Abstract
This study presents a case series demonstrating obstetric strategies for different types of placenta accreta spectrum (PAS). In the first case, there was grade 1 abnormal attachment of the accessory placental lobe (PAS 1) according to the FIGO classification. The diagnosis was made on the third day after delivery when a control pelvic ultrasound was performed. The patient underwent hysteroresectoscopy with removal of the accessory lobe within intact tissues and complete fertility preservation. In the second case, there was grade 2 placental invasion (PAS 2) according to the FIGO classification and type 3 according to the topographic classification – invasion into the anterior wall of the lower uterine segment and the anterior section of the cervix. In conditions of selective balloon-assisted occlusion of the common iliac arteries, excision of the uterine aneurysm and the anterior section of the cervix with subsequent metroplasty was performed. The final option of surgical hemostasis was ligation of the internal iliac arteries. The third case presented grade 3 placental invasion (PAS 3) according to the FIGO classification and type 4 according to the topographic classification – placental invasion into the anterior wall of the lower uterine segment, invading the serous membrane and the posterior wall of the bladder, as well as the cervix, vaginal vaults, parametrium and the lower third of the left ureter. Simultaneous surgical intervention was performed by a multidisciplinary team of gynecologists, urologists and endovascular surgeons with hysterectomy, resection of the posterior wall of the bladder with its subsequent plasty and ureteral stenting. Key words: placental invasion, hysterectomy, FIGO classification of placenta accreta spectrum, uterine aneurysm, metroplasty, Placenta Accreta Spectrum, topographic classification of placenta accreta spectrum
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call