Placentation abnormalities related to the assisted reproductive technologies
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2024.497
Abstract
Placentation abnormalities resulting from using assisted reproductive technologies (ART) is a pressing global obstetrical issue due to complications associated with the pathology: bleeding during pregnancy, postpartum hemorrhage, higher number of cesarean sections, perinatal and maternal morbidity and mortality. This pathology rate tends to increase also due to higher number of pregnancies achieved via in vitro fertilization (IVF). In this regard, we decided to find out the key risk factors for developing this pathology, identify new international data on placentation abnormalities, ART impact on this disease, since ART have been increasingly used to achieve pregnancy in women, both in Russia and abroad. Recent studies have proven the unique morphological structure of the placental hematopoietic barrier in post-IVF women as well as an increased incidence of placentation abnormalities, placenta accreta and premature abruption in comparison with spontaneous pregnancy.
About the Authors
A. R. Iskandarova
Ufa City Clinical Perinatal Center
Russian Federation
Russian Federation
Aliya R. Iskandarova - MD.
131 Koltsevaya Str., Ufa 450065
A. G. Yashchuk
Bashkir State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Alfiya G. Yashchuk - MD, Dr Sci Med, Prof.
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, Dr Sci Med, Prof.
3 Lenin Str., Ufa 450008
P. A. Berg
Bashkir State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Polina A Berg - MD.
3 Lenin Str., Ufa 450008
E. A. Berg
Bashkir State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Edward A. Berg - MD, PhD.
3 Lenin Str., Ufa 450008
V. A. Gumerova
Bashkir State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Victoria A. Gumerova.
3 Lenin Str., Ufa 450008
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What is already known about this subject?
► Placentation abnormalities include pathological invasion of the myometrium, as well as altered placenta and umbilical cord location, morphology.
► The major factors of abnormal placentation are considered to be related to invasive intrauterine interventions, uterine scarring, chronic endometritis and uterine malformations.
► Placental abnormalities are associated with higher rate of cesarean sections, maternal and perinatal morbidity and mortality.
What are the new findings?
► It has been increasingly evident that abnormalities of placental attachment and use of assisted reproductive technologies (ART) have a clear relation.
► Ultrastructural differences with regard to the morphology of placental hematopoietic barrier were demonstrated in mothers whose pregnancy occurred due to in vitro fertilization, compared with spontaneous pregnancy.
► When transferring thawed embryos, a higher rate of premature detachment of the normally located placenta was observed, whereas the rate of placenta previa, on the contrary, was higher in the "fresh" cycle.
How might it impact on clinical practice in the foreseeable future?
► It is possible to develop a modified risk scale for obstetric bleeding, in accordance with the data obtained on the high risk of placental abnormalities in post-ART women.
► Due to the increased risk of placental abnormalities, and, consequently, maternal and perinatal morbidity and mortality, post-ART patients should be closely monitored in antenatal clinic and maternity hospital.
► The increased rate of placenta accretion after using ART confirms the need for ultrasound screening of such patients by specialists experienced in visualizing such pathology.
Review
For citations:
Iskandarova A.R., Yashchuk A.G., Musin I.I., Berg P.A., Berg E.A., Gumerova V.A. Placentation abnormalities related to the assisted reproductive technologies. Obstetrics, Gynecology and Reproduction. 2024;18(4):540-546. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2024.497
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