PLACENTA ACCRETA SPECTRUM: MODERN APPROACH TO ORGAN-PRESERVATION

Pathologically invasive placenta has been a problem in obstetrics for several centuries. Recently, its importance has increased due to the growing number of women with a previously operated or compromised uterus, which is a direct risk factor for placenta accreta. In addition to the unpleasant development of events during childbirth for the obstetrician-gynecologist, this pathology is a danger to the mother's health. And this is not surprising, because even with quick action of the surgeon and prevention of massive blood loss after hysterectomy - a classic surgical procedure for implantation of the placenta - such women lose their reproductive organ, which can cause social and psychological discomfort. That is why organ-preserving operations are being developed today, the results of the evaluation of the effectiveness of one of them are given in this work. Aim: to compare the effectiveness of the proposed organ-preserving CLAP technique in women with placenta accreta spectrum compared to classic hysterectomy. Materials and methods: Women with placenta accreta spectrum underwent cesarean section and CLAP in the main group (n=19) and classical hysterectomy in the control group (n=18). Blood loss, neonatal outcome, and length of hospital stay were compared. Statistical analysis was performed using MedStat and Microsoft Excel software. Patients' rights were respected in accordance with the Declaration of Helsinki and the Universal Declaration of Bioethics and Human Rights (UNESCO). All pregnant women signed an informed consent form to participate in the study. Results: The two groups did not differ in terms of age, medical history and comorbidities. Statistically less blood loss was found in the main group (2377±322 ml vs. 3339±358 ml in the control group, p<0.001), while there was no difference in the condition of newborns, postpartum women, and length of hospital stay. Conclusions: The use of the CLAP technique in comparison with hysterectomy allows, in addition to the preservation of the female reproductive organ, to achieve less blood loss during surgical delivery of a pathologically invasive placenta, without changing the condition of the newborn, the postpartum woman, or the length of hospital stay. At the same time, in comparison with other organ-preserving techniques, CLAP does not require the use of special additional equipment and can be performed in any medical institution with sufficient qualifications of the surgeon.