EXPERIENCE OF ORGAN-PRESERVING MANAGEMENT TACTICS FOR PLACENTA ACCRETION

Abstract

The purpose of this study is to substantiate the possibility of successful organ-preserving management tactics for placenta accretion based on the study of a clinical case. We studied the results of examination and treatment of a pregnant woman, a woman in labor and a maternity ward, 32 years old, who received medical care in inpatient conditions at the Perinatal Center of the V.D. Seredavin State Medical University. It can be assumed that the cause of the abnormal attachment of the placenta in this patient could be an infection, in particular, chronic endometritis. This is evidenced by the premature rupture of the fetal membranes, the cause of which is most often an infectious factor. Diagnosis of anomalies of placental attachment is based on the data of instrumental studies. It should be detected in the antenatal period with ultrasound. Despite the presence of placenta accretion, this pathology, unfortunately, was not detected at the stage of pregnancy, which would make it possible to draw up a plan for pregnancy and childbirth in accordance with the tactics recommended for this pathology. In this clinical case, an additional placental lobule isolated from the main part of the placental tissue apparently grew in, which made it possible to avoid massive bleeding in the postpartum period before attempting to separate this part. Careful observation of the patient in the postpartum period with dynamic ultrasound control allowed the diagnosis of placental ingrowth. With diagnostic hysteroscopy, the diagnosis was confirmed, an organ-preserving operation was performed: hysteroesectoscopy with electrosurgical resection of placenta increta. During the control examination, no pathology of the myometrium was detected. It is necessary to take into account the presence of all causes that can lead to abnormalities of placental attachment, in particular, an infectious factor. Active identification of risk factors and early diagnosis of placental abnormalities are the main conditions in the prevention of massive obstetric bleeding and reduction of maternal mortality rates. It is necessary to strive to perform organ-preserving surgical interventions, if there are conditions that ensure their implementation. In this clinical case, despite the presence of a difficult-to-diagnose variant of placental ingrowth, it was possible to perform an organ-preserving operation and preserve the patient's ability to realize reproductive function in the future.