Placenta accreta: a modern view on etiopathogenesis and obstetric tactics

DOI

https://dx.doi.org/10.18565/aig.2023.251

Ignatko I.V., Bogomazova I.M., Timokhina E.V., Belousova V.S., Fedyunina I.A., Kardanova M.A., Samara A.B., Gutsu V.
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia

Placenta accreta spectrum refers to a form of abnormal placentation and its severity depends on the depth of trophoblast invasion. This abnormality leads to a partial or complete delay in the separation of the placenta in the third stage of labor. The incidence of placental attachment disorders has increased by more than 9 times over the past 20 years. The etiological factors of the abnormality include placenta previa, the presence of postoperative uterine scar, the history of intrauterine interventions, pelvic inflammatory diseases, etc. Placenta previa and uterine scar after cesarean section (CS) are the most common causes of placenta accreta; moreover, the risk of placenta accreta after one CS increases by 7 times, and it increases by 56 times after two or more CS.
Currently, the main theory on the pathogenesis of placenta accreta consists in an impaired decidualization of the endometrium, which leads to uncontrolled invasion of the trophoblast. It is the decidua basalis that regulates proper invasion of the trophoblast by producing pro- and anti-invasive factors. This review presents the evolution of placenta accreta classifications. The main methods of antenatal diagnosis of placenta accreta are ultrasound assessment and magnetic resonance imaging, but none of them has 100% sensitivity and specificity; therefore, laboratory studies are currently conducted to search for biomarkers associated with the depth of trophoblast invasion.
Conclusion: The tactics of managing patients with placenta accreta depends on the depth of invasion, the amount of blood loss and the experience of surgeons, as well as the woman’s desire to preserve her fertility. There are conservative or organ-preserving methods of surgical treatment and non-conservative ones which include hysterectomy. The conservative methods include leaving the placenta in situ, one-stage surgical management, and the Triple-P procedure. The traditional technique involving CS followed by hysterectomy is characterized by a high maternal morbidity due to the development of intra- and postoperative complications.

Authors’ contributions: Ignatko I.V., Bogomazova I.M. – developing the concept and design of the study; Samara A.B.,
Fedyunina I.A. – collecting and processing the material; Gutsu V., Kardanova M.A. – statistical data processing; Samara A.B., Bogomazova I.M. – writing the text; Ignatko I.V., Timokhina E.V., Belousova V.S. – editing the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
For citation: Ignatko I.V., Bogomazova I.M., Timokhina E.V., Belousova V.S., Fedyunina I.A.,
Kardanova M.A., Samara A.B., Gutsu V. Placenta accreta: a modern view on etiopathogenesis and obstetric tactics.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (1): 5-11 (in Russian)
https://dx.doi.org/10.18565/aig.2023.251

placenta accreta

placenta increta

placenta percreta

PAS

etiology of placenta accreta

classification of placenta accreta

diagnosis of placenta accreta

conservative treatment of placenta accreta

Full text (in Russian)

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Received 07.11.2023

Accepted 14.12.2023

Irina V. Ignatko, Dr. Med. Sci., Corresponding Member of the Russian Academy of Sciences, Professor of the Russian Academy of Sciences, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, ignatko_i_v@staff.sechenov.ru, https://orcid.org/0000-0002-9945-3848
Irina M. Bogomazova, PhD, Associate Professor, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, +7(926)305-04-03, bogomazova_i_m@staff.sechenov.ru, https://orcid.org/0000-0003-1156-7726
Elena V. Timokhina, Dr. Med. Sci., Associate Professor, Professor of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University),
119991, Russia, Moscow, Trubetskaya str., 8-2, timokhina_i_m@staff.sechenov.ru, https://orcid.org/0000-0001-6628-0023
Vera S. Belousova, Dr. Med. Sci., Associate Professor, Professor of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University),
119991, Russia, Moscow, Trubetskaya str., 8-2, belousova_v_s@staff.sechenov.ru, https://orcid.org/0000-0001-8332-7073
Irina A. Fedyunina, PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, fedyunina_i_m@staff.sechenov.ru , https://orcid.org/0000-0002-9661-5338
Madina A. Kardanova, PhD, Assistant of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2,
kardanova_i_m@staff.sechenov.ru, https://orcid.org/0000-0002-4315-0717
Alina B. Samara, student of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, linaasamaraa@gmail.com, https://orcid.org/0000-0001-8266-6524
Vladimir Gutsu, Resident of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, gutsu_vladimir@mail.ru,
https://orcid.org/0009-0000-3712-3280
Corresponding author: Irina M. Bogomazova, bogomazova_i_m@staff.sechenov.ru

Placenta accreta: a modern view on etiopathogenesis and obstetric tactics

Ignatko I.V., Bogomazova I.M., Timokhina E.V., Belousova V.S., Fedyunina I.A., Kardanova M.A., Samara A.B., Gutsu V.

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