Algorithm for providing medical care to patients with placenta percreta
Prikhodko A.M., Amiraslanov E.Yu., Chuprynin V.D., Kan N.E., Baev O.R.
Placenta percreta is a serious obstetric complication, arising from the pathological attachment of the placenta. It is characterized by the invasion of the trophoblast beyond the basal lamina of the endometrium, into the myometrium, reaching as far as the bladder. Women with placenta percreta often experience profuse bleeding during childbirth, which leads to massive blood loss and a significant increase in the number of hysterectomies. The condition also adversely affects women’s reproductive function and poses a risk of maternal mortality. Every year, the number of cases of this pathology grows with the increasing number of caesarean sections. Timely diagnosis and competent management of pregnancy in the presence of placental percreta is critical to reduce both maternal and perinatal morbidity. The choice of appropriate obstetric tactics, from the outpatient phase to hospital discharge, can significantly improve patient outcomes.
This algorithm addresses key issues related to hospitalization, examination, treatment and medical tactics, which depend on the depth of invasion and the intraoperative period. Special attention is given to postnatal care for women with diagnosis of placenta percreta. It is important to note that a comprehensive approach to the diagnosis and treatment of this pathology, effective organization of medical care and constant monitoring of women’s condition not only reduces the risk of complications, but also improves the quality of life of patients in the future.
Conclusion: Placenta percreta is a serious life-threating condition that requires a careful and comprehensive approach to diagnosis and treatment. Effective obstetric tactics, from antenatal to postnatal care, can significantly reduce the risk of complications and improve reproductive outcomes. Continuous medical follow-up and a personalized approach are key factors in reducing maternal mortality.
Authors’ contributions: Prikhodko A.M. – writing the text; Amiraslanov E.Yu., Chuprynin V.D. – collecting and processing literature data; Kan N.E., Baev O.R. – editing the article.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Prikhodko A.M., Amiraslanov E.Yu., Chuprynin V.D., Kan N.E., Baev O.R.
Algorithm for providing medical care to patients with placenta percreta.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (11): 200-206 (in Russian)
https://dx.doi.org/10.18565/aig.2024.179
Keywords
caesarean section
placental percreta
algorithm
diagnosis
treatment
References
- D'Antonio F., Iacovella C., Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2013; 42(5): 509-17. https://dx.doi.org/10.1002/uog.13194.
- Jain V., Bos H., Bujold E. Guideline No. 402: Diagnosis and Management of Placenta Previa. J. Obstet. Gynaecol. Can. 2020; 42(7): 906-917.e1. https://dx.doi.org/10.1016/j.jogc.2019.07.019.
- Jauniaux E., Ayres-de-Campos D., Langhoff-Roos J., Fox K.A., Collins S.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int. J. Gynaecol. Obstet. 2019; 146(1): 20-4. https://dx.doi.org/10.1002/ijgo.12761.
- Jauniaux E., Alfirevic Z., Bhide A.G., Belfort M.A., Burton G.J., Collins S.L. et al.; Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG. 2019; 126(1): e1-e48. https://dx.doi.org/10.1111/1471-0528.15306.
- Jauniaux E., Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2017; 217(1): 27-36. https://dx.doi.org/10.1016/j.ajog.2017.02.050.
- Palacios-Jaraquemada J.M., Fiorillo A., Hamer J., Martínez M., Bruno C. Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique. J. Matern. Fetal Neonatal. Med. 2022; 35(2): 275-82. https://dx.doi.org/10.1080/14767058.2020.1716715.
- Guidelines for the Blood Transfusion Services in the United Kingdom. 8th ed. London: TSO; 2013.
- Виницкий А.А., Шмаков Р.Г., Быченко В.Г. Современные методы инструментальной диагностики врастания плаценты. Акушерство и гинекология. 2017; 3: 12-7. [Vinitsky A.A., Shmakov R.G., Bychenko V.G. Current methods for instrumental diagnosis of placenta increta. Obstetrics and Gynecology. 2017; (3): 12-7. (in Russian)]. https://dx.doi.org/10.18565/ig.2017.3.12-7.
- Савельева Г.М., Курцер М.А., Бреслав И.Ю., Панина О.Б., Андреев А.И., Барыкина О.П., Латышкевич О.А. Врастание предлежащей плаценты (placenta accreta) у пациенток с рубцом на матке после кесарева сечения. Клинико-морфологическое сопоставление. Акушерство и гинекология. 2015; 11: 41-5. [Savelyeva G.M., Kurtser M.A., Breslav I.Yu., Panina O.B., Andreev A.I., Barykina O.P., Latyshkevich O.A. Invasion of placenta previa in patients with a uterine scar after cesarean section: Clinical and morphological sections. Obstetrics and Gynecology. 2015; (11): 41-5.(in Russian)].
- Шмаков Р.Г., Пирогова М.М., Васильченко О.Н., Чупрынин В.Д., Ежова Л.С. Хирургическая тактика при врастании плаценты с различной глубиной инвазии. Акушерство и гинекология. 2020; 1: 78-82. [Shmakov R.G., Pirogova M.M., Vasilchenko O.N., Chuprynin V.D., Ezhova L.S. Surgery tactics for placenta increta with different depths of invasion. Obstetrics and Gynecology. 2020; (1): 78-82. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.1. 78-82.
- Сухих Г.Т., Шмаков Р.Г., Курцер М.А., Баринов С.В., Чупрынин В.Д., Михеева А.А., Амирасланов Э.Ю., Григорьян А.М., Коноплев Б.А., Кутакова Ю.Ю., Карапетян Т.Э., Васильченко О.Н., Забелина Т.М., Серова О.Ф., Пырегов А.В., Куликов И.А., Белоусова Т.Н., Плахотина Е.Н., Пенжоян Г.А., Макухина Т.Б., Андреева М.Д., Шаповалова О.А., Каменских Г.В., Лобач С.В., Позднякова Т.И., Савельева И.В., Бухарова Е.А., Носова Н.В., Цхай В.Б., Распопин Ю.С., Гарбер Ю.Г., Веккер И.Р., Журлова О.Н., Нечаева М.В., Белоконева Т.С., Протопопова Н.В., Дудакова В.Н., Новичков Д.А., Хворостухина Н.Ф., Владимирова Н.Ю., Федорова К.В., Ринчиндоржиева М.П., Тудупова Б.Б., Панова Т.В., Гусева О.И., Мануйленко О.В., Брум О.Ю., Дорфман О.В., Веровская Т.А., Бабаева Л.К., Рымашевский А.Н., Хвалина Т.В., Дмитриева С.Л., Горев С.Н., Малышкина А.И., Песикин О.Н., Зубенко В.Б., Лобач Н.В., Брюхачева Т.В., Караваева А.А., Беженарь В.Ф., Аракелян Б.В., Ральникова А.Ю., Курлеева Т.Ю., Вологодская Е.В., Дикарёва Л.В., Малышева И.П., Идам-Сюрюн А.М., Шакурова Е.Ю., Семёнов Ю.А., Шерстобитов А.В., Фортыгин А.Я., Зюзин Е.С., Кашлевская Н.Л., Шамина М.С., Густоварова Т.А., Хаванский В.А., Щегольков М.Е., Кулакова С.А., Клишина В.В. Хирургическое лечение при врастании плаценты в Российской Федерации (пилотное многоцентровое исследование). Акушерство и гинекология. 2024; 1: 50-66. [Sukhikh G.T., Shmakov R.G., Kurtser M.A., Barinov S.V., Chuprynin V.D., Mikheeva A.A.,Amiraslanov E.Yu., Grigoryan A.M., Konoplev B.A., Kutakova Yu.Yu., Karapetyan T.E., Vasilchenko O.N., Zabelina T.M., Serova O.F., Pyregov A.V., Kulikov I.A., Belousova T.N., Plakhotina E.N., Penzhoyan G.A., Makukhina T.B., Andreeva M.D., Shapovalova O.A., Kamenskikh G.V., Lobach S.V., Pozdnyakova T.I., Saveljeva I.V., Bukharova E.A., Nosova N.V., Tskhay V.B., Raspopin Yu.S., Garber Yu.G., Wecker I.R., Zhurlova O.N., Nechaeva M.V., Belokoneva T.S., Protopopova N.V., Dudakova V.N., Novichkov D.A., Khvorostukhina N.F., Vladimirova N.Yu., Fedorova K.V., Rinchindorzhieva M.P., Tudupova B.B., Panova T.V., Guseva O.I., Manuilenko O.V., Brum O.Yu., Dorfman O.V., Verovskaya T.A., Babaeva L.K., Rymashevsky A.N., Khvalina T.V., Dmitrieva S.L., Gorev S.N., Malyshkina A.I., Pesikin O.N., Zubenko V.B., Lobach N.V., Briukhacheva T.V., Karavaeva A.A., Bezhenar V.F., Arakelyan B.V., Ralnikova A.Yu.,Kurleeva T.Yu., Vologodskaya E.V., Dikareva L.V., Malysheva I.P., Idam-Syuryun A.M., Shakurova E.Yu., Semenov Yu.A., Sherstobitov A.V.,Fortygin A.Ia., Ziuzin E.S., Kashlevskaya N.L., Shamina M.S., Gustovarova T.A., Khavansky V.A., Shchegolkov M.E., Kulakova S.A.,Klishina V.V. Surgical management of placenta accreta spectrum in the Russian Federation (a pilot multicenter study). Obstetrics and Gynecology. 2024; (1): 50-66. (in Russian)]. https://dx.doi.org/10.18565/aig.2023.306.
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Патологическое прикрепление плаценты (предлежание и врастание плаценты). 2023. [Ministry of Health of the Russian Federation. Clinical guidelines. Pathological placental attachment (placental presentation and ingrowth). 2023.(in Russian)].
Received 22.07.2024
Accepted 06.11.2024
About the Authors
Andrey M. Prikhodko, Dr. Med. Sci., Deputy Director for Research at the Institute of Obstetrics, Head of the Department of Innovative Development, Associate Professor at the Department of Obstetrics and Gynecology, Associate Professor of the Russian Academy of Sciences, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-30-47, a_prikhodko@oparina4.ruElrad Yu. Amiraslanov, PhD, Head of the Obstetric Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-30-47, eldis@mail.ru, https://orcid.org/0000-0001-5601-1241
Vladimir D. Chuprynin, PhD, Head of the Surgical Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, v_chuprynin@oparina4.ru, https://orcid.org/0000-0002-2997-9019
Natalya E. Kan, Professor, Dr. Med. Sci., Deputy Director for Research, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(926)220-86-55, kan-med@mail.ru, https://orcid.org/0000-0001-5087-5946
Oleg R. Baev, Professor, Dr. Med. Sci., Head of the Maternity Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4; Professor at the Department of Obstetrics, Gynecology, Perinatology, and Reproductology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, +7(495)438-11-88, o_baev@oparina4.ru,
https://orcid.org/0000-0001-8572-1971
Similar Articles
