in 15 (27.8%) patients, placenta increta in 30 (55.6%), and placenta percreta in 8 (14.8%). There was a combination of the placental ingrowth into the uterine scar region of different depths in 8 cases and a concurrent deeply invasive lesion of the posterior wall of the lower segment and corpus of the uterus. Conclusion: The complex compression hemostasis proposed by R.G. Shmakov and V.D. Chuprynin is the most rational and promising blood conservation method that is acceptable amongst the majority of patients with placenta accreta spectrum (PAS). Temporary cleaving of the common iliac arteries is advisable if the posterior bladder wall is damaged. Preservation of the uterus in a deeply invasive lesion, including concurrent damage to the posterior wall of the lower-segment or corpus of the uterus, significant blood loss before the woman is admitted to the hospital, is not an imperative of surgical strategy.

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About the authors

Zaur J. Karimov

Main Healthcare Directorate for the City of Tashkent, Tashkent City Perinatal Center; Center for the Development of Professional Qualifications of Healthcare Workers

Doctor of Medicine, Professor of the First Department of Obstetrics, Gynecology and Perinatal Medicine; Director Tashkent, Republic of Uzbekistan

Bulat S. Abdikulov

Main Healthcare Directorate for the City of Tashkent, Tashkent City Perinatal Center

Email: dr.bek@bk.ru
Head of the Department of Gynecology Tashkent, Republic of Uzbekistan

Mamurzhon I. Urinov

Main Healthcare Directorate for the City of Tashkent, Tashkent City Perinatal Center

Head of the Department of Pathology of Pregnancy Tashkent, Republic of Uzbekistan

Shavkat Kh. Masharipov

Main Healthcare Directorate for the City of Tashkent, Tashkent City Perinatal Center

Head of the Department of Anesthesiology and Reanimation Tashkent, Republic of Uzbekistan

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