Estimated efficiency of uterine cavity suturing in patients during organ-preserving surgery with placenta increta while examining reproductive function in the postpartum period
Abstract
Aim: to assess the reproductive function of patients who underwent organ-preserving delivery using a modified method of uterine cavity suturing placenta increta.
Materials and Methods. There were retrospectively investigated 77 history cases of patients admitted for planned delivery in 2018–2020, subdivided into two groups: Group 1 (control) – 32 patients with uterine scar after previous cesarean section, Group 2 (main) – 45 patients diagnosed with placenta increta further assigned to 2 subgroups – 2A (n = 23) underwent a modified uterine cavity suturing, and subgroup 2B (n = 22) where a linear suturing was used.
Results. The groups studied were comparable on anthropometric data and reproductive history. The ultrasound examination of the uterus size 6 months later revealed more prominent changes in main group that might be due to larger volume of excised uterine tissue during surgery. Significant differences in subgroup 2A (uterus length – 54 [48; 62] mm, uterus width – 38 [29; 47] mm; p = 0.036 and p = 0.024, respectively) and subgroup 2B (uterus length – 51 [42; 60] mm, uterus width – 30 [24; 44] mm; p = 0.003 and p < 0.001) vs. control group (uterus length – 60 [55; 66] mm, uterus width – 48 [42; 54] mm) were observed. Magnitude of change in size and shape of the uterus were found in subgroup 2A vs. 2B (p = 0.022 for uterus length, p = 0.004 for uterus width). Examining intrauterine blood flow revealed no significant differences between the groups compared (p > 0.1).
Conclusion. Assessing results of the applied new method for uterine cavity suturing in patients with placenta increta showed a marked efficiency in maintaining anatomically most natural shape of the uterus and uterine cavity. Despite the results obtained, the problem of restoring female reproductive function after organ-preserving delivery remains a pressing issue relevant and requires to be further investigated.
About the Authors
E. A. Berg
Bashkir State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Edward A. Berg – MD, Assistant, Department of Obstetrics and Gynecology
3 Lenin Str., Ufa 450008
A. G. Yashchuk
Bashkir State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Alfiya G. Yashchuk – MD, Dr Sci Med, Professor, Head of the Department of Obstetrics and Gynecology
3 Lenin Str., Ufa 450008
I. I. Musin
Bashkir State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Ilnur I. Musin – MD, PhD, Associate Professor, Department of Obstetrics and Gynecology
3 Lenin Str., Ufa 450008
Yu. N. Fatkullina
Bashkir State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Yulia N. Fatkullina – MD, Postgraduate Student, Department of Obstetrics and Gynecology
3 Lenin Str., Ufa 450008
References
1. Savelieva G.M., Kurtser M.A., Breslav I.Yu. et al. Development and practical implementation of organ preservation surgery in case of placenta accrete in patients with a scar on the uterus. [Razrabotka i vnedrenie v praktiku organosohranyayushchih operacij pri vrastanii predlezhashchej placenty u pacientok s rubcom na matke]. Problemy social'noj gigieny, zdravoohraneniya i istorii mediciny. 2019;27(S):693–8. (In Russ.). https://doi.org/10.32687/0869-866X-2019-27-si1-693-698.
2. Jauniaux E., Ayres-de-Campos D., Langhoff-Roos J. et al.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146(1):20–4. https://doi.org/10.1002/ijgo.12761.
3. Silver R.M., Branch D.W. Placenta accreta spectrum. New Engl J Med. 2018;378(16):1529–36. https://doi.org/10.1056/nejmcp1709324.
4. Kurtser M.A., Breslav I.Yu., Grigorian A.M. et al. Temporary balloon occlusion of common iliac arteries during organ preservation surgery in patients with placental ingrowth. [Vremennaya ballonnaya okklyuziya obshchih podvzdoshnyh arterij pri osushchestvlenii organosohranyayushchih operacij u pacientok s vrastaniem placenty]. Akusherstvo i ginekologiya. Novosti, mneniya, obuchenie. 2018;6(4):31–7. (In Russ.). https://doi.org/10.24411/2303-9698-2018-14003.
5. Piñas-Carrillo A., Chandraharan E. Conservative surgical approach: The Triple P procedure. Best Pract Res Clin Obstet Gynaecol. 2020 Jul 20;S1521-6934(20)30119-X. https://doi.org/10.1016/j.bpobgyn.2020.07.009.
6. Mulla B.M., Weatherford R., Redhunt A.M. et al. Hemorrhagic morbidity in placenta accreta spectrum with and without placenta previa. Arch Gynecol Obstet. 2019;300(6):1601–6. https://doi.org/10.1007/s00404-019-05338-y.
7. Hecht J.L., Baergen R., Ernst L.M. et al. Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel. Mod Pathol. 2020;33(12):2382–96. https://doi.org/10.1038/s41379-020-0569-1.
8. Escobar M.F., Gallego J.C., Nasner D. et al. Management of abnormal invasive placenta in a low- and medium-resource setting. Best Pract Res Clin Obstet Gynaecol. 2020 Aug 13:S1521-6934(20)30135-8. https://doi.org/10.1016/j.bpobgyn.2020.08.004.
9. Einerson B.D., Branch D.W. Surgical management of placenta accreta spectrum. Clin Obstet Gynecol. 2018;61(4):774–82. https://doi.org/10.1097/GRF.0000000000000406.
10. Di Mascio D., Calì G., D'antonio F. Updates on the management of placenta accreta spectrum. Minerva Ginecol. 2019;71(2):113–20. https://doi.org/10.23736/S0026-4784.18.04333-2.
11. Vinitskiy A.A. Placenta accreta: diagnosis and organ-preserving tactics in operative delivery. [Vrastanie placenty: diagnostika i organosohranyayushchaya taktika pri operativnom rodorazreshenii]. Avtoref. dis. kand. med. nauk. Moscow, 2018. 26 p. (In Russ.).
12. Bisschop С.N.S., Schaap T.P., Vogelvang T.E, Scholten P.C. Invasive placentation and uterus preserving treatment modalities: a systematic review. Arch Gynecol Obstet. 2011;284(2):491–502. https://doi.org/10.1007/s00404-011-1934-6.
13. Provansal M., Courbiere B., Agostini A. et al. Fertility and obstetric outcome after conservative management of placenta accreta. Int J Gynecol Obstet. 2010;109(2):147–50. https://doi.org/10.1016/j.ijgo.2009.12.011.
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For citations:
Berg E.A., Yashchuk A.G., Musin I.I., Fatkullina Yu.N. Estimated efficiency of uterine cavity suturing in patients during organ-preserving surgery with placenta increta while examining reproductive function in the postpartum period. Obstetrics, Gynecology and Reproduction. 2021;15(6):658-668. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.184
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