Multidisciplinary approach in placenta accreta surgical treatment

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INTRODUCTION

Effective medical care for patients with placenta accreta spectrum (PAS) is a multi-stage process with radiation diagnostic methods, including magnetic resonance imaging, to verify the diagnosis before delivery, hospitalization of a pregnant woman in an obstetric hospital as part of a multidisciplinary hospital of at least 3 technological levels, surgical treatment with the participation of a multidisciplinary team.

OBJECTIVE

Is to demonstrate the features of surgical treatment of placenta accrete by a multidisciplinary surgical team.

MATERIALS AND METHODS

We searched for publications in the Pubmed database for a narrative review of the organization and current methods of surgical treatment of placenta accreta.

RESULTS

Diagnosed or suspected antenatally, PAS is an indication for surgical treatment. Surgical operation always includes a cesarean section with delivery of the fetus, and after that it is necessary to make any treatment option selected in advance and specified during laparotomy: 1) hysterectomy immediately after delivery of the fetus without trying to separate the placenta; 2) after delivery of the fetus without placenta, suturing of the uterine incision with the remaining attached placenta in the uterus for subsequent conservative management; 3) after delivery of the fetus, resection of the uterine wall with placenta and reconstruction of the uterus; 4) delayed hysterectomy with the remaining placenta in the uterus. High risk of placenta invasion into the bladder, parametrium is an indication for diagnostic cystoscopy, placement of a ureteral stent before surgery. For caesarean section, 28.6% of patients with PA undergo bladder and/or ureteral surgery. PAS surgery usually has massive bleeding. An important strategy for reducing bleeding is to perform short-term and invertible pelvic ischemia. For this purpose, balloon occlusion of the common iliac, internal iliac arteries, aorta or uterine artery embolization are used. Conservative treatment with the remaining uterus requires a long-term hospital stay with surgical care available twenty-four hours.

CONCLUSIONS

Prenatal diagnosis of placenta accreta with specification of the depth of placenta ingrowth, timely organization of medical care, high qualification and coordinated work of the surgical team prevent massive blood loss and surgical complications.

Keywords:

bleeding

arterial embolization

balloon occlusion

placenta accreta

hysterectomy

Authors:

Baranouskaya E.I.

Belarusian State Medical University

Voroneckij A.N.

Belarusian State Medical University

Received:

01.02.2021

Accepted:

16.05.2022

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