The characteristics of the course of pregnancy and surgical management in placenta increta in patients with reproductive tract malformations
Background: The impact of congenital uterine malformations on reproductive outcomes remains a highly controversial issue in the modern world. In patients with an internal genital malformation, the frequency of spontaneous abortions, premature detachment of a normally located placenta, premature delivery, and fetal death is increased; the risk of placenta increta is also higher in this category of women. In connection with the above, it seems relevant to analyze the course of pregnancies, surgical tactics, and outcomes in case of abnormal placental invasion in patients with a uterine malformation, as well as to compare the authors’ own experience with foreign data on the concurrence of these pathologies.Mikheeva A.A., Yarygina T.A., Shmakov R.G., Nizyaeva N.V., Amiraslanov E.Yu., Karapetyan T.E., Rogachevskiy O.V., Pyregov A.V.
Case report: In the foreign sources, there are 4 cases of placenta increta in uterine malformations, each of which was accompanied by substantial blood loss requiring hysterectomy. A full-term baby was born only in 1 of the presented cases; 2 cases of antenatal fetal death occurred; one baby was born alive at 28 weeks’ gestation. It is important to note that abnormal placental invasion was not diagnosed until the onset of pain or bleeding in 3 of the published cases. The authors describe Russia’s first clinical case of pregnancy resulting from in vitro fertilization in a patient with a reproductive tract malformation and antenatally diagnosed placental ingrowth into the area of a postoperative uterine scar.
Conclusion: Due to the timely diagnosis of abnormal placental invasion, correct patient routing, a multidisciplinary approach to pregnancy management, and a proven technique of organ-sparing surgery for placenta increta, it was possible to bring the pregnancy to full term, to perform organ-sparing surgery using blood-saving technologies.
Keywords
pregnancy
uterine and vaginal malformations
bicornuate uterus
cervical duplication
vaginal septum
placenta increta
metroplasty
organ-sparing surgery
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Received 10.06.2022
Accepted 24.06.2022
About the Authors
Alexandra A. Mikheeva, postgraduate student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,Ministry of Health of Russia, shuratora@mail.ru, https://orcid.org/0000-0002-8159-6373, 117997, Russia, Moscow, Oparina str., 4.
Tamara A. Yarygina, PhD, specialist of ultrasound diagnostics, researcher at the Perinatal Cardiology Center, A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, +7(495)414-78-75, tamarayarygina@gmail.com, https://orcid.org/0000-0001-6140-1930, 121552, Russia, Moscow, Roublyevskoe Shosse, 135.
Roman G. Shmakov, Dr. Med. Sci., Professor, Director of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(495)438-72-00, r_shmakov@oparina4.ru, https://orcid.org/0000-0002-2206-1002, 117997, Russia, Moscow, Oparina str., 4.
Natalia V. Nizyaeva, Dr. Med. Sci., Head of the Reproduction Pathology Laboratory, Avtsyn Research Institute of Human Morphology, +7(926)248-28-93,
niziaeva@gmail.com, https://orcid.org/0000-0001-5592-5690, SPIN 9893-2630, 117418, Russia, Moscow, Tsyurupy str., 3.
Elrad Yu. Amiraslanov, PhD, Head of the Department of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, eldis@mail.ru, https://orcid.org/0000-0001-5601-1241, 117997, Russia, Moscow, Oparina str., 4.
Tamara E. Karapetyan, Dr. Med. Sci., doctor at the Department of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics,
Gynecology and Perinatology, Ministry of Health of Russia, tomamed02@mail.ru, https://orcid.org/0000-0003-0025-3182, 117997, Russia, Moscow, Oparina str., 4.
Oleg V. Rogachevskiy, Dr. Med. Sci., Head of the Department of Extracorporal Methods of Treatment and Detoxification, Professor at the Department of Anesthesiology and Resuscitation, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia,
+7(495)438-71-35, о_rogachevskiy@oparina4.ru, https://orcid.org/0000-0002-4332-430X, 117997, Russia, Moscow, Oparina str., 4.
Aleksey V. Pyregov, Dr. Med. Sci., Director of the Institute of Anesthesiology and Intensive Care, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(495)438-78-30, pyregov@oparina4.ru, https://orcid.org/0000-0001-8382-9671,
117997, Russia, Moscow, Oparina str., 4.
Authors' contributions: Mikheeva A.A., Yarygina T.A., Shmakov R.G., Rogachevskiy O.V. – concept and design of the investigation; Mikheeva A.A., Yarygina T.A., Karapetyan T.E., Amiraslanov E.Yu. – material collection and processing; writing the text; Nizyaeva N.V. – morphological and immunohistochemical studies; Yarygina T.A. – ultrasound examination; Shmakov R.G., Rogachevskiy O.V., Pyregov A.V. – editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has been conducted without additional funding.
Ethical Approval: The investigation has been approved by the Ethics Committee, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
Patient Consent for Publication: The patient provided informed consent for the publication of her data and associated images.
For citation: Mikheeva A.A., Yarygina T.A., Shmakov R.G., Nizyaeva N.V., Amiraslanov E.Yu., Karapetyan T.E., Rogachevskiy O.V., Pyregov A.V. The characteristics of the course of pregnancy and surgical management in placenta increta in patients with reproductive tract malformations.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 9: 146-154 (in Russian)
https://dx.doi.org/10.18565/aig.2022.9.146-154
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