Relationship between the severity of respiratory and cardiovascular disorders in preterm infants and the degree and size of maternal abnormal placentation
Balakina A.D., Balashova E.N., Ionov O.V., Kirtbaya A.R., Mikheeva A.A., Vasilchenko O.N., Zubkov V.V., Shmakov R.G., Degtyarev D.N.
Objective: To assess the severity of respiratory and cardiovascular disorders in preterm infants based on the degree and anatomical and topographic type of placenta accreta spectrum disorders as well as the diameter of the placental hernia in their mothers.
Materials and methods: A retrospective cohort study was conducted involving 288 preterm infants with a gestational age (GA) of 330–366 weeks born to mothers with placenta accreta spectrum disorders. The clinical data were analyzed in three stages. In Stage I, patients were divided into three groups based on the type of placenta accreta spectrum (accreta, increta, and percreta). In Stage II, infants were classified into five groups according to the anatomical and topographic types of the placenta accreta spectrum, following H. Palacius's classification. In Stage III, the infants were divided into two groups based on the placental hernia diameter. In the study groups, GA, anthropometric parameters, sex, Apgar scores at 1 and 5 min after birth, and the correspondence of body weight and length to GA were compared. The severity and duration of respiratory disorders were assessed using indirect criteria: frequency and duration of respiratory therapy, including mechanical ventilation (MV) and high-frequency oscillatory ventilation (HFOV), maximum required mean airway pressure (MAP), frequency and duration of additional oxygen supplementation, and frequency of surfactant replacement therapy. The severity of acute cardiovascular disorders was evaluated based on the frequency of cardiotonic and vasopressor therapies, including the use of dopamine and dobutamine, and the maximum vasoactive inotropic index (VII). Integral indicators of the severity of preterm infants' conditions after birth included the length of stay in the NICU and total duration of hospitalization in days.
Results: The analysis revealed no significant differences in the severity of respiratory and cardiovascular disorders among newborns based on the degree of placental invasion or type of accreta. However, a significant increase in hospitalization duration was observed in newborns of mothers with placenta percreta compared to those born to mothers with placenta accreta, likely due to the lower GA of infants born to mothers with placenta percreta. Additionally, an increase in the duration of HFOV and the need for higher HFOV parameters, particularly MAP, were noted in preterm infants born to mothers with a placental hernia diameter exceeding 7 cm.
Conclusion: The severity of respiratory and cardiovascular disorders in preterm infants was not influenced by the degree of abnormal placental invasion or the anatomical and topographic type of placental implantation. However, a correlation was found between the severity of respiratory disorders and the placental hernia diameter.
Authors' contributions: Balashova E.N., Balakina A.D., Vasilchenko O.N. – conception and design of the study; Balashova E.N., Balakina A.D., Mikheeva A.A., Kirtbaya A.R., Vasilchenko O.N. – database creation, material acquisition and processing; Balashova E.N., Balakina A.D. – statistical analysis; Balakina A.D., Balashova E.N. – drafting of the manuscript; Ionov O.V., Zubkov V.V., Shmakov R.G., Degtyarev D.N. – general supervision, acquisition of information, editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: The study was conducted under the State Order on Planned Research and Development 25-A19 "Prognosis, Diagnosis and Treatment of Patients with Placenta Accreta Spectrum" No. R&D AAAA-A19-119021490133-6.
Ethical approval: The study was reviewed and approved by the Research Ethics Committee of the V.I. Kulakov NMRC for OG&P (Ref. No: 11 of 11.11.2021).
Patient consent for publication: All patients provided informed consent for the publication of their data.
Authors' data sharing statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Balakina A.D., Balashova E.N., Ionov O.V., Kirtbaya A.R., Mikheeva A.A., Vasilchenko O.N., Zubkov V.V., Shmakov R.G., Degtyarev D.N. Relationship between the severity of respiratory and cardiovascular disorders
in preterm infants and the degree and size of maternal abnormal placentation.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (3): 72-83 (in Russian)
https://dx.doi.org/10.18565/aig.2024.282
Keywords
preterm infant
placenta accreta spectrum
respiratory disorders
References
- De Mucio B., Serruya S., Alemán A., Castellano G., Sosa C.G. A systematic review and meta-analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta. Int. J. Gynaecol. Obstet. 2019; 147(3): 281-91. https://dx.doi.org/10.1002/ijgo.12948.
- Higgins M.F., Monteith C., Foley M., O'Herlihy C. Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section. Eur. J. Obstet. Gynecol. Reprod. Biol. 2013; 171(1): 54-6. https://dx.doi.org/10.1016/j.ejogrb.2013.08.030.
- Mehrabadi A., Hutcheon J.A., Liu S., Bartholomew S., Kramer M.S., Liston R.M. et al.; Maternal Health Study Group of the Canadian Perinatal Surveillance System (Public Health Agency of Canada). Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage. Obstet. Gynecol. 2015; 125(4): 814-21. https://dx.doi.org/10.1097/AOG.0000000000000722.
- Cahill A.G., Beigi R., Heine R.P., Silver R.M., Wax J.R.; Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Placenta accreta spectrum. Am. J. Obstet. Gynecol. 2018; 219(6): B2-B16. https://dx.doi.org/10.1016/j.ajog.2018.09.042.
- Balayla J., Bondarenko H.D. Placenta accreta and the risk of adverse maternal and neonatal outcomes. J. Perinat. Med. 2013; 41(2): 141-9. https://dx.doi.org/10.1515/jpm-2012-0219.
- Федеральная служба государственной статистики. Здравоохранение в России 2021. Статистический сборник. Росстат; 2021. 171 с. [Federal State Statistics Service. Healthcare in Russia 2021. Statistical compilation. Rosstat; 2021. 171 p. (in Russian)].
- Jauniaux E., Ayres-de-Campos D., Langhoff-Roos J., Fox K.A., Collins S.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int. J. Gynaecol. Obstet. 2019; 146(1): 20-4. https://dx.doi.org/10.1002/ijgo.12761.
- Palacios-Jaraquemada J.M., Fiorillo A., Hamer J., Martínez M., Bruno C. Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique. J. Matern. Fetal Neonatal Med. 2022; 35(2): 275-82. https://dx.doi.org/10.1080/14767058.2020.1716715.
- Moeini R., Dalili H., Kavyani Z., Shariat M., Charousaei H., Akhondzadeh A. et al. Maternal and neonatal outcomes of abnormal placentation: a case-control study. J. Matern. Fetal Neonatal Med. 2021; 34(19): 3097-103. https://dx.doi.org/10.1080/14767058.2019.1678128.
- Gielchinsky Y., Mankuta D., Rojansky N., Laufer N., Gielchinsky I., Ezra Y. Perinatal outcome of pregnancies complicated by placenta accreta. Obstet. Gynecol. 2004; 104(3): 527-30. https://dx.doi.org/10.1097/01.AOG.0000136084.92846.95.
- Spillane N.T., Zamudio S., Alvarez-Perez J., Andrews T., Nyirenda T., Alvarez M. et al. Increased incidence of respiratory distress syndrome in neonates of mothers with abnormally invasive placentation. PLoS One. 2018; 13(7): e0201266. https://dx.doi.org/10.1371/journal.pone.0201266.
- Munoz J.L, Kimura AM., Julia J., Tunnell C., Hernandez B., Curbelo J. et al. Impact of placenta accreta spectrum (PAS) pathology on neonatal respiratory outcomes in cesarean hysterectomies. J. Matern. Fetal Neonatal Med. 2022; 35(26): 10692-7. https://dx.doi.org/10.1080/14767058.2022.2157716.
- Балашова Е.Н., Ионов О.В., Киртбая А.Р., Никонец А.Д., Михеева А.А., Васильченко О.Н., Зубков В.В., Шмаков Р.Г., Дегтярев Д.Н. Особенности дыхательных и сердечно-сосудистых нарушений у недоношенных детей, рожденных у матерей с врастанием плаценты. Акушерство и гинекология. 2021; 5: 85-93. [Balashova E.N., Ionov O.V., Kirtbaya A.R., Nikonets A.D., Mikheeva A.A., Vasilchenko O.N., Zubkov V.V., Shmakov R.G., Degtyarev D.N. The features of respiratory and cardiovascular disorders in preterm infants born to mothers with abnormally invasive placenta. Obstetrics and Gynecology. 2021; (5): 85-93 (in Russian)]. https://dx.doi.org/10.18565/aig.2021.5.85-93.
- Belletti A., Lerose C.C., Zangrillo A., Landoni G. Vasoactive-inotropic score: evolution, clinical utility, and pitfalls. J. Cardiothorac. Vasc. Anesth. 2021; 35(10): 3067-77. https://dx.doi.org/10.1053/j.jvca.2020.09.117.
- Favia I., Vitale V., Ricci Z. The vasoactive-inotropic score and levosimendan: time for LVIS? J. Cardiothorac. Vasc. Anesth. 2013; 27(2): e15-6. https://dx.doi.org/10.1053/j.jvca.2012.11.009.
- Seet E.L., Kay H.H., Wu S., Terplan M. Placenta accreta: depth of invasion and neonatal outcomes. J. Matern. Fetal Neonatal Med. 2012; 25(10): 2042-5. https://dx.doi.org/10.3109/14767058.2012.678429.
- Detlefs S.E., Carusi D.A., Modest A.M., Einerson B.D., Lyell D., Grace M.R. et al. The association between placenta accreta spectrum severity and incidence of small for gestational age neonates. Am. J. Perinatol. 2023; 40(1): 9-14. https://dx.doi.org/10.1055/s-0042-1757261.
- Palacios-Jaraquemada J.M., Basanta N., Fiorillo A., Labrousse C., Martínez M. Neonatal outcome after conservative-reconstructive surgery for placenta accreta spectrum disorders. J. Matern. Fetal Neonatal Med. 2022; 35(25): 4994-6. https://dx.doi.org/10.1080/14767058.2021.1873944.
- Munoz J.L., Pfeiffer A.F., Ramsey P.S. Correlation of clinical outcomes with the application of the 2020 consensus panel on histological classification for Placenta Accreta Spectrum (PAS). J. Matern. Fetal Neonatal Med. 2022; 35(25): 10044-8. https://dx.doi.org/10.1080/14767058.2022.2086797.
Received 06.11.2024
Accepted 26.02.2025
About the Authors
Anastasia D. Balakina, anesthesiologist-resuscitator of the NICU named after Prof. A.G. Antonov of the Institute of Neonatology and Pediatrics, V.I. Kulakov NMRCfor OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4, +7(495)438-22-77, nikon.na@yandex.ru, https://orcid.org/0000-0002-4717-1865
Ekaterina N. Balashova, Dr. Med. Sci., Leading Researcher at the NICU named after Prof. A.G. Antonov of the Institute of Neonatology and Pediatrics, V.I. Kulakov NMRC
for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4; Associate Professor at Neonatology Department of the Faculty of Pediatrics,
I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), +7(495)438-22-77, e_balashova@oparina4.ru, https://orcid.org/0000-0002-3741-0770
Oleg V. Ionov, Dr. Med. Sci., Head of the NICU named after Prof. A.G. Antonov of the Institute of Neonatology and Pediatrics, V.I. Kulakov NMRC for OG&P,
Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4; Professor at Neonatology Department of the Faculty of Pediatrics, I.M. Sechenov First MSMU,
Ministry of Health of Russia (Sechenov University); Chief Researcher, Research Clinical Institute of Childhood, Ministry of Health of the Moscow Region, +7(495)438-22-77, o_ionov@oparina4.ru, https://orcid.org/0000-0002-4153-133X
Аnna R. Kirtbaya, Dr. Med. Sci., Head of the Clinical Work, NICU named after Prof. A.G. Antonov of the Institute of Neonatology and Pediatrics, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4; Professor at Neonatology Department of the Faculty of Pediatrics, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), +7(495)438-22-77, a_kirtbaya@oparina4.ru, https://orcid.org/0000-0002-7628-8157
Alexandra A. Mikheeva, obstetrician-gynecologist, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4, shuratora@mail.ru
Oksana N. Vasilchenko, PhD, Senior Researcher at the Department of Innovative Technologies, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
117997, Russia, Moscow, Oparin str., 4, +7(495)438-30-47, o_vasilchenko@oparina4.ru, https://orcid.org/0000-0001-9434-0011
Victor V. Zubkov, Dr. Med. Sci., Professor, Director of the Institute of Neonatology and Pediatrics, Head of Neonatology Department of the Department of Professional Education, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4; Professor at Neonatology Department of the Faculty of Pediatrics, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), +7(495)438-22-66, v_zubkov@oparina4.ru, https://orcid.org/0000-0001-8366-5208
Roman G. Shmakov, Dr. Med. Sci., Director of Academician V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, 101000, Russia, Moscow, Pokrovka str., 22a; Professor at the Department of Obstetrics and Gynecology, Faculty of Pediatrics, Pirogov Russian National Research Medical University, Ministry of Health of Russia; Chief Freelance Obstetrics Specialist of the Ministry of Health of the Russian Federation, Mdshmakov@mail.ru, https://orcid.org/0000-0002-2206-1002
Dmitriy N. Degtyarev, Dr. Med. Sci., Professor, Deputy Director, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4; Professor at Neonatology Department, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University), +7(495)438-23-88, d_degtiarev@oparina4.ru,
https://orcid.org/0000-0001-8975-2425
Similar Articles
