A.V. KAYUMOVA, O.A. MELKOZEROVA, YU.A. SEMENOV, N.V. BASHMAKOVA

 Ural Research Institute of Maternity and Childhood, Yekaterinburg

 Contact details:

Kayumova A.V. — PhD (Medicine), Leading Researcher, Deputy Chief Physician for Quality Control and Safety of Medical Activities

Address: 1 Repina St., 620028 Yekaterinburg, Russian Federation, tel.: +7-982-623-20-47, e-mail: kaum-doc@mail.ru

 Currently, a severe complication associated with pathological invasion of the placenta has arisen in modern obstetrics, which according to the ICD has a separate code — placenta accreta (043.2). The proportion of this pathology is growing every year, making a significant contribution to maternal morbidity and mortality. The possibility of timely correct diagnosing and determining predictors that contribute to the formation of this pathology is one of the main tasks of obstetrics in the near future.

The purpose — to determine significant anamnestic, clinical and instrumental predictors of placenta accreta.

Material and methods. A retrospective analysis of 252 birth histories was carried out. The cases were divided into 2 groups: the main group — 131 patients who gave birth due to placenta accreta, the comparison group — 121 patients who gave birth due to placenta previa. We conducted a comparative analysis of clinical and anamnestic data, parity (number of confirmed pregnancies), features of the pregnancy course, ultrasound data during screening, delivery terms, stages of surgical intervention, surgical outcomes, volume and composition of infusion-transfusion therapy, and hospital discharge dates. A rule for predicting placenta accreta based on the most significant and reliably different patterns was developed.

Results. Our analysis identified a number of significant indicators that were reliably more common in the main group. These predictors are available for any level of patient observation. Parity, extragenital pathology, complications of the current pregnancy, as well as a screening test for aneuploidy in the first trimester, which is mandatory during pregnancy, screening ultrasound studies are assessed in all patients. Interpretation and analysis of significant indicators allowed us to develop a prognosis rule that can be used to predict placenta accreta and make timely decisions on further tactics, as well as on correct patient routing. Since placenta accreta has different depths of invasion with various possible complications, additional instrumental and molecular studies are required for timely identification of the placenta accreta degree.

Conclusion. The possibility of retrospective analysis of cases of delivery of patients with placenta previa and placenta accreta allowed us to identify reliable predictors that can be used for timely prediction of pathological invasion and determination of the actions algorithm.

Key words: placenta previa, placenta accreta, pathological placental invasion, uterine scar.

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