Ведення вагітності та розродження жінок з оперованою маткою і локалізацією плаценти на передній стінці матки (огляд літератури)

Abstract

Purpose – to bring to the attention of obstetrician-gynecologists the relevance of influence of the placental location on the anterior uterine wall in women with an operated uterus after cesarean section (CS) on the course of pregnancy and childbirth with the prevention and minimization of possible complications. The placental location on the anterior wall of the uterus in pregnant women with a uterine scar after CS is the object of research in modern obstetrics. This factor of placental location can affect the course of pregnancy and childbirth, as well as creation increased risk of complications related to the health of the mother and fetus. An operated uterus with placental location on the anterior uterine wall can become a potential etiological factor of perinatal morbidity, which can be accompanied by intrauterine growth restriction, an increase in miscarriage and preterm birth, placenta previa and placenta accreta spectrum frequency, as well as an increased risk of uterine rupture in attempting vaginal birth after cesarean. As commonly stated, optimal conditions for fetal development are created by the placental location at uterus fundus, though labor dystocia is often observed during childbirth in this case. An increase in the percentage of CS and pregnancy in women with a uterine scar is often the cause of the decidual membrane defect and increases the frequency of placenta accretion (placenta accreta/increta/percreta) cases up to 30% in the cohort. One of the possible factors contributing to the attachment of the placenta to the anterior uterine wall is the presence of uterine scar after previous CS. Numerous studies indicate a significant increase in the frequency of placenta accreta cases over the past 20 years due to increase in CS cases and wide implementation of assisted reproductive technologies. Studies according to established criteria are still insufficient in modern obstetrics due to the limited number of pregnant women with localization of the placenta along the anterior wall after CS. More attention in studies is paid to the course of pregnancy and the method of delivery of pregnant women with a scar on the uterus. That states the focus of this article on the importance of clarification the pathogenesis, prevention of complications and delivery of pregnant women with uterine scar after CS and the placental anterior uterine wall localization. These findings confirm the need for further scientific research on this obstetric problem. Understanding the mechanisms behind this etiological connections can contribute to the development of better strategies for monitoring, diagnosis and various options for the delivery with the minimization of possible perinatal complications. No conflict of interests was declared by the authors.