Management of placenta increta at delivery: our experience

Objective: To compare two surgical techniques for placenta increta management at delivery.

Materials and methods: The study included 57 (100%) patients with placenta increta who delivered at the Rostov Regional Perinatal Center from 2019 to 2021. Group 1 included 32/57 (56%) patients with a placental defect <120 mm in the largest diameter and no bladder dissection difficulties, who underwent intraoperative ultrasound navigation to find the upper edge of the placenta. Subsequently, a caesarean section was performed in the lower uterine segment with an incision above the upper edge of the uterine aneurysm with application of distal hemostasis (Foley catheter), followed by metroplasty. Group 2 included 25/57 (44%) patients with a placental defect >120 mm in the largest diameter who underwent cesarean section to extract the fetus (the placenta remains in situ), suturing the uterine incision, followed by dissection of the vesical-uterine fold with excision and distal lowering of the bladder followed by distal hemostasis (Foley catheter), a second uterine incision above the herniated bulge, and metroplasty.

Results: The total blood loss was 1200 (900; 1700) and 2500 (1400; 4000) ml in groups 1 and 2, respectively (p=0.001). Blood loss > 2000 ml occurred in 4/32 (12%) and 15/25 (60%) patients in groups 1 and 2, respectively (p<0,001). Intraoperative autologous blood transfusions were performed more frequently in Group 2 (22/57 (88%)) than in Group 1 (16/57 (50%)) (p=0,004). Their volumes and the frequency and volume of blood component transfusions did not differ significantly.

Conclusion: Organ-sparing surgery is an acceptable treatment option for patients with placenta increta. Surgical treatment of patients in Group 1 showed the best hemostatic effect; however, under certain conditions, a surgical technique involving two uterine incisions should be used.