Obstetrics, Gynecology and Reproduction

Advanced search

The role of prenatal diagnosis of abnormally invasive placenta in pregnancy outcome

Full Text:


Aim: to demonstrate the role and importance of prenatal diagnosis of abnormally invasive placenta.
Materials and methods. Retrospective analysis of 3 clinical cases of the delivery in Health Center Medina. All women were diagnosed with the complete placenta praevia and invasion of chorion in the myometrium, the last was confirmed by the results of histological examination. Anamnesis data, extragenital pathology and results of examination during pregnancy were analyzed. In the prenatal period the diagnosis was confirmed by the results of ultrasound examination and MRI in two women.
Results. All women were diagnosed with the different degree of placenta praevia, 2 women had a cesarean section in the past history. All patients had unifetal pregnancy without complications and no extragenital pathology was noted. 2 women were diagnosed with the placenta praevia using ultrasound scan and MRI, were estimated the degree and topography of placental invasion. Both women had planned caesarean section. During operation was performed autohemotransfusion using a Cell Saver system. In one of the cases urgent c-section was performed due to the massive bleeding, presence of placental invasion was diagnosed intraoperatively. Hysterectomy was performed in all 3 cases, total blood loss was 950–1450 ml in patients with the prenatally diagnosed invasive placentation. Iliac artery ligation was performed to the third patient, due to excessive bleeding and development of coagulopathy, 1200 ml of fresh frozen plasma has been transfused for correction of coagulopathy, as well as transfusion of donor erythrocyte mass.
Conclusion. Probably the development of placental invasion abnormalities along with other factors is mostly affected by presence of placenta previa and cesarean section in the patient’s past history. Prenatal assessment of presence and degree of the abnormal placental invasion is important factor for planning of delivery: gestational age, method and the hospital level.

About the Authors

J. Yu. Ungiadze
Shota Rustaveli Batumi State University; Iris Borchashvili Health Center Medina

Jumber Yu. Ungiadze – MD, Dr Sci Med, Professor, Faculty of Medicine, Director

35 Ninoshvili Str., Batumi, 6010, Georgia

237 Fridon Khalvashi Avenue, Batumi, 6004, Georgia

I. V. Nikuradze
Shota Rustaveli Batumi State University

Irina V. Nikuradze – MD, Assistant, Faculty of Medicine

35 Ninoshvili Str., Batumi, 6010, Georgia

N. D. Zamtaradze
Shota Rustaveli Batumi State University

Natiya D. Zamtaradze – MD, Assistant, Faculty of Medicine

35 Ninoshvili Str., Batumi, 6010, Georgia


1. Jauniaux E., Chantraine F., Silver R.M., Langhoff‐Roos J.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynecol Obstet. 2018;140(3)265–73. DOI: 10.1002/ijgo.12407.

2. Jauniaux E., Collins S., Burton G.J. The placenta accretaspectrum: Pathophysiology and evidence‐based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218(1):75–87. DOI: 10.1016/j.ajog.2017.05.067.

3. Jauniaux E., Jurkovic D. Placenta accreta: Pathogenesis of a 20th century iatrogenic uterine disease. Placenta. 2012;33(4):244–51. DOI: 10.1016/j.placenta.2011.11.010.

4. Parra‐Herran C., Djordjevic B. Histopathology of placenta creta: Chorionic villi intrusion into myometrial vascular spaces and extravilloustrophoblast proliferation are frequent and specific findings with implications on diagnosis and pathogenesis. Int J GynecolPathol. 2016;35(6):497–508. DOI: 10.1097/PGP.0000000000000250.

5. Fitzpatrick K., Sellers S., Spark P. et al. The management and outcomes of placenta accreta, increta, and percreta in the UK: A population‐based descriptive study. BJOG. 2014; 121(1):62–70; discussion 70–1. DOI: 10.1111/1471-0528.12405.

6. Thurn L., Lindqvist P.G., Jakobsson M. et al. Abnormally invasive placenta‐prevalence, risk factors and antenatal suspicion: Results from a large population‐based pregnancy cohort study in the Nordic countries. BJOG. 2016;123(8):1348–55.DOI: 10.1111/1471-0528.13547.

7. Wu S., Kocherginsky M., Hibbard J.U. Abnormal placentation: Twenty‐year analysis. Am J Obstet Gynecol. 2005;192(5):1458–61. DOI: 10.1016/j.ajog.2004.12.074.

8. Sentilhes L., Merlot B., Madar H. et al. Postpartum haemorrhage: Prevention and treatment. Expert Rev Hematol. 2016;9(11):1043–61. DOI: 10.1080/17474086.2016.1245135.

9. Silver R.M., Landon M.B., Rouse D.J. et al.; National Institute of Child Health and Human Development Maternal‐Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226–32. DOI: 10.1097/01.AOG.0000219750.79480.84.

10. Creanga A.A., Bateman B.T., Butwick A.J. et al. Morbidity associated with cesarean delivery in the United States: Is placenta accreta an increasingly important contributor? Am J Obstet Gynecol. 2015;213(3):384.e1–e11. DOI: 10.1016/j.ajog.2015.05.002.

11. Jauniaux E., Jurkovic D. Long‐term complications after caesarean section. In: A textbook of caesarean section. Eds. E. Jauniaux, W. Grobman. Oxford: Oxford University Press, 2016. 129–44.

12. Jauniaux E., Burton G.J. Pathophysiology of placenta accretaspectrum disorders: A review of current findings. Clin Obstet Gynecol. 2018;61(4):743–54. DOI: 10.1097/GRF.0000000000000392.

13. Solheim K.N., Esakoff T.F., Little S.E. et al. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med. 2011;24(11):1341–6. DOI: 10.3109/14767058.2011.553695.

14. Ananth C.V., Demissie K., Smulian J.C., Vintzileos A.M. Placenta previa in singleton and twin births in the United States, 1989 through 1998: A comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol. 2003;188(1):275–81. DOI: 10.1067/mob.2003.10.

15. D'Antonio F., Iacovella C., Bhide A. Prenatal identification of invasive placentation using ultrasound: Systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2013;42(5):509–17. DOI: 10.1002/uog.13194.

16. McLean L.A., Heilbrun M.E., Eller A.G. et al. Assessing the role of magnetic resonance imaging in the management of gravid patients at risk for placenta accreta. Acad Radiol. 2011;18(9):1175–80. DOI: 10.1016/j.acra.2011.04.018.

17. Meng X., Xie L., Song W. Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: A systematic review and meta‐analysis.Ultrasound Med Biol. 2013;39(11):1958–65. DOI: 10.1016/j.ultrasmedbio.2013.05.017.

18. D'Antonio F., Iacovella C., Palacios‐Jaraquemada J. et al. Prenatal identification of invasive placentation using magnetic resonance imaging: Systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2014;44(1):8–16. DOI: 10.1002/uog.13327.

19. Bailit J.L., Grobman W.A., Rice M.M. et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol. 2015;125(3):683–9. DOI: 10.1097/AOG.0000000000000680.

20. Grace Tan S.E., Jobling T.W., Wallace E.M. et al. Surgical management of placenta accreta: A 10‐year experience. Acta Obstet Gynecol Scand. 2013;92(4):445–50.DOI: 10.1111/aogs.12075.

21. Brookfield K.F., Goodnough L.T., Lyell D.J. Butwick A.J. Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation. Transfusion. 2014;54(6):1530–6. DOI: 10.1111/trf.12483.

22. Woldu S.L., Ordone M.A., Devin P.C., Wright J.D. Urologic considerations of placenta accreta: A contemporary tertiary care institutional experience. Urol Int. 2014;93(1):74–9. DOI: 10.1159/000356064.

For citation:

Ungiadze J.Yu., Nikuradze I.V., Zamtaradze N.D. The role of prenatal diagnosis of abnormally invasive placenta in pregnancy outcome. Obstetrics, Gynecology and Reproduction. 2020;14(3):384-394. (In Russ.)

Views: 161

ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)