Efficacy of distal haemostasis during caesarean delivery in women with placenta accreta spectrum disorders.

Autor: Barinov SV; Federal State Budget Institution of Higher Education 'Omsk State Medical University' of the Russian Ministry of Health, Omsk, Russia., Shmakov RG; Federal State Budget Institution National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia., Medyannikova IV; Federal State Budget Institution of Higher Education 'Omsk State Medical University' of the Russian Ministry of Health, Omsk, Russia., Tirskaya YI; Federal State Budget Institution of Higher Education 'Omsk State Medical University' of the Russian Ministry of Health, Omsk, Russia., Kadtsyna TV; Federal State Budget Institution of Higher Education 'Omsk State Medical University' of the Russian Ministry of Health, Omsk, Russia., Lazareva OV; Federal State Budget Institution of Higher Education 'Omsk State Medical University' of the Russian Ministry of Health, Omsk, Russia., Razdobedina IN; Perinatal Centre of Omsk Regional Clinical Hospital, Omsk, Russia., Neustroyeva TN; Perinatal Center of the State Autonomous Institution of the Republic of Sakha (Yakutia) Republican Hospital No. 1, Yakutsk, Russia., Stepanov SS; Federal State Budget Institution of Higher Education 'Omsk State Medical University' of the Russian Ministry of Health, Omsk, Russia.
Jazyk: angličtina
Zdroj: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians [J Matern Fetal Neonatal Med] 2022 Dec; Vol. 35 (25), pp. 8778-8785. Date of Electronic Publication: 2021 Nov 18.
DOI: 10.1080/14767058.2021.2005019
Abstrakt: Pregnancies complicated by the placenta praevia are associated with an increased risk of massive obstetric bleeding and high rates of hysterectomy which are often caused by the placenta accreta. The aim of our study was to identify the risk factors for placenta praevia associated with PAS disorders and the efficacy of distal haemostasis during Cesarean delivery.
Methods: This was a cohort study carried out between 2014 and 2020 in 532 women with abnormal placental localization and attachment. The placental attachment spectrum (PAS) disorder diagnosis was confirmed during the surgery and by the histology results in 164/532 participants. Depending on the surgical approach during the Cesarean delivery, patients were divided into three groups. In Group 1 ( n  = 52), patients underwent bilateral uterine artery ligation. In Group 2 ( n  = 33), we used the combined compression haemostasis approach including the placement of tourniquets and insertion of an intrauterine balloon for controlled tamponade. In Group 3 ( n  = 79), we used the combination of surgical haemostasis with the controlled intrauterine tamponade using the vaginal and intrauterine Zhukovsky balloon.
Results: PAS was observed in 30.8% of the placenta praevia cases, and in 93.3% was associated with the presence of a uterine scar. Women with the placenta praevia and PAS had a significantly higher number of past deliveries ( р = .001). According to the FIGO classification, 53.8% of women with placenta praevia observed during the Cesarean had РА1 and 46.2% PA2. With regards to the PAS disorders observed in 30.8% of patients, 38.4% had PAS3, 34.7% PAS4, 18.3% PAS5 and 8.5% PAS6. The histology analysis showed normal placental attachment in 42.9% of the total number of study participants, placenta accreta in 28.2%, placenta increta in 16.7%, and placenta percreta in 12.2%. In Group 1, we performed the resection of uterine wall with the attached portion of the placenta in 13.5% of women, in Group 2 in 30.3% women, and in Group 3 in 50.6% women. There was a significant 4.8-fold reduction in the number of hysterectomies in Group 3 versus Group 2 ( р = .043) and a 4.4-fold reduction in Group 2 versus Group 1 ( р = .003). In Group 2, the volume of blood loss was 1.3-fold lower and in Group 3 1.5-fold lower than in Group 1. Conclusion : The techniques of compression distal haemostasis evaluated in this study in women with PAS are efficacious in the reduction of adverse maternal outcomes and should be used more widely in clinical practice.
Databáze: MEDLINE
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