Early diagnosis of abnormally deep invasion of the chorion as a predictor of invasive placentation
Volkov A.E., Solonchenko A.S., Rymashevsky A.N., Voloshin V.V., Khloponina A.V., Kantsurova M.R.
Background: Placenta accreta spectrum (PAS) is an advanced invasive placentation, which is a serious condition associated with high maternal mortality due to massive uterine hemorrhages. These complications can be reduced by early diagnosis of PAS.
Case report: A 35-year-old multiparous patient with a burdened obstetric and gynecological history had indirect signs of abnormally deep invasion of the chorion which were revealed during ultrasound examination at 7+1 weeks gestation. The ultrasound scan showed a heterogeneous structure with the expansion of lacunar spaces and areas of hypervascularization of the myometrium of the anterior uterine wall. The diagnosis of abnormal placental attachment was confirmed by dynamic echography with stereoscopic blood flow imaging (LumiFlow). A planned cesarean section by transverse uterine fundal incision was performed at 37+2 weeks. Metroplasty was performed on both sides after ligation of the internal iliac and ovarian arteries. The diagnosis of PAS was confirmed by a pathology study, and placenta increta (PAS 3a) was verified.
Conclusion: The presented clinical observation clearly demonstrates the real possibility of early ultrasound diagnosis of advanced invasive placentation. The detection of signs of advanced invasive placentation at the earliest possible time of gestation suggests that patients can be referred to a high-risk PAS group for the subsequent search for specific signs of this placental pathology and optimal planning of organ-preserving methods of delivery in these patients.
Authors’ contributions: Volkov A.E. – developing the concept and design of the study, obtaining the data, their analysis and interpretation, writing the text of the article, surgical treatment of the patient; Solonchenko A.S. – ultrasound diagnosis of the case in early pregnancy; Rymashevsky A.N. – developing the concept and design of the study, scientific editing of the text, surgical treatment of the patient, Voloshin V.V. – carrying out morphological research, editing the obtained data, writing the text; Khloponina A.V. – echography of a case in late pregnancy, Kantsurova M.R. – management of the patient in the postoperative period.
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 patient provided informed consent for the publication of her data and associated images.
For citation: Volkov A.E., Solonchenko A.S., Rymashevsky A.N., Voloshin V.V., Khloponina A.V., Kantsurova M.R. Early diagnosis of abnormally deep invasion of the chorion as a predictor of invasive placentation.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (3): 180-186 (in Russian)
https://dx.doi.org/10.18565/aig.2024.33
Keywords
abnormal chorionic invasion
placenta accreta spectrum
diagnosis
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Received 12.02.2024
Accepted 13.03.2024
About the Authors
Andrey E. Volkov, PhD (Med.), 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
Alexey S. Solonchenko, ultrasound diagnostics doctor at the Department of Antenatal Fetal Protection, Rostov Regional Perinatal Center, 344068, Russia, Rostov-on-Don, Bodraya str., 90, +7(863)235-50-18, a-solonchenko@mail.ru, https://orcid.org/0009-0000-9971-5521
Alexander N. Rymashevsky, Dr. Sci. (Med.), 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, lane. Nakhichevan Lane, 29, +7(863)234-24-23, rymashevskyan@mail.ru, https://orcid.org/0000-0003-3349-6914
Vladimir V. Voloshin, PhD (Med.), Associate Professor, Rostov State Medical University, Ministry of Health of Russia, 344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)234-24-23, voloshinvv2006@yandex.ru, https://orcid.org/0000-0001-8632-082X
Anna V. Khloponina, Dr. Sci. (Med.), Head of the Department of Ultrasound Diagnostics of NIIAP, Rostov State Medical University, Ministry of Health of Russia,
344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)201-44-31, annakhloponina@yandex.ru, https://orcid.org/0000-0002-2056-5231
Maria R. Kantsurova, Assistant at 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: Andrey E. Volkov, avolkov@aaanet.ru
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