Delivery of pregnant women with placenta increta and no uterine scar
Background. The main factor for placenta increta is the presence of a uterine scar after cesarean section. Placenta increta with no scar is extremely rare, which is due to the absence of specific diagnostic signs. This type of ingrowth is most often detected only during surgery and is confirmed only postoperatively by pathomorphological verification. Placenta increta with no scar occurs in pregnant women with a family obstetric and gynecological history (uterine curettage or manual examination of the postpartum uterus, which leads to damage and chronic inflammation of the myometrium). This is associated with a high massive blood loss risk, hysterectomy, and maternal mortality.Zabelina T.M., Vasilchenko O.N., Karimova G.N., Ezhova L.S., Uchevatkina P.V., Shmakov R.G.
Case report. The paper describes three clinical cases of placenta increta with no uterine scar after cesarean section. One patient underwent organ-sparing surgery, such as metroplasty using tourniquet hemostasis by autoerythrocyte reinfusion, infusion of fresh frozen plasma and red blood cells for the controlled reduction of blood loss. Two patients underwent hysterectomy.
Conclusion. Placenta increta without uterine scarring after cesarean section has no pathognomonic symptoms or typical diagnostic signs, which increases the risk of intraoperative and postoperative complications, their most formidable ones are massive blood loss and hysterectomy.
Keywords
true placenta increta
placenta increta with no uterine scar after cesarean section
hysterectomy
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Received 28.10.2020
Accepted 13.01.2021
About the Authors
Tatyana M. Zabelina, Ph.D. student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(977)957-17-29. E-mail: romashova-1993@bk.ru. 117997, Russia, Moscow, Ac. Oparina str., 4.Oksana N. Vasilchenko, Ph.D., senior researcher, Department of Innovative Technologies of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(977)957-17-29. E-mail: o_vasilchenko@oparina4.ru.
117997, Russia, Moscow, Ac. Oparina str., 4.
Galiya N. Karimova, Ph.D., obstetrician-gynecologist, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. Tel.: +7(977)957-17-29. E-mail: g_karimova@oparina.ru. 117997, Russia, Moscow, Ac. Oparina str., 4.
Larisa S. Ezhova, senior researcher at the Pathologo-Anatomical Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(977)957-17-29. E-mail: l_ezhova@oparina4.ru. 117997, Russia, Moscow, Ac. Oparina str., 4.
Polina V. Uchevatkina, Physician at the Department of Diagnostic Imaging, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(977)957-17-29. E-mail: p_uchevatkina@oparina4.ru. 117997, Russia, Moscow, Ac. Oparina str., 4.
Roman G. Shmakov, MD, professor of the RAS, director of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(977)957-17-29. E-mail: r_shmakov@oparina.ru. 117997, Russia, Moscow, Ac. Oparina str., 4.
For citation: Zabelina T.M., Vasilchenko O.N., Karimova G.N., Ezhova L.S., Uchevatkina P.V., Shmakov R.G. Delivery of pregnant women with placenta increta and no uterine scar.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 4: 150-156 (in Russian)
https://dx.doi.org/10.18565/aig.2021.4.150-156
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