Management of patients with abnormal invasive placenta in different gestation age

• Grigoriy A. Penzhoyan
• Tatyana B. Makukhina
• Mingaleva Natalia V.
• Alina V. Solntseva
• Amirkhanyan Arpine M.

Abstract

Increasing of caesarean section numbers lead to abnormal invasive placenta (AIP) rate. Management of asymptomatic patients with caesarean scar (CS) and low-lying implantation pregnancy (LLIP) in I trimester is not standardized.

Aim - to compare results of the treatment of AIP in different gestation age for developing management strategy of patients with AIP.

Materials and methods. Retrospective multicentral study of patients with AIP: 1^st group (n=37) - LLIP in I-II trimester; 2^nd group (n=103) - placenta praevia in patients with CS in II-III trimester. The 1^st group was diagnosed based on clinical data, ultrasound examination (US), HCG level. In the 2^nd group AIP was suspected by US, MRI, but confirmed during operation and histologically.

Results. In the 2^nd group of 103 patients with placenta praevia AIP was verified in 89 (86.4%), blood loss during surgery was significantly higher, than if LLIP was terminated in the 1^st group (р<0.0000): organpreserving effect achieved in 48.3%, (in 1^st group - 100%) (р<0.0000); postoperative complications took place in 16.9% (in 1^st group - 2.6%) (р<0.003).

Conclusion. Patients with AIP have high risk of bleeding and hysterectomy in delivery. Termination of LLIP in the I trimester allowed to reduce risks and to preserve fertility. Early US-examination and consultation for prognosis in the case of pregnancy progression are strongly recommended for patients with previous CS.

Keywords:abnormal invasive placenta, low-lying implantation ectopic pregnancy, cesarean scar pregnancy, hysterectomy, ultrasound

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