THE AIM OF THE STUDY
Was to analyze the catamnesis of patients who underwent surgical treatment of placenta accreta in specialized perinatal centers in the Russian Federation.
MATERIALS AND METHODS
A retrospective multicenter study, analysis of clinical and anamnestic data, gynecological and obstetric catamnesis of 2.652 patients who underwent surgical treatment for placenta accreta in 2014—2024 in 31 regions of the Russian Federation, as well as V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation, V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia and hospitals of the Mother and Child Group of Companies.
RESULTS
Among the total cohort of 2652 patients, 229 (8.6%) patients underwent hysterectomy during surgical treatment of placenta accreta, 2423 (91.4%) patients underwent organ-preserving surgery, of which 609 (23%) underwent surgical sterilization. Hysterectomy compared with metroplasty was accompanied by a significantly greater blood loss of 2403 (1974—2850) versus 1693 (1105—23 75) ml (p<0.001), a higher incidence of intraoperative complications such as massive blood loss of more than 2500 ml (30.56% (n=70) versus 6.93%, (n=168), (p<0.001) and bladder resection (31.88% (n=73) vs. 2.23% (n=54), (p<0.001).
In 2018 (83.28%) patients with organ-preserving surgery, the regular menstrual cycle was restored 4 (1—18) months after the operation. Menstrual cycle disorders and/or a symptomatic niche of the postoperative scar were noted in 55 (2.27%) cases. Clinical and laboratory manifestations of premature menopause were not observed in any case. Among 229 patients who underwent hysterectomy, 17 (7.42%) cases showed symptoms of premature menopause. The frequency of urinary problems did not differ significantly between the groups, amounting to 116 (4.78%) versus 15 (6.55%) cases (p=0.242), in metroplasty and hysterectomy, respectively.
According to the PISQ questionnaire, sexual satisfaction was statistically higher in the group with organ-preserving surgery — 5 points, compared with organ-bearing surgery — 3 points (p=0.031). When analyzing the quality of life and health based on the Short Form 6 Dimensions SF-6D questionnaire in women with metroplasty, the median score was significantly higher than in patients with a removed uterus: 4 (3—5) versus 3 (1—4) of the maximum 5, respectively (p=0.031). Of the 1.814 patients with preserved reproductive function, subsequent pregnancies were observed in 7.88% (n=143), 88.11% (n=126) of which ended in delivery. The frequency of timely delivery was significantly higher than that of preterm delivery: 83.33% (n=105) cases versus 16.67% (n=21) (p<0.001). Among all deliveries, the median volume of intraoperative blood loss was 880 ml. Placenta accreta was diagnosed in 7.1% (n=9) of the cases, in one of which (0.79%, 1/126) it was complicated by massive blood loss, which caused a hysterectomy. Postpartum bleeding occurred in 3 (2.38%) patients. Neonatal outcomes did not differ from the population data.
An analysis of blood flow reduction methods in the previous surgical treatment of placenta accreta demonstrated a significant correlation between the use of complex compression hemostasis with the possibility of organ-preserving surgery and the uncomplicated course of subsequent pregnancy.
CONCLUSION
The results of the second stage of a multicenter nationwide study demonstrated that organ-preserving surgery for placenta accreta is associated with fewer intra– and postoperative complications, improved quality of life in patients and the possibility of further realization of their reproductive function.
