Врастание плаценты: принципы коррекции послеродовых кровотечений

Abstract

Study Objective: To assess the extent of blood loss and underlying factors in patients with placenta accreta, who underwent caesarean section, when various methods of haemostasis are used. Study Design: Perspective study. Materials and Methods. We performed a prospective multivariate analysis of 147 medical cards of pregnant women and new mothers, labour and delivery records for single pregnancies termination with labour or abrupt termination of pregnancy. All examined women were divided into three clinical groups. The key factor for division into groups was the type of surgery for postpartum haemorrhage because of placenta accreta. Group I included women (n = 106, mean age: 29.2 ± 2.9 years old), who underwent uterine artery embolisation; group II (n = 31, mean age: 32.2 ± 3.4 years old) had hysterectomy; and group III (n = 10, mean age: 31.6 ± 3.4 years old) underwent surgical haemostasis (uterine and ovarian vessels ligation, compression suture of uterus) without hysterectomy. Study Results. Minimal blood loss was recorded in patients who underwent uterine artery embolisation. The rate was 176.5% lower than in post-hysterectomy women and 96% lower than in patients who underwent surgical haemostasis (p < 0.05 in both cases). The highest blood loss rate was recorded in post-hysterectomy women, and the value was 41.1% higher than mean values for patients who underwent surgical haemostasis (p < 0.05). There is direct strong correlation between the number of deliveries and the rate of blood loss, where the overall number of deliveries was not more than two (R = 0.87, р < 0.05). However, for more than 3 deliveries, the correlation between the number of deliveries and the rate of blood loss was not statistically significant (R < 0.3, p > 0.05). The highest blood loss was recorded after 2 deliveries (p < 0.05). The group of patients who had 2 deliveries was the only examined group where the blood loss exceeded 2 L. The lowest blood loss rate was in first-time-mothers (less than 800 mL). Conclusion. Uterine artery embolisation is the most efficient surgical method to arrest bleeding. When assessing risk factors impacting the rate of blood loss, it is essential to pay attention to the number of previous pregnancies and deliveries, as well as a history of surgical termination of pregnancy (endometrectomy) and caesarean sections. Keywords: placenta accreta, uterine artery embolisation, haemostasis, hysterectomy.