Clinical case of delivery of a pregnant woman with Placenta previa/percreta 3с by modified cesarean section technique

Abstract

Placenta accreta spectrum (PAS) is a severe obstetric pathology, in which placental tissue invades the myometrium. According to the current classification of FIGO (2019), depending on the depth of placental tissue invasion, PAS is divided into Placenta accreta – about 75% of cases, Placenta increta – 15% and Placenta percreta – up to 10% of all cases.The most severe cases associated with the delivery of pregnant women with Placenta percreta, especially with placental tissue sprouting not only the myometrium of the front wall of the uterus, but also the back wall of the urinary bladder or parametrial and paracervical tissue, which according to the FIGO classification are defined as cases of Placenta percreta with a degree of severity 3b and 3c. These are the most dangerous cases of the development of severe hemorrhagic complications, coagulopathic disorders, and the occurrence of intraoperative complications with damage to adjacent organs, primarily the bladder and intestines due to hysterectomy.This article presents for the general public of obstetricians and gynaecologists the analysis of a clinical case in a pregnant woman with complete presentation and placental ingrowth into the prostatic parametrial tissue and partial adhesion to the posterior bladder wall (Placenta previa/percreta 3c).The use of a modified interiliac incision of the anterior abdominal wall, medical and technical support with the use of modern energies (radio wave scalpel, argon plasma tissue coagulation) to minimize the volume of blood loss were described. The intervention was carried out at the main clinical base of the Department of Obstetrics and Gynaecology No. 1, the Kyiv Regional Perinatal Centre.