Reproductive history of pregnant women with abnormal placentation

Abnormal placentation is considered a pathological invasion of the placenta with the germination of its villi deeper than the decidual membrane. The frequency of pathology does not exceed 0.1% of the total number of births, however, it is accompanied by severe consequences for the maternal organism. The classic risk factor is placenta previa, which, in turn, is a result of previous cesarean sections. The role of other interventions in the uterine cavity that disrupt the normal structure of the endometrium is poorly studied.The objective: to study the factors of gynecological and reproductive history in women with placenta accreta.Materials and methods. An analysis of medical documentation of 81 postpartum women with histologically confirmed diagnosis of placenta accreta, who gave birth in obstetric institutions in Kyiv, for 2014–2023 (main group) and 50 women who gave birth by cesarean section due to placenta previa in the Perinatal Center of Kyiv (comparison group) was conducted. The frequency of operations and course of previous cesarean sections and surgical interventions in the uterine cavity were determined.Results. The number of surgical incisions on the uterine wall increases the risk of abnormal placentation: among women in the main group 43.2% of patients had 2 interventions, 29.7% – 3 or more incisions, in the comparison group – only 20.0% and 8.0%, respectively. The degree of penetration of villous tissue into the myometrium depends on the area of damage to the contact zone (decidual membrane – myometrium), and for normal epithelialization the thickness of the scar is important, which decreases with each subsequent incision on the uterus. They had previous cesarean section which was performed before the onset of labor (55.6%), among women with placenta previa without placenta accreta – 26.0%.Also, the characteristic feature of the main group is abdominal delivery on the background of a long period since rupture of the membranes – 34.6%, in the comparison group – only 16.0%. Its outcome is the higher frequency of septic complications of previous cesarean section – the relative risk of abnormal placentation for postoperative hyperthermia was 1.41, for suppuration of the postoperative wound – 1.45 (95% confidence interval). Among women with placenta previa without signs of accreta, only 18% had in the anamnesis the instrumental revision of the uterine cavity for pregnancy interruption, and among women with abnormal placentation on the background of placenta previa – 45 (55.5%).Every second patient in the main group had indications for hysteroscopic polypectomy in anamnesis, and 18.5% of patients had 2 or more endoscopic interventions in the uterine cavity, in the group of placenta previa without adhesions – only 12.0% and 4.0%, respectively. Less common among women in the main group was hysteroscopic myomectomy in the history – 19.8%, but this is more than in patients in the comparison group (4,0%).Conclusions. In addition to abdominal delivery, patients with abnormal placentation in 43.2% of cases had 2 cesarean sections in the history, in 29.6% – 3 or more (in the placenta previa group – 20.0% and 8.0%, respectively). In 13.5% of cases women with placenta accreta had prolonged hyperthermia after previous deliveries, in 19.8% – suppuration of the postoperative wound (in the placenta previa group – 4.0% and 6.0%, respectively).In 43.2% of women with abnormal placentation curettage of the uterine cavity was performed to evacuate the missed pregnancy, in 55.5% – for the purpose of artificial interruption of pregnancy (in the placenta previa group – 16.0% and 18.0%, respectively). Hysteroscopic polypectomy was performed in 48.1% of women with abnormal placentation, myomectomy – in 19.8%, in the placenta previa group – in 6.0% and 4.0%, respectively.