Comparative evaluation of the efficiency of surgical hemostatic techniques during organ-sparing delivery in patients with placenta  increta

Vinitsky, Vinitsky A.A.; Shmakov, Shmakov R.G.; Chuprynin, Chuprynin V.D.

doi:10.18565/aig.2017.7.68-74

Cited by 5 publications

(2 citation statements)

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“…Таким методом служит комплексный компрессионный гемостаз, при котором используется билатеральное наложение турникетных жгутов на основание широких связок, где происходит компрессия трубных ветвей и коммуникантов, связывающих яичниковую и маточную артерии, а также восходящие маточные артерии в шеечно-перешеечной области. Этот метод показал высокую эффективность и безопасность при минимальном общем объеме кровопотери [22]…”

Section: Discussionunclassified

Conservative Surgery in Abnormal Placenta Invasion (5-year Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine)

Shmakov¹,

Pirogova²,

Васильченко³

et al. 2019

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Цель исследования: оценить эффективность комплексного компрессионного гемостаза у пациенток с различной глубиной инвазии трофобласта. Дизайн: проспективное исследование. Материалы и методы. Проведен анализ данных 98 беременных с врастанием плаценты. Диагнозы placenta accreta, placenta increta, placenta percreta подтверждены при помощи морфологического исследования у 28 (28,6%), 64 (65,3%) и 6 (6,1%) пациенток. Оценивали возраст, предшествующие операции на матке, информацию о предыдущих беременностях, объем кровопотери, экстирпацию матки, перевязку внутренних подвздошных сосудов. Всем пациенткам с подозрением на врастание плаценты проводилось оперативное лечение в объеме срединной лапаротомии, донного кесарева сечения, комплексного компрессионного гемостаза, баллонной тампонады матки, метропластики. Результаты. Объем суммарной кровопотери возрастал с увеличением глубины врастания плаценты: при placenta accreta он составил 975 мл, при placenta increta-1300 мл, при placenta percreta-2200 мл (p = 0,048). Гистерэктомия чаще требовалась пациенткам с более выраженной степенью врастания плаценты: 9,4% против 33,3% (p = 0,038), а при placenta accreta она не понадобилась вовсе. Частота перевязки внутренних подвздошных сосудов также повышалась с увеличением глубины инвазии трофобласта: 7,1%, 14,1% и 50% (р = 0,026). Заключение. Выявлена взаимосвязь объема кровопотери и глубины инвазии трофобласта, что дает возможность предикции и позволяет разработать оптимальную хирургическую тактику родоразрешения беременных с врастанием плаценты. Необходимо дальнейшее изучение проблемы для улучшения исходов у женщин с наиболее тяжелыми случаями данной патологии. Ключевые слова: беременность, врастание плаценты, инвазия трофобласта, рубец на матке, комплексный компрессионный гемостаз, кровотечение, гистерэктомия.

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Section: Discussionunclassified

Conservative Surgery in Abnormal Placenta Invasion (5-year Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine)

Shmakov¹,

Pirogova²,

Васильченко³

et al. 2019

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“…для пациентки в связи с уменьшением риска массивного кровотечения [13,14]. Впрочем, в настоящее время существует ряд факторов, при учете которых возможна органосохраняющая операция, и подобная практика описана в литературе [15,16]. Однако органосохраняющая операция методом донного чревосечения ставит под вопрос сохранение репродуктивной функции ввиду высокого риска разрыва беременной матки при наличии на ней двух рубцов в разных локализациях, так что подобная операция ведет к тому же результату, что и гистерэктомия,невозможности женщине иметь детей.…”

Section: клинический случайunclassified

Clinical Experience with Organ-Preserving Surgery in Placenta Accreta

Arutyunyants¹,

Ovchinnikova²

2022

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. A higher number of repeated cesarean sections determine a higher risk of placental ingrowth into the scar area of the uterus. The absence of current clinical guidelines in this field necessitates the need for development of various methods for organ-preserving surgery in placenta accreta, which preserve a woman’s reproductive function, as well as reduce risks for future pregnancies and childbirth.Materials and methods. The paper presents the successful clinical experience of organ-preserving surgical treatment of placental ingrowth, excluding the stage of fundal cesarean section (Perinatal Center, Noyabrsk, Yamalo-Nenets Autonomous District).Case description. The paper describes two clinical cases of successful organ-preserving surgical treatment of placental ingrowth with preservation of reproductive function and provision of a more favorable prognosis for subsequent reproductive plans due to excluding formation of two scars on the uterus in different localizations.Results and discussion. Early dissection of adhesions in order to provide access to the surgical site is crucial and reduces the blood loss after fetal extraction and the risk of intraoperative complications such as bladder, ureteric and intestinal injury. Temporary compression hemostasis via performing endovascular temporary balloon occlusion of the infrarenal aorta, or via temporary turnstile hemostasis using a Foley catheter, allows for organpreserving surgery that excludes the formation of two scars on the uterus in different localizations without increasing the amount of blood loss.Conclusion. Surgical tactics in organ-preserving treatment of placental ingrowth excludes the stage of fundal cesarean section, and involves the cesarean section at the border of the uterine-placental hernia and the body of the uterus with subsequent metroplasty. The surgery performed demonstrate the optimal result – a relatively low blood loss, a short duration of the operation and, above all, more favorable prognosis for subsequent reproduction.

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Ingrown chorionic villi of the first trimester as a result of a non-developing pregnancy in the post-cesarean scar, associated with the development of arteriovenous malformation: а clinical case

Kulabukhova,

Kondrashina,

Akinfiev

et al. 2024

Almanac of Clinical Medicine

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Background: Identification of residual chorionic tissue and ingrowing chorionic villi after uterine cavity curettage due to non-developing pregnancy, spontaneous abortions, and medical abortions has been a poorly studied problem. The most challenging is the differential diagnosis of this condition when the chorion grows into the scar from a caesarean section and is associated with arteriovenous malformations of the uterine wall. Nowadays, ultrasound has been recognized as the primary diagnostic method; however, the absence of specific echo-signs makes magnetic resonance imaging (MRI) and computed tomography (CT) the methods of choice and final diagnosis. Clinical case: This was a 39-year-old patient with a history of 3 caesarean sections and non-developing pregnancy and complete spontaneous miscarriage at 4 to 5 weeks of gestation in March 2021. Her final diagnosis was “growing of the chorionic villi of the first trimester of gestation into the myometrium to the entire depth of the uterine wall and up to the serous membrane without germination of the latter (placenta increta). At admission to the clinic in April 2021, she complained of pelvic pain, ongoing low intensity intermittent uterine bleeding, weakness, dizziness, and breast pain. The ultrasound revealed a mass in the uterine cavity. The MRI showed an incompetent post-cesarean uterine scar and residual chorionic tissue spreading to the uterine serosa, with peripheral arteriovenous structures of a neoangiogenous type. Multiaxial CT with angiography could not exclude an arteriovenous malformation within the uterine wall and residual chorionic tissue. During embolization, the angiograms showed the arteriovenous malformation in the projection of the uterus, with afferent vessels as bilateral uterine and cervicovaginal arteries and efferent vessels as bilateral parametric veins, internal iliac and ovarian veins. Based on the clinical and imaging pictures, embolization of the uterine arteries was performed as a first step and laparoscopic clipping of the uterine arteries and hysterectomy with fallopian tubes as a second step. Postoperatively the patient improved and beta-chorionic gonadotropin levels decreased. She was discharged home on the 5th day with no complaints. The clinical case demonstrates the important role of MRI and CT in the differential diagnosis and assessment of the zone and degree of chorionic villi ingrowth, aimed at determination of the possibility of organ-preserving treatment, or the need to perform a radical surgery should metroplasty be impossible. Conclusion: If an additional intrauterine mass is visualized by ultrasound examination after pregnancy termination, the method of choice and final diagnosis is MRI, which is performed to exclude the ingrown chorionic villi and to assess the degree of their invasion. MRI also allows for assessment of the viability of the post-cesarean scar and the presence of neoangiogenesis areas at the periphery of the ingrowth zone. CT is a method of clarifying diagnostics used to exclude vascular malformations of the uterine wall.

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Comparative evaluation of the efficiency of surgical hemostatic techniques during organ-sparing delivery in patients with placenta increta

Cited by 5 publications

References 0 publications

Conservative Surgery in Abnormal Placenta Invasion (5-year Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine)

Conservative Surgery in Abnormal Placenta Invasion (5-year Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine)

Clinical Experience with Organ-Preserving Surgery in Placenta Accreta

Ingrown chorionic villi of the first trimester as a result of a non-developing pregnancy in the post-cesarean scar, associated with the development of arteriovenous malformation: а clinical case

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