Effectiveness of modern methods of delivery of pregnant women with placenta previa/percreta 3b and 3c

The most severe cases of abnormal placenta invasion (placenta accrete spectrum – PAS) are associated with the invasion of the myometrium and serosa, attachment to the bladder, cervix, parametrial tissue – placenta previa/percreta 3b and 3c according to the classification of the International Federation of Gynecologists and Obstetricians (FIGO, 2019). These are the most dangerous cases with severe hemorrhagic complications, coagulopathic disorders and the occurrence of intraoperative damage to the bladder and ureters.The objective: to determine the clinical effectiveness of various methods of delivery of pregnant women with placenta previa/percreta 3b and 3c using endovascular balloon occlusion of the abdominal aorta (EBOAA) and the internal iliac artery ligation (IIAL).Materials and methods. During 2015–2023 at the clinical bases of the Department of Obstetrics and Gynecology No. 1 of Shupyk National Healthcare University of Ukraine, a corporal/fundal cesarean section (CS) and hysterectomy were performed in 43 pregnant women with a diagnosis of placenta previa/percreta 3b and 3c at a gestational age of 35–37 weeks. The prenatal diagnosis was established according to ultrasound and magnetic resonance imaging, and the final diagnosis was confirmed by macroscopic and histopathological studies.I group (main group) included 12 women with pl. percreta 3b,c, who had CS with EBOAA before performing hysterectomy. II group (comparison one) included 14 pregnant women with the same diagnosis and who had CS and IIAL before performing hysterectomy. III group (control one) included 17 women with a similar diagnosis who had CS and hysterectomy without the use of additional surgical hemostasis methods. In all groups, monopolar diathermy, argon plasma coagulation and bipolar coagulation were used.Results. Blood loss in the main group was on average 950 ± 90 ml, in the comparison group – 1400 ± 130 ml (p1,2 < 0.05) and in the control group – 2100 ± 150 ml (p1,3 < 0.001 and p2,3 < 0.01). The average duration of the operation was 97.0 ± 9.0 min in the main group and 119.0 ± 11.0 min and 161 ± 15.0 min in the comparison and control groups, respectively (p < 0.05). Duration of the hospital stay was from 7 ± 1 day to 9 ± 1 day and up to 12 ± 2 days in groups, respectively.Conclusions. The use of innovative technology of temporary EBOAA in the delivery of pregnant women with placenta previa/percreta 3b and 3c before hysterectomy is the most clinically effective method, which significantly reduces the total volume of blood loss, the likelihood of massive bleeding and damage to adjacent organs, the duration of surgical intervention and stay in the obstetric hospital.