Placental location and invasion: current state of the problem, illustration of medical support and management used in Perinatal Center of Kyiv
DOI:
https://doi.org/10.15574/HW.2025.2(177).8496Keywords:
pregnancy, childbirth, placenta accreta spectrum, placenta praevia, cesarean section, operative deliveryAbstract
Placental anomalies in terms of localization and anatomy include low placentation, placenta previa (PP) and placenta accreta spectrum (PAS).
Aim - systematize modern scientific data on the pathogenesis of placenta invasion anomalies, placenta location; to study the world and analyze our own experience in the prevention and medical support of pregnancy and childbirth in this pathology.
Placental abnormalities create the risk of antenatal, intrapartum and postpartum massive, life-threatening bleeding for the mother and fetus, causing fetal impairment. The above-mentioned pathological conditions are characterized by a high level of maternal morbidity and mortality (over 7% in PAS), primarily due to catastrophic bleeding and peripartum hysterectomies. Medical care for these patients should be provided exclusively in a level III or higher institution with constant access to highly qualified obstetric and interdisciplinary personnel and with experience in intensive care. In accordance with modern trends in medical support for pregnancy and childbirth in pregnant women with placental abruption and invasion, we analyzed all cases of pregnancy and childbirth with clinical diagnoses of PP and PAS identified in 2024. The age, gestational age at delivery, the ratio of planned and urgent operative delivery, the scope of surgical intervention, intraoperative conditions and complications, the frequency of changes in previously planned operative delivery, the uterine-sparing method of delivery in pregnant women with PAS, which is used in the 1st Clinical Hospital "Perinatal Center of Kyiv", was described and evaluated.
Conclusions. Analysis of literature data and our own research allows us to conclude that the correctly chosen time and tactics of delivery of pregnant women with PP and PAS help in the vast majority of cases to avoid the occurrence of complications typical of PP and PAS.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the participating institution. Informed consent of the patients was obtained for the research.
The authors declare that there is no conflict of interest.
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