Contemporary approaches to the choice of optimal delivery strategies for patients with placenta accreta spectrum
Ignatko I.V., Lebedev V.A., Bogomazova I.M., Timokhina E.V., Belousova V.S., Pashkov V.M., Fedyunina I.A., Sarakhova D.Zh., Samoylova Yu.A., Samara A.B., Askerova S.F., Gutsu V.V.
Objective: To explore the features of delivery in pregnant women with placenta accreta spectrum (PAS) based on clinical and anamnestic data and the course of gestation.
Materials and methods: The study included 107 patients with singleton pregnancies. Among them, 57 women with PAS comprised the main group, and 50 women without placental abnormalities were included in the comparison group. We analyzed the age of patients, somatic, obstetric and gynecological history, the course of current pregnancy, timing and types of delivery, as well as the volume of blood loss using different uterine devascularization techniques.
Results: Analysis of the obstetric and gynecological history showed that patients with PAS were significantly more likely to have two or more uterine scars after cesarean section. Pregnancy-related complications were significantly more often associated with the risk of preterm birth. In patients with PAS, no cases of preeclampsia, placental insufficiency, or fetal growth restriction were observed. Vaginal bleeding in patients with PAS occurred at 22–36.6 weeks of pregnancy. Blood volume loss was higher during emergency delivery in patients with PAS versus planned delivery, regardless of the method used for uterine devascularization. However, the differences were not statistically significant.
Conclusion: Given the absence of statistically significant differences in the volume of blood loss, as well as similar risks of bleeding at different stages of the second half of gestation, delivery of patients with PAS in the absence of episodes of vaginal bleeding should be considered optimal near to full-term pregnancy, in the context of preventing perinatal complications associated with prematurity.
Authors' contributions: Ignatko I.V., Lebedev V.A., Pashkov V.M., Sarakhova D.Kh. – study concept and design; Samara A.B., Samoylova Yu.A., Fedyunina I.A., Askerova S.F. – material collection and processing; Samara A.B., Bogomazova I.M., Gutsu V.V. – statistical data processing; Samara A.B., Bogomazova I.M. – manuscript writing; Ignatko I.V., Timokhina E.V., Belousova V.S., Lebedev V.A. – manuscript editing.
Conflicts of interest: The authors confirm that they have no conflict of interest to declare.
Funding: The study was conducted without any sponsorship.
Ethical Approval: The study was approved by the local Ethics Committee of I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University).
Patient Consent for Publication: The patients have signed informed consent for publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Ignatko I.V., Lebedev V.A., Bogomazova I.M., Timokhina E.V., Belousova V.S., Pashkov V.M., Fedyunina I.A., Sarakhova D.Zh., Samoylova Yu.A., Samara A.B., Askerova S.F., Gutsu V.V.
Contemporary approaches to the choice of optimal delivery strategies for patients with placenta accreta spectrum.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (3): 75-84 (in Russian)
https://dx.doi.org/10.18565/aig.2025.324
Keywords
placenta accretа
uterine devascularization
delivery in patients with placenta accreta
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Received 10.11.2025
Accepted 03.03.2026
About the Authors
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, 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, bldg. 2, ignatko_i_v@staff.sechenov.ru,https://orcid.org/0000-0002-9945-3848
Vladimir A. Lebedev, Dr. Med. Sci., Professor, Professor at the Department of Obstetrics, Gynecology, and Perinatology, 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, bldg. 2, lebedev_v_a@staff.sechenov.ru, https://orcid.org/0000-0002-3302-5533
Irina M. Bogomozova, PhD, Associate Professor, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology, 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, bldg. 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 at the Department of Obstetrics, Gynecology, and Perinatology, 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, bldg. 2, timokhina_e_v@staff.sechenov.ru, https://orcid.org/0000-0001-6628-0023
Vera S. Belousova, Dr. Med. Sci., Associate Professor, Professor at the Department of Obstetrics, Gynecology, and Perinatology, 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, bldg. 2, belousova_v_s@staff.sechenov.ru, https://orcid.org/0000-0001-8332-7073
Vladimir M. Pashkov, Dr. Med. Sci., Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology, 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,
bldg. 2, pashkov_v_m@staff.sechenov.ru, https://orcid.org/0000-0003-3768-7822
Irina A. Fedyunina, PhD, Associate Professor at the Department of Obstetrics, Gynecology, and Perinatology, 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, bldg. 2, fedyunina_i_a@staff.sechenov.ru, https://orcid.org/0000-0002-9661-5338
Dzhamilya Kh. Sarakhova, PhD, Deputy Chief Physician for Obstetrics and Gynecology, S.S. Yudin City Clinical Hospital, Moscow Healthcare Department, 115446, Russia, Moscow, Kolomenskiy proezd, 4, bldg. 2, dzh2010@yandex.ru, https://orcid.org/0009-0008-0531-0899
Yulia A. Samoylova, PhD, Head of the 1st Obstetrics Department of Pregnancy Pathology, S.S. Yudin City Clinical Hospital, Moscow Healthcare Department, 115446, Russia, Moscow, Kolomenskiy proezd, 4, bldg. 2, Samoylova2005@yandex.ru, https://orcid.org/0000-0001-7448-515X
Alina B. Samara, Resident at the Department of Obstetrics, Gynecology and Perinatology, 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, bldg. 2, linaasamaraa@gmail.com,
https://orcid.org/0000-0001-8266-6524
Sevda F. Askerova, PhD student at the Department of Obstetrics, Gynecology and Perinatology, 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, bldg. 2, askerova_sevda12@mail.ru, https://orcid.org/0000-0002-4925-594X
Vladimir V. Gutsu, PhD student at the Department of Obstetrics, Gynecology, and Perinatology, 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, bldg. 2; Obstetrician-Gynecologist at the Consultative and Diagnostic Department of Maternity Hospital, S.S. Yudin City Clinical Hospital, Moscow Healthcare Department, 115446, Russia, Moscow, Kolomenskiy proezd, 4, bldg. 2, gutsu_vladimir@mail.ru, https://orcid.org/0009-0000-3712-3280
Corresponding author: Irina M. Bogomazova, bogomazova_i_m@staff.sechenov.ru
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