Comparative assessment of the scar after organ-sparing surgery for placenta increta
Objective. To assess the scar after cesarean delivery for placenta increta.Dobrokhotova Yu.E., Kozlov P.V., Bakhareva I.V., Kuznetsov P.A., Ivannikov N.Yu., Olenev A.S., Zubareva E.A., Zubarev A.R., Zalesskaya S.A., Samochatov D.N., Aponovich I.A.
Subjects and methods. The outcomes of 17 observations of cesarean delivery for placenta increta were comparatively analyzed. According to the choice of surgical technique, all the patients were divided into two groups: 1) 8 patients in whom standard cesarean section procedures were used; 2) 9 patients who received organ-sparing methods, including bottom cesarean section to extract the fetus, followed by placental removal and metroplasty in the lower uterine segment. Ultrasonography was used to comparatively assess uterine involution; the nature and characteristics of blood flow in the area of a suture on the anterior uterine wall were examined. Eight months later, ultrasonography using elatography was repeated to assess the competence of the formed scar on the anterior uterine wall and to determine tissue stiffness in the scar.
Results. The evidence obtained in this investigation suggests that the process of scar formation in patients who have undergone bottom cesarean section, followed by placental removal and metroplasty in the lower uterine segment, occurs with a predominance of elastic muscle fibers.
Conclusion. Timely diagnosis of placenta increta makes it possible to prepare for surgery and to use novel technologies. Meticulous hemostasis and tissue matching ensure proper scar formation, vascular microinvasion (angiogenesis), and no ischemia. These processes contribute to the formation of an adequate scar, which is further determined by ultrasound methods.
Keywords
placenta accreta
uterine scar
placenta increta
bottom cesarean section
Supplementary Materials
- Table 1. Term of gestation during delivery in patients with placenta ingrowth (n = 17)
- Table 2a. Involution of the uterus after a cesarean section for 5 days
- Table 2b. Involution of the uterus after a cesarean section for 10 days
- Table 3. Determination of tissue quality in the scar area with the help of the elastography method
- Fig. 1. Blood flow in the postoperative area on day 14 in the patient after delivery a) by way of the caesarean section, metaplasty, balloon occlusion of the common iliac arteries; b) by a standard caesarean section technique
- Fig. 2a. Defect of the rumen area in the form of a "niche" in a patient with ingrowth of the placenta, delivered by the standard method of cesarean section
- Fig. 2 b. Blood flow in the rumen area in the same patient after delivery by a standard cesarean section technique. Arrows indicate: 1-defect in the form of a "niche", 2,3 – vessels in the rumen area
- Fig. 3 a. Elastography. The arrow indicates the area of the scar in the patient after delivery through the caesarean section, metaplasty, balloon occlusion of the common iliac arteries
- Fig. 3 b. Elastography. The arrow indicates the scar area in the patient after delivery by a standard cesarean section technique
References
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Received 18.01.2017
Accepted 17.02.2017
About the Authors
Dobrokhotova Yulia Eduardovna, MD, professor, head of the Department of Obstetrics and Gynecology, N.I. Pirogov Russian National Research Medical University,Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74955369270. E-mail: pr.dobrohotova@mail.ru
Kozlov Pavel Vasilievich, MD, Professor of the Department of Obstetrics and Gynecology, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74956134509. E-mail: kozlovpv@rambler.ru
Bakhareva Irina Viktorovna, MD, Professor of the Department of Obstetrics and Gynecology, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74954941253. E-mail: iribakhareva@yandex.ru
Pavel Andreevich Kuznetsov, Ph.D., Associate Professor of the Department of Obstetrics and Gynecology, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74956134509. E-mail: poohsmith@mail.ru. orcid.org/0000-0003-2492-3910
Ivannikov Nikolay Y., Ph.D., Chief Physician of Branch, Maternity Hospital One, L.A. Vorokhobov City Clinical Hospital Sixty-Seven, Moscow Healthcare Department.
125480, Russia, Moscow, Vilis Latsis str. 4. Tel.: +74954948330
Olenev Anton Sergeevich, Candidate of Medical Science, Deputy chief doctor of the Branch Two, City Clinical Hospital Twenty-Four, Moscow Healthcare Department. 127287, Russia, Moscow, 4th Vyatsky per. 39. Tel.: +74956134509. E-mail: felidis@mail.ru
Zubareva Elena Anatolievna, MD, professor of the Department of Hospital Pediatrics, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74954900439
Zubarev Andrey Ruslanovich, MD, Professor, Head of the Department of Ultrasound Diagnostics, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74954900439. E-mail: a.zubarev@yahoo.com
Zalesskaya Sofya Alekseevna, assistant of the Department of Obstetrics and Gynecology, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74955369270. E-mail: sofa.zalesskaya@mail.ru
Samochatov Denis, PhD, Head of the Department of Angiography of the L.A. Vorokhobov City Clinical Hospital Sixty-Seven, Moscow Healthcare Department.
123423, Russia, Moscow, Salyama Adilya str. 2/44. Tel.: +74955303388
Aponovich Irina Aleksandrovna, postgraduate student of the Department of Obstetrics and Gynecology, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia. 117997, Russia, Moscow, Ostrovityanova str. 1. Tel.: +74955369270.
For citations: Dobrokhotova Yu.E., Kozlov P.V., Bakhareva I.V., Kuznetsov P.A., Ivannikov N.Yu., Olenev A.S., Zubareva E.A., Zubarev A.R., Zalesskaya S.A., Samochatov D.N., Aponovich I.A. Comparative assessment of the scar after organ-sparing surgery for placenta increta. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (9): 114-20. (in Russian)
http://dx.doi.org/10.18565/aig.2017.9.114-20
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