A PEER-REVIEWED JOURNAL OF RESEARCH AND CLINICAL MEDICINEISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Conservative Surgery in Abnormal Placenta Invasion (5-year Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine)

DOI:10.31550/1727-2378-2019-166-11-29-34
For citation: Shmakov R.G., Pirogova M.M., Vasilchenko O.N., Chuprynin V.D., Piregov A.V., Khodzhaeva Z.S., Klimenchenko N.I., Fedorova T.A., Ezhova L.S., Bychenko V.G., Boykova Yu.V. Conservative Surgery in Abnormal Placenta Invasion (5-year Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine). Doctor.Ru. 2019; 11(166): 29–34. DOI: 10.31550/1727-2378-2019-166-11-29-34

Study Objective: to assess the efficiency of a comprehensive compression hemostasis in patients with various rate of trophoblast invasion.
Study Design: retrospective clinical study.
Materials and Methods: 98 pregnant women diagnosed with placenta ingrowth were analysed. Diagnoses: placenta accretа, placenta increta, placenta percreta were confirmed with morphological study in 28 (28,6%), 64 (65,3%) and 6 (6,1%) patients. Age, previous uterine surgeries, information about previous pregnancies, blood loss, uterine extirpation, ligation of internal iliac vessels were assessed. All pregnant women with suspected placenta ingrowth diagnosed had to undergo surgery (lower midline incision), bottom caesarean section, comprehensive compression hemostasis, balloon uterus tamponade, metroplasty.
Study Results: the cumulative blood loss has grown: in placenta accreta it was 975 mL, in placenta increta — 1,300 mL, and in placenta percreta — 2,200 mL (p = 0.048). Uterectomy was indicated in patients with more marked placenta ingrowth: 9,4% vs 33,3% (p = 0,038), and in placenta accreta it was not needed at all. The frequency of ligation of internal iliac vessels also increased with increasing depth of trophoblast invasion: 7,1%, 14,1%, 50% (p = 0,026).
Conclusion: the relation between blood loss and the rate of trophoblast invasion was identified, making it possible to predict and design an optimal surgery plan for delivery by patients with placenta ingrowth. The issue needs further studying in order to improve the outcome for patients with severe pathology.

R.G. Shmakov — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 3804-3269. ORCID.org 0000-0002-2206-1002. E-mail: r_shmakov@oparina4.ru

M.M. Pirogova — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. E-mail: pirogovamariya@gmail.com

O.N. Vasilchenko — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 3009-1899. E-mail: o_vasilchenko@oparina4.ru

V.D. Chuprynin — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 3909-5201. E-mail: v_chuprynin@oparina4.ru

A.V. Piregov — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 5456-0224. Е-mail:a_pyregov@oparina4.ru

Z.S. Khodzhaeva — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 4512-2375. E-mail: z_khodzhaeva@oparina4.ru

N.I. Klimenchenko — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 8556-3251. E-mail: n_klimenchenko@oparina4.ru

T.A. Fedorova — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 4652-4701. Е-mail: t_fyodorova@oparina4.ru

L.S. Ezhova — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 1397-7517. E-mail: l_ezhova@oparina4.ru

V.G. Bychenko — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 1962-0956. E-mail: v_bychenko@oparina4.ru

Yu.V. Boykova — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 1962-0956. E-mail: j_boikova@oparina4.ru


Contribution: Shmakov R.G. — patient management, article reviewing after peer review, approval of the final article version; Pirogova M.M. — patient selection and examination, data processing, first version of the article; Vasilchenko O.N. — patient selection and examination, data processing, article preparation; Chuprynin V.D. — patient management, review of critically important material; Pyregov A.V. — eview of critically important intellectual material, approval of the final article version; Khodzhaeva Z.S. — approval of the manuscript for publication, approval of the final article version; Klimenchenko N.I. — patient examination, approval of the final article version; Fedorova T.A. — article preparation, approval of the manuscript for publication; Ezhova L.S. — patient examination, data interpretation, article preparation; Bychenko V.G. — patient examination, data interpretation, article preparation; Boikova Yu.V. — patient examination, data interpretation, article preparation, article reviewing after peer review.

The authors declare that they do not have any conflict of interests.

Доктор.ру
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