Researchers have identified the most effective ways to stop bleeding in patients with placenta accreta spectrum disorders

A large-scale All-Russian study initiated by the V.I. Kulakov NMRC for OG&P showed which surgical methods are most often used in Russian hospitals during surgical delivery of women with placenta accreta spectrum disorders.

Placenta accreta spectrum is a life-threatening complication of pregnancy, causing massive bleeding, hysterectomy, maternal morbidity, and mortality

Experts note that over the past 50 years, there has been a sharp increase in the incidence of this complication from 1.7 to 577 per 10,000 births. The rate of non-organ-sparing surgery for placenta accreta spectrum worldwide averages 46.5% and ranges from 13% to 100%, depending on the surgical technique, material capabilities, and algorithms developed at a particular medical institution.

Several approaches have been used in Russian clinics to prevent and stop bleeding, including complex compression hemostasis, temporary occlusion, ligation, embolization, and ballooning of the vessels supplying the uterus. To evaluate the efficacy of different surgical blood-sparing techniques, the clinical and anamnestic data and surgical delivery outcomes of 2297 patients with placenta accreta were analyzed.

The results of the study were published in the first issue 2024 of in the journal of Obstetrics and Gynecology.

The analysis included women who underwent surgery during 6 years (from 2017 to 2023) in 33 regions of the Russian Federation, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia and the Mother and Child Group of Companies. The mean gestational age at delivery was 35.3 ± 3.3 weeks. Organ-removing surgery was performed in 342 (14.9%) patients, including one surgical delivery at 18 weeks of gestation due to missed miscarriage.

Physicians most often used complex compression hemostasis in 1196 (52.1%) patients, temporary balloon occlusion of the common iliac arteries in 280 (12.2%) patients, and other methods in 589 (25.6%) patients. Abdominal access techniques included lower midline laparotomy, which was performed in 1954 (85.1%) patients, and transverse suprapubic incision, which was performed in 343 (14.9%) patients. A fundal uterine incision was used in 1327 (57.7%) patients. Lower uterine segment incision and corporal cesarean section were performed in 685 (29.9%) and 284 (12.4%) patients, respectively.

  In most cases, surgical delivery was planned at 34–36 weeks of pregnancy. However, every fourth woman (593/2297) underwent emergency caesarean section. The most common cause of emergency caesarean section was bleeding (353/593, 59.6%). In other cases, emergency intervention was associated with suspected cesarean scar defects, 135/593 (22.7%), and the onset of regular labor, 105/593 (17.7%).

The authors noted that this is the first large-scale Russian study devoted to placenta accreta spectrum. A prospective multicenter study is planned to evaluate the factors that influence the development of early and long-term complications and the feasibility of subsequent reproductive function.

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