Early diagnosis of abnormally deep invasion of the chorion as a predictor of invasive placentation

Мұқаба

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Background: Placenta accreta spectrum (PAS) is an advanced invasive placentation, which is a serious condition associated with high maternal mortality due to massive uterine hemorrhages. These complications can be reduced by early diagnosis of PAS.

Case report: A 35-year-old multiparous patient with a burdened obstetric and gynecological history had indirect signs of abnormally deep invasion of the chorion which were revealed during ultrasound examination at 7+1 weeks gestation. The ultrasound scan showed a heterogeneous structure with the expansion of lacunar spaces and areas of hypervascularization of the myometrium of the anterior uterine wall. The diagnosis of abnormal placental attachment was confirmed by dynamic echography with stereoscopic blood flow imaging (LumiFlow). A planned cesarean section by transverse uterine fundal incision was performed at 37+2 weeks. Metroplasty was performed on both sides after ligation of the internal iliac and ovarian arteries. The diagnosis of PAS was confirmed by a pathology study, and placenta increta (PAS 3a) was verified.

Conclusion: The presented clinical observation clearly demonstrates the real possibility of early ultrasound diagnosis of advanced invasive placentation. The detection of signs of advanced invasive placentation at the earliest possible time of gestation suggests that patients can be referred to a high-risk PAS group for the subsequent search for specific signs of this placental pathology and optimal planning of organ-preserving methods of delivery in these patients.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Andrey Volkov

Rostov State Medical University, Ministry of Health of Russia

Хат алмасуға жауапты Автор.
Email: avolkov@aaanet.ru
ORCID iD: 0000-0002-5899-1252

PhD (Med.), Associate Professor, Department of Obstetrics and Gynecology No. 1

Ресей, Rostov-on-Don

Alexey Solonchenko

Perinatal Center

Email: a-solonchenko@mail.ru
ORCID iD: 0009-0000-9971-5521

ultrasound diagnostics doctor at the Department of Antenatal Fetal Protection

Ресей, Rostov-on-Don

Alexander Rymashevsky

Rostov State Medical University, Ministry of Health of Russia

Email: rymashevskyan@mail.ru
ORCID iD: 0000-0003-3349-6914

Dr. Sci. (Med.), Professor, Head of the Department of Obstetrics and Gynecology No. 1

Ресей, Rostov-on-Don

Vladimir Voloshin

Rostov State Medical University, Ministry of Health of Russia

Email: voloshinvv2006@yandex.ru
ORCID iD: 0000-0001-8632-082X

PhD (Med.), Associate Professor

Ресей, Rostov-on-Don

Anna Khloponina

Rostov State Medical University, Ministry of Health of Russia

Email: annakhloponina@yandex.ru
ORCID iD: 0000-0002-2056-5231

Dr. Sci. (Med.), Head of the Department of Ultrasound Diagnostics of NIIAP

Ресей, Rostov-on-Don

Maria Kantsurova

Rostov State Medical University, Ministry of Health of Russia

Email: madlax_san@mail.ru
ORCID iD: 0000-0003-4916-8042

Assistant at the Department of Obstetrics and Gynecology No. 1

Ресей, Rostov-on-Don

Әдебиет тізімі

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2. Fig. 1. A - transvaginal echogram during pregnancy 7+1 weeks: the fertilized egg is localized in the projection of the “postoperative scar”, retrochorial lacuna (2D scanning mode); B - transvaginal echogram during pregnancy 7+1 weeks: retrochorial hypervascularization of the myometrium (CDC mode)

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3. Fig. 2. A - transabdominal echogram during pregnancy 19 weeks: retroplacental hypervascularization, lack of visualization of the myometrium in the “scar” area (CDC mode); B - transabdominal echogram during pregnancy 19 weeks: subplacental vessels reaching the posterior wall of the bladder without penetrating into it (LumiFIow mode

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4. Fig. 3. Intraoperative view of the uterus: “jellyfish head” in the lower segment

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5. Fig. 4. A - microscopic examination of the excised myometrium (hematoxylin-eosin staining, magnification x 100); B - microscopic examination of the excised myometrium (hematoxylin-eosin staining, magnification x 40); B - microscopic examination of the excised myometrium (hematoxylin-eosin staining, magnification x 200); D - microscopic examination of the excised myometrium (hematoxylin-eosin staining, magnification x 200)

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6. Fig. 5 Location of PJ in the scar area at 7+1 weeks. Sign COS-1 (retrospective reconstruction of echogram)

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