Placenta Accreta Spectrum: experience of the surgical treatment

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Background: Placenta accreta spectrum (PAS) is the cause of maternal mortality due to massive uterine bleeding. These complications can be reduced by improving the algorithm of surgical treatment of PAS.

Objective: To present the experience of managing patients whose pregnancy is complicated by PAS.

Materials and methods: This is a retrospective analysis of the deliveries of 54 patients with PAS which was diagnosed prenatally.

Results: A 10-year experience in managing 54 patients with PAS is divided into two stages. The first stage is the management of the first six cases (2012–2016). Two laparotomies were performed via Pfannenstiel incision with subsequent cesarean section in the lower uterine segment and metroplasty. Supracervical hysterectomy was performed in one case, and total hysterectomy was performed in three cases. The second stage is the management of 48 cases (2017–2023): corporeal cesarean section was performed in 3/48 (6.25%) cases, and transverse uterine fundal incision with metroplasty was performed in 45/48 (93.75%) cases. After childbirth, ligation of internal iliac and ovarian arteries was performed in 100% of cases. Compression sutures were applied in 5/48 (16.6%) cases. Total hysterectomy was performed in 6/48 (12.5%) cases, and one with vesicoplasty was done in 3/48 (6.25%) cases. Postoperative transfusion was performed in 5/48 (16.7%) patients. Intraoperative blood reinfusion was performed in 100% of cases. Complex antianemic therapy included a high dose of non-dextran iron preparation, ferric carboxymaltose.

Conclusion: The following algorithm is proposed: lower midline laparotomy, transverse uterine fundal incision, exclusion of manual placental separation, ligation of ovarian and internal iliac arteries on both sides after childbirth; in cases of secondary uterine hypotonia, application of compression sutures is possible; intraoperative blood reinfusion; antianemic therapy using iron preparations for parenteral administration in the postoperative period.

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Sobre autores

Alexander Rymashevsky

Rostov State Medical University, Ministry of Health of Russia

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

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

Rússia, Rostov-on-Don

Andrey Volkov

Rostov State Medical University, Ministry of Health of Russia

Email: avolkov@aaanet.ru
ORCID ID: 0000-0002-5899-1252

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

Rússia, Rostov-on-Don

Maria Kantsurova

Rostov State Medical University, Ministry of Health of Russia

Autor responsável pela correspondência
Email: madlax_san@mail.ru
ORCID ID: 0000-0003-4916-8042

assistant of the Department of Obstetrics and Gynecology No. 1

Rússia, Rostov-on-Don

Bibliografia

  1. Say L., Chou D., Gemmill A., Tunçalp Ö., Moller A.B., Daniels J. et al. Global causes of maternal death: A WHO systematic analysis. Lancet Glob. Heal. 2014; 2(6): e323-33. https://dx.doi.org/10.1016/S2214-109X(14)70227-X.
  2. Forster D.S. A case of placenta accrete. Can. Med. Assoc. J. 1927; 17: 204-7.
  3. Irving C., Hertig A.T. A study of placenta accreta. Surg. Gynecol. Obstet. 1937; 64: 178-200.
  4. Здравоохранение в России. Статистический сборник. Росстат. М.; 2019: 59. [Healthcare in Russia. Statistical compendium. Rosstat. Moscow; 2019: 59. (in Russian)].
  5. Palacios Jaraquemada J.M., Pesaresi M., Nassif J.C., Hermosid S. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet. Gynecol. Scand. 2004; 83(8): 738-44. https://dx.doi.org/10.1111/ j.0001-6349.2004.00517.x.
  6. Chandraharan E., Rao S., Belli A.M., Arulkumaran S. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int. J. Gynecol. Obstet. 2012; 117(2): 191-4. https://dx.doi.org/ 10.1016/j.ijgo.2011.12.005.
  7. Курцер М.А., Бреслав И.Ю., Григорян А.М., Латышкевич О.А. Опыт использования временной баллонной окклюзии общих подвздошных артерий при органосохраняющих операциях у пациенток с врастанием плаценты. Акушерство и гинекология. 2013; 7: 80-4. [Kurtzer M.A., Breslav I.Yu., Grigoryan A.M., Latyshkevich O.A. The experience of using temporary balloon occlusion of the common iliac arteries in organ-preserving operations in patients with placenta accreta. Obstetrics and Gynecology. 2013; (7): 80-4. (in Russian)].
  8. Патент RU 2578183 C1. Курцер М.А., Савельева Г.М., Бреслав И.Ю. Способ консервативного хирургического лечения при родоразрешении пациенток с врастанием плаценты. Заявка 2015104592/14, 12.02.2015. Опубликовано 2016.03.20. [Patent RU 2578183 C1. Kurtzer M.A., Savelyeva G.M., Breslav I.Y. Method of conservative surgical treatment during delivery of patients with placenta accreta. 20.03.2016. Application 2015104592/14, 2015.12.02. Publ. 2016.03.20. (in Russian)].
  9. Патент RU 2626984 С1. Шмаков Р.Г., Чупрынин В.Д., Виницкий А.А. Способ двухуровнего гемостаза при выполнении органосохраняющего оперативного родоразрешения у пациенток с врастанием плаценты. Заявка 2016139121, 2016.10.05. Опубликовано 2017.08.02. [Patent RU 2626984 C1. Shmakov R.G., Chuprynin V.D., Vinnitsky A.A. A method of two-level hemostasis during organ-preserving operative delivery in patients with placenta accreta. Application 2016139121, 2016.10.05. Publ. 2017.08.02. (in Russian)].
  10. Патент RU 2625286 C1. Шмаков Р.Г., Чупрынин В.Д., Кан Н.Е., Тютюнник В.Л., Виницкий А.А. Способ временной окклюзии общих подвздошных артерий при выполнении органосохраняющего оперативного родоразрешения у пациенток с врастанием плаценты. Заявка 2016138106, 2016.26.09. Опубликовано 2017.07.12. [Patent RU 2625286 C1. Shmakov R.G., Chuprynin V.D., Kan N.E., Tyutyunnik V.L., Vinnitsky A.A. Method of temporary occlusion of the common iliac arteries during organ-preserving operative delivery in patients with placenta accreta. Application 2016138106, 2016.26.09. Publ. 2017.07.12. (in Russian)].
  11. Патент RU 2706530 C1. Шмаков Р.Г., Чупрынин В.Д., Приходько А.М. Способ органосохраняющего оперативного родоразрешения у пациенток с врастанием плаценты. Заявка 2019119188, 2019.06.20. Опубликовано 2019.11.19. [Patent RU 2706530 C1. Shmakov R.G., Chuprynin V.D., Prikhodko A.M. Method of organ-preserving operative delivery in patients with placenta accreta. Application 2019119188, 2019.06.20. Publ. 2019.11.19. (in Russian)].
  12. Ральникова А.Ю., Беженарь В.Ф., Аракелян Б.В., Габелова К.А. Органосохраняющее хирургическое лечение при предлежании плаценты и ее врастании в рубец на матке (клиническое наблюдение). Акушерство и гинекология Санкт-Петербурга. 2019; 3-4: 66-70. [Ralnikova A.Yu., Bezhenar V.F., Arakelyan B.V., Gabelova K.A. Organ-sparing surgery in placenta praevia and accreta (clinical observation). Obstetrics and gynecology of St. Petersburg. 2019; (3-4): 66-70. (in Russian)].
  13. Патент RU 2708369 C1. Куликов И.А., Белоусова Т.Н., Соваев Н.И., Плахотина Е.Н., Милютина Е.Р., Павлютина К.М., Латышев Р.В. Способ оперативного родоразрешения пациенток с врастанием плаценты в рубец на матке с использованием турникетного гемостаза. Заявка 2019112811, 2019.04.26. Опубликовано 2019.12.05. [Patent RU 2708369 C1. Kulikov I.A., Belousova T.N., Sovaev N.I., Plakhotina E.N., Milyutina E.R., Pavlyutina K.M., Latyshev R.V. Method of operative delivery of patients with placenta accretion into the uterine scar using turnstile hemostasis. Application 2019112811, 2019.04.26. Publ. 2019.12.05. (in Russian)].
  14. Pereira A., Nunes F., Pedroso S., Saraiva J., Retto H., Meirinho M. Compressive uterine sutures to treat postpartum bleeding secondary to uterine atony. Obstet. Gynecol. 2005; 106(3): 569-5. https://dx.doi.org/10.1097/ 01.AOG.0000168434.28222.d3.
  15. B-Lynch C., Coker A., Lawal A.H., Abu J., Cowen M.J. The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br. J. Obstet. Gynecol. 1997; 104(3): 372-5. https://dx.doi.org/10.1111/j.1471-0528.1997.tb11471.x.
  16. Hayman R.G., Arulkumaran S., Steer P.J. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet. Gynecol. 2002; 99(3): 502-50. https://dx.doi.org/10.1016/s0029-7844(01)01643-x.
  17. Cho J.H., Jun H.S., Lee C.N. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet. Gynecol. 2000; 96(1): 129-31. https://dx.doi.org/ 10.1016/s0029-7844(00)00852-8.
  18. Радзинский В.Е. Акушерская агрессия. V.2.0. М.: Изд-во журнала StatusPraesens; 2017. [Radzinsky V.E. Obstetric aggression. V.2.0. Moscow: StatusPraesens; 2017. (in Russian)].
  19. Рымашевский А.Н., Волков А.Е., Никитина Е.С., Волошин В.В., Волошина А.В., Смирнова И.В. Опыт ведения родов, осложненных Placenta Accreta. Вестник Национального медико-хирургического центра им. Н.И. Пирогова. 2016; 11(3): 76-80. [Rymashevsky A.N., Volkov A.E., Nikitina E.S., Voloshin V.V., Voloshina A.V., Smirnova I.V. Experience of childbirth complicated by Placenta Accreta. Bulletin of the N.I. Pirogov National Medical and Surgical Center. 2016; 11(3): 76-80. (in Russian)].
  20. Jauniaux E., Chantraine F., Silver R.M., Langhoff-Roos J. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int. J. Gynecol. Obstet. 2018; 140(3): 265-73. https://dx.doi.org/10.1002/ijgo.12407.
  21. Bergmann R.L., Richter R., Bergmann K.E., Dudenhausen J.W. Prevalence and risk factors for early postpartum anemia. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 150(2): 126-31. https://dx.doi. org/10.1016/j.ejogrb.2010.02.030.

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