Combined staged surgical hemostasis in a case of Placenta previa and Placenta accreta spectrum disorders

Abstract

The objective: to develop the optimal delivery algorithm in persons with Placenta previa alone and with partial Placenta accreta, using innovative technologies with the priority of organ-saving operations.Materials and methods. 106 pregnant women with prenatal diagnosis of Placenta previa and the possibility of the safe pregnancy prolongation till 34-36 weeks of gestation were included in the study. To achieve the aim of the study, two groups were formed: the first (control) group – 75 patients were delivered via standard elective cesarean section in terms of 34-36 weeks; the second (main) group – 51 patients delivered in the same terms via our organ-saving method (elective cesarean section using argon-plasma tissue coagulation, agonists of oxytocin and vasopressors; and ligation of main uterine vessels and internal iliac arteries).The following characteristics of cesarean section were taken into account: time of the fetal extraction, duration of the operation, intraoperative blood loss volume and Placenta accreta spectrum disorders (PAS) complications were compared in groups with further statistical data analysis.Results. The mean indices of the cesarean section duration and time from the start of an operation till the fetal extraction were significantly lower (p<0.05) in the second group and amounted 55.7±5.1 min and 195.0±21.0 sec, respectively, versus 74.5±4.3 min and 274.0±17.0 sec in the first group. Intraoperative blood loss volume was also significantly lower in the second group than in the first one – 775.0±60.0 ml versus 970.0±55.0 ml, p<0.05).The part of Placenta previa and PAS combination in one patient amounted to 20.0% in the first group and 17.6% in the second one. Pl. accreta was diagnosed in 17.33% cases in the first group, Pl. increta – in 1.33%, Pl. percreta – in 1.33%. Hysterectomy has been performed in 8.0% cases, all Pl. increta and percreta cases required the hysterectomy and were followed by massive obstetric hemorrhages (MOH). DIC-syndrome developed in 2.67%. In the second group Pl. accreta was diagnosed in 19.61% and Pl. increta – in 3.92%, patients with Pl. increta had hysterectomy. MOH were observed in 38.7% cases in the first group versus 9.7% cases in the second group (p<0.05). Furthermore, in the first group hysterectomy was performed almost four times more frequently than in the second group (24.0% versus 6.5% respectively, p<0.05).Conclusions. The developed delivery algorithm in pregnant women with Placenta previa alone or in a combination with PAS allowed to reduce intraoperative blood loss significantly, prevent the MOH development, therefore to reach secure hemostasis and save the uterus.