PLACENTA ACCRETA SPECTRUM ON UTERINE SCAR: THE ANALYSIS OF THE WORK OF THE TASHKENT PERINATAL CENTER FOR THE PERIOD 2018-2020

B.S. ABDIKULOV, Z.D. KARIMOV, I.Y. YAKHSHIBОEV, S.M. MUMINOV, B.P. KHAMIDOV, S.H. MASHARIPOV, D.L. KIM, M.I. URINOV, G.A. KHODIEVA1, I.Y. OSIPOVA

Abstract

Objective. Study presents the results of delivery of pregnant women with placenta accreta on uterine scar, depending on the clinical status and blood-saving methods used.Material and Methods. A selective retrospective study included 54 pregnant women with central placenta previa and uterine scarring after cesarean section (CS), with histologically confirmed placenta accreta. From available blood-saving methods we used: the ligation of three pairs main uterine vessels, ligation of the internal iliac arteries, the complex compression hemostasis according to R.G. Shmakov, temporary clamping of the common iliac arteries.Results. 47of 54 women (87.0%) were delivered by lower segment cesarean section. Hysterectomy was performed in 17 of 54 women (31.5%). In the remaining 37(68.5%) cases, metroplastic and organ preservation were performed. There was no relaparotomy; there was no maternal mortality; perinatal mortality was 4 (7.4%); forced opening and bladder resection – in 7(13.0%) cases; opening of the bladder without wall resection – in 2 (3.7%); cases of “near miss” were noted in 2 clinical episodes; there were no complications associated with temporary clipping of the common iliac arteries; endometritis (recovery after conservative treatment) was noted in 2 (3.7%) of women. The histological examination results: placenta accreta was in 15 (27.8%), placenta increta – in 30(55.6%), placenta percreta – in 8(14.8%) cases. In 8 cases, there was a combination of different depth of placenta accreta in the area of the uterine scar, and in 2 (3.7%) - a combined deep - invasive lesion of the posterior wall of the lower segment and the uterine body.Conclusion. The complex compression hemostasis according to R.G. Shmakov is the most rational and promising method of blood saving, acceptable among the majority of patients with placenta accreta. Temporary clipping of the common iliac arteries is advisable when the posterior wall of the bladder is affected. Preservation of the uterus: in case of a deep-invasive lesion, including cases of combined damage to the posterior wall of the uterus lower segment or uterus body, significant blood loss before the woman is admitted to the hospital is not an imperative of surgical tactics