Surgery tactics for placenta increta with different depths of invasion
Objective. To evaluate the effectiveness of surgery tactics in patients with different depths of trophoblast invasion.Shmakov R.G., Pirogova M.M., Vasilchenko O.N., Chuprynin V.D., Ezhova L.S.
Subjects and methods. The data of 64 patients diagnosed with placenta increta confirmed by the results of pathomorphological examination were retrospectively analyzed. The patients were divided into 3 groups according to the depth of trophoblast invasion. All pregnant women with suspected placenta increta underwent surgical treatment as lower midline laparotomy with left-sided umbilical bypass, fundal cesarean section, complex hemostatic compression, uterine balloon tamponade, metroplasty, and autoerythrocyte reinfusion.
Results. The data of 64 pregnant women were analyzed; a morphological study could confirm the diagnosis of placenta accreta in 18 patients, placenta increta in 42, and placenta percreta in 4. All the women with placenta increta had a history of a cesarean section uterine scar, but showed no difference in the frequency of prior surgical interventions (p = 0.476). A uterine scar after myomectomy was found in patients with placenta increta and placenta percreta and more frequently observed in those with a greater depth of placental invasion (p = 0.039). The volume of total blood loss increased: that was 975 ml in patients with placenta accreta, 1300 ml in those with placenta increta, and 2200 ml in those with placenta accreta (p = 0.048). The frequency of internal iliac vessel ligation rose and amounted to 5.6, 14.3, and 50%, respectively (p = 0.026). Patients with a greater degree of placenta increta significantly more frequently required hysterectomy (p = 0.038).
Conclusion. There was a relationship between the volume of blood loss and the depth of trophoblast invasion, which allows the elaboration of the most optimal surgery tactics for delivery in pregnant women with this complication. In addition, the findings suggest that additional risk factors are important in assessing the development of placenta increta.
Keywords
pregnancy
placenta increta
trophoblast invasion
uterine scar
complex hemostatic compression
bleeding
hysterectomy
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Received 19.06.2019
Accepted 21.06.2019
About the Authors
Roman G. Shmakov, MD, Ph.D, professor, Director of the Institute of Obstetrics, FSBI V.I. Kulakov Research Centre for Obstetrics, Gynaecology, and Perinatology.Address: E-mail: r_shmakov@oparina4.ru
117997, Russia, Moscow, Oparina st., 4.
Maria M. Pirogova, postgraduate student, FSBI V.I. Kulakov Research Centre for Obstetrics, Gynaecology, and Perinatology. E-mail: pirogovamariya@gmail.com
Address: 117997, Russia, Moscow, Oparina st., 4.
Oksana N. Vasilchenko, Ph.D, senior researcher, FSBI V.I. Kulakov Research Centre for Obstetrics, Gynaecology, and Perinatology. E-mail: o_vasilchenko@oparina4.ru
Address: 117997, Russia, Moscow, Oparina st., 4.
Vladimir D. Chuprinin, Ph.D, head surgical department, FSBI V.I. Kulakov Research Centre for Obstetrics, Gynaecology, and Perinatology. E-mail:v_chuprynin@oparina4.ru
Address: 117997, Russia, Moscow, Oparina st., 4.
Larisa S. Ezhova, Ph.D, senior researcher in the pathology department, FSBI V.I. Kulakov Research Centre for Obstetrics, Gynaecology, and Perinatology.
E-mail: l_ezhova@oparina4.ru
Address: 117997, Russia, Moscow, Oparina st., 4.
For citation: 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.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 1: 78-82. (In Russian).
https://dx.doi.org/10.18565/aig.2020.1. 78-82
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