To present one-center experience of the management of abnormally invasive placenta (AIP).
Materials and methods
This was a retrospective cohort study of clinical cases of abnormally invasive placenta (the AIP) in Perinatal Center (PC), which is part of General Hospital— Regional Clinical Hospital N2 of Krasnodar city, in the period from 2014 to August 2016.
The total number of childbirth for the period was 24 078, and AIP was diagnosed in 0.17%. The average age of women was 31.5 ± 0.8 years. About 97.5% were multiparous women and 85% women in the previous pregnancy had childbirth by cesarean section (CS): One CS—41.18%, two—32.35%, and three—23.53%. An AIP was first diagnosed in pregnancy at 11 to 39 weeks of pregnancy by ultrasound or magnetic resonance imaging (MRI). Cesarean section performed in the conditions of the X-ray operating of the endovascular department. The relative risk (RR) for accurate diagnosis of AIP by ultrasound was 1.789 ± 0.709 [95% confidence interval (CI) 0.446–7.186], and for MRI RR was 0.944 ± 0.142 (95% CI 0.715–1.246). At CS, in 85% of women balloon dilatation of the iliac vessels was performed, in 15%, uterine artery embolization (UAE), and in 72.5%, metroplasty. In 15% of women with AIP were the cause of hysterectomy without adnexa. The total blood loss was 1152.56 ± 107.67 (4,000–35,000) mL or 15.539 ± 1.7374 (5,0000–58,330) mL/kg. Maximum blood loss was in women with placenta previa and its localization in the area of the scar on the uterus that required a hysterectomy.
Despite increasing incidence of AIP, it is possible to prevent massive blood loss during delivery by combined treatment using radiological endovascular procedures for devascularization of the lower pelvis. Early diagnosis of placental abnormalities with regionalized approach in perinatal health makes it possible not only to preserve the women's reproductive health and fertility but also to minimize postpartum hemorrhage.
How to cite this article
Penzhoyan G, Novikova V. Management of Abnormally Invasive Placenta: One-center Experience. Donald School J Ultrasound Obstet Gynecol 2017;11(3):184-188.