Current structure of risk factors for abnormal invasion (PAS) and placenta previa in Ukraine

Abnormal placental invasion (PAS) and placenta previa (PP) continue to be one of the key issues of modern obstetrics due to the severity of peripartum and intrapartum complications for pregnant women and mothers in labor. Despite significant advances in the diagnosis of PP and PAS and modern delivery technologies that allow for the prevention of massive intranatal blood loss, optimal strategies for managing pathologies of this spectrum have not yet been found, probably due to the focus on the management of clinical cases that already occur. Aim - to conduct an analysis of obstetric and gynecological history, the course of pregnancy and childbirth in pregnant women with PP, PAS based on medical documentation of childbirth in Kyiv for the period 2011-2021, in order to identify significant risk factors. Materials and methods. A retrospective case-control study of cases of PP, PAS, recorded in medical institutions of Kyiv in the period 2011-2021 among 195147 births was conducted. All pregnant women were assessed for age, pregravid extragenital pathology, menstrual cycle characteristics, patency, gravity, number of caesarean sections (СS), manual separation and removal and remnants of the placenta in the postpartum period, use of assisted reproductive technologies (ART), gestational age, method of delivery, blood loss, duration of hospitalization, and basic parameters of newborns. Statistical analysis was performed using the statistical software package. Results. The analysis revealed that the main risk factors for PP are СS, and the risk significantly depends on the number of СS in the anamnesis, ART, parity, instrumental abortions and to a lesser extent age. Factors such as obesity, smoking, multiple pregnancy and fetal sex have a less close relationship with PAS disorders. Conclusions. Based on the results obtained, it can be concluded that the main risk factor for PAS spectrum disorders is PP, which is diagnosed in more than half of patients, and the vast majority of them have a history of СS. Another option is the presence of PAS in the absence of a history of uterine scars, and it is in them that the greatest risk of not establishing a diagnosis of PAS before childbirth. In addition to СS, the most significant risk factors are ART and surgical interventions on the uterus. An accessible method for assessing the degree of risk of developing PAS has been developed, which allows the formation of risk groups for additional examination and preconception preparation. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. The authors declare no conflict of interest.