Diagnosis, prevention and organ-preserving method of delivery in pregnant women with placenta accreta

Abstract

The article considers one of the causes of maternal mortality - uterine postpartum bleeding developing as a result of the placental growth into the uterus and surrounding organs. It is highlighted that the processes of trophoblast invasion during pregnancy and tumor progression have much in common. The article describes a significant role of Kiss1-gene and its receptor GPR54 in the placenta accreta development. The causes of placental abnormalities and conventional methods of treatment and surgical management in placenta accreta (controlled uterine balloon tamponade, uterine vessels ligation, uterine compression sutures, uterine artery embolization, internal iliac arteries ligation, temporary clamping or major uterine vessels ligation, hysterectomy, «Triple-P» method) are analyzed, the possible complications of these methods of treatment are listed. The developed at the Department of Obstetrics and Gynecology №1 of Kazan State Medical University examination algorithm when planning pregnancy, gestation management and organ-preserving method of delivery in pregnant women with abnormal placental attachment is presented. Used by authors methods of uterine scar examination after organ-preserving surgery or caesarean section in women in the non-pregnant state (hysterography, hysteroscopy, ultrasound scan, double-contrast study) and sonographic signs of scar failure (myometrial thinning in the scar area, irregular contour of the scar, discontinuous contours of the scar, significant number of hyperechoic inclusions, presence of non-vascular liquid formations in the scar area, triangle in the scar area) are listed. Interesting illustrative material is also presented.