Abnormal placentation: modern views on etiology, pathogenesis and diagnosis

Abstract

The increasing trend in surgical delivery (caesarean section) rates observed over the last several years results in a rise of abnormal placentation (AP) cases. In this context, timely diagnosis and correct routing of patients with abnormal placentation to level 3 specialized healthcare institutions will ensure the provision of quality medical care and thus to minimize maternal and infant mortality. The article presents modern views on the main risk factors and pathogenesis of AP, updated definitions of placenta adherenta, increta and percreta and the latest clinical and morphological classification. The authors highlight the advanced diagnostic criteria based on sonographic imaging, Doppler color flow mapping, an important method required for making diagnosis. They also specify cases where MRI techniques could be more informative than ultrasound methods and describe MRI findings that suggest abnormal placentation. Major strategies for providing effective healthcare are considered, including organ preserving surgical procedures, hemostasis (endovascular occlusion or embolization) and replacement of blood loss (reinfusion or hemotransfusion), etc. to reduce the prevalence of unfavorable obstetric and perinatal outcomes. KEYWORDS: placentation, uterine scar, caesarean section, placenta adherenta, placenta increta, placenta percreta, hemorrage. FOR CITATION: Dobrokhotova Yu.E., Borovkova E.I., Kulikov I.A. et al. Abnormal placentation: modern views on etiology, pathogenesis and diagnosis. Russian Journal of Woman and Child Health. 2023;6(1):20–25 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-20-25.