The importance of a multidisciplinary approach to the delivery and subsequent management of patients with placenta increta
Background: Placenta increta is an abnormal partial or complete attachment of placental villi to the uterine wall. The main etiological factor of placenta increta is uterine traumatization, in particular during repeat caesarean sections or intrauterine surgical interventions. With a rise in the frequency of these operations, the prevalence of the pathology under consideration also increases by more than 10 times over the past 30 years. Undiagnosed placenta increta is associated with a high risk for massive blood loss and maternal mortality in delivery.Gritskevich А.А., Baitman T.P., Simonov A.D., Melnikov M.V., Chuprynin V.D., Karelskaya N.A.
Case report: The paper describes a clinical case of placenta increta first detected during caesarean section (a third childbirth). The delivery was complicated by uterine and urinary bladder rupture, ureteral traumatization, and massive blood loss. Hysterectomy and bladder wall defect suturing were done as vitally indicated. The early postoperative period was complicated by urinary peritonitis that made sanitation and drainage of the abdominal cavity and small pelvis, fistuloplasty and ureteral reimplantation to be performed. At 3 months when urine resumed to flow into the bladder, vesicovaginal fistula formation and microcystis were diagnosed due to dislocation of one of the nephrostomes. Cystectomy and orthotopic vesiculoplasty were electively carried out. An 8-month follow-up demonstrated improvements in general condition of the patient and her quality of life.
Conclusion: Placenta increta increases the risk of life-threatening intra- and postoperative complications, which makes a multidisciplinary approach to preoperative preparation, perioperative management and delivery of the patients at high risk for placenta increta particularly important.
Keywords
placenta increta
cesarean section
hysterectomy
vesicovaginal fistulas
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Received 12.09.2022
Accepted 03.10.2022
About the Authors
Alexander A. Gritskevich, Dr. Med. Sci., Head of the Oncourology Department, A.V. Vishnevsky National Medical Research Center of Surgery; Professor at the Department of Urology with the course of oncology, radiology and andrology of the Medical Institute, Peoples` Friendship University of Russia, grekaa@mail.ru,https://orcid.org/0000-0002-5160-925X, 115093, Russia, Moscow, Bolshaya Serpukhovskaya str., 27.
Tatiana P. Baitman, Researcher at the Oncourology Department, A.V. Vishnevsky National Medical Research Center of Surgery, bit.t@mail.ru,
https:// orcid.org/0000-0002-3646-1664, 115093, Russia, Moscow, Bolshaya Serpukhovskaya str., 27.
Anton D. Simonov, urologist, Specialist at the Organizational and Methodological Department, A.V. Vishnevsky National Medical Research Center of Surgery,
simonov_ad@mail.ru, https:// orcid.org/0000-0003-3202-6873, 115093, Russia, Moscow, Bolshaya Serpukhovskaya str., 27.
Mikhail V. Melnikov, PhD, Head in Clinical Work, Surgery Department, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, m_melnikov@oparina4.ru, 117997, Russia, Moscow, Ac. Oparina str., 4.
Vladimir D. Chuprynin, PhD, Head of the Surgical Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, v_chuprynin@oparina4.ru, 117997, Russia, Moscow, Ac. Oparina str., 4.
Natalia A. Karelskaya, MD, Senior Researcher at the Radiology Department, V. Vishnevsky National Medical Research Center of Surgery, karelskaya.n@yandex.ru,
https:// orcid.org/0000-0001-8723-8916, 115093, Russia, Moscow, Bolshaya Serpukhovskaya str., 27.
Authors’ contributions: Gritskevich А.А. – concept and design of the investigation; Baitman T.P., Simonov A.D. – material collection and processing, interpretation of the findings, writing the article; Melnikov M.V. – concept and design of the investigation, interpretation of the findings; Chuprynin V.D. – concept and design of the investigation, interpretation of the findings, editing the article; Karelskaya N.A. – interpretation of the findings, editing the article.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: The patient provided informed consent for the publication of her data and associated images.
For citation: Gritskevich А.А., Baitman T.P., Simonov A.D., Melnikov M.V., Chuprynin V.D., Karelskaya N.A. The importance of a multidisciplinary approach to the delivery and subsequent management of patients with placenta increta.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 10: 186-194 (in Russian)
https://dx.doi.org/10.18565/aig.2022.10.186-194
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