Placenta accreta spectrum: experience of the surgical treatment
Rymashevsky A.N., Volkov A.E., Kantsurova M.R.
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.
Authors’ contributions: Rymashevsky A.N. – developing the concept and design of the study, scientific editing of the text;
Volkov A.E. – developing the concept and design of the study, obtaining the data, their analysis and interpretation, writing the text of the article; Kantsurova M.R. – writing the text of the article.
Conflicts interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Ethical Approval: The study was approved by the Ethical Review Board of the Rostov State Medical University, Ministry of Health of the Russian Federation, Rostov-on-Don.
Patient Consent for Publication: The patients provided informed consent for the publication of their data and associated images.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Rymashevsky A.N., Volkov A.E., Kantsurova M.R. Placenta accreta spectrum: experience of the surgical treatment.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (3): 118-122 (in Russian)
https://dx.doi.org/10.18565/aig.2024.25
Keywords
abnormal placental invasion
placenta accreta spectrum
treatment algorithm
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Received 02.02.2024
Accepted 20.03.2024
About the Authors
Alexander N. Rymashevsky, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology No. 1, Rostov State Medical University, Ministry of Health of Russia, 344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)234-24-23, rymashevskyan@mail.ru, https://orcid.org/0000-0003-3349-6914Andrey E. Volkov, PhD, Associate Professor, Department of Obstetrics and Gynecology No. 1, Rostov State Medical University, Ministry of Health of Russia,
344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)234-24-23, avolkov@aaanet.ru, https://orcid.org/0000-0002-5899-1252
Maria R. Kantsurova, assistant of the Department of Obstetrics and Gynecology No. 1, Rostov State Medical University, Ministry of Health of Russia,
344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)234-24-23, madlax_san@mail.ru, https://orcid.org/0000-0003-4916-8042
Corresponding author: Maria R. Kantsurova, madlax_san@mail.ru
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