ABNORMAL PLACENTATION IN PREGNANT WOMEN WITH A SCAR ON THE UTERUS
DOI:
https://doi.org/10.11603/24116-4944.2021.1.12355Keywords:
uterine scar, placentation, diagnosis, prognosisAbstract
The aim of the study – to assess the frequency of abnormal placentation in pregnant women with a scar on the uterus.
Materials and Methods. The study was performed on the basis of the Odesa Regional Perinatal Center during 2016–2020. 435 women with a scar on the uterus were examined, including 118 (27.1 %) – with two or more scars. The average age of the patients was (33.3–1.2) years. The frequency of detection of placental abnormalities at the prenatal stage was analyzed. All patients during the 20-week pregnancy period underwent a transvaginal ultrasound examination using an Accuvix V20 Prestige expert-class scanner (Samsung Medison, Republic of Korea). Additionally, a Doppler study of blood flow through the uterine arteries was performed. Statistical analysis was performed using Statistica 13.0 software (TIBCO, USA).
Results and Discussion. In all examined pregnant women more than 2 years passed since the operation. Scar after conservative myomectomy was in 109 (25.1 %) women. The average term after CME was (2.7±0.2) years. Fundamental (28 or 25.7 %) and corporal (73 or 66.9 %) incisions were most often registered. Anomalies of placental attachment were a frequent phenomenon – in 70.3 %, with a low location of the placenta in the structure of the lesion – 163 cases or 53.3 %. Placenta accrete was registered in 131 or 42.8 %. The cases of placenta increta (2.6 %) and placenta previa (1.3 %) were casuistic. When assessing the frequency of complications in women with a scar on the uterus, it was found that in the first trimester of pregnancy the threat of abortion occurred in 20.4 % of pregnant women, early preeclampsia – in 50.3 %, anemia in pregnant women – in 64.1 %. Fetal growth retardation was registered in 69.6 % of pregnant women. In the third trimester, manifestations of placental dysfunction were registered in 72.1 %, preeclampsia – in 66.8 %, anemia of pregnant women – in 73.6 %. According to the literature, the prevalence of similar complications in women without scarring is three times lower. 103 (25.9 %) women underwent operative delivery, the rest gave birth per via naturales.
The most common cause of scarring on the uterus is СS (74.9 %). Scar after conservative myomectomy (CME) was in 109 (25.1 %) women. The average term after CME was (2.7±0.2) years. In contrast to women after CS, in whom the incision was always localized in the lower segment of the uterus, in patients with a scar on the uterus after CME, its location corresponded to the primary location of the removed myoma. Fundamental (28 or 25.7 %) and corporal (73 or 66.9 %) incisions were most often registered. Anomalies of placental attachment were a frequent phenomenon in 70.3 % of women, with a low location of the placenta in the structure of the lesion – 163 (53.3 %). Placenta accrete was registered in 42.8 % of pregnant women, placenta increta in 2.6 % and placenta previa in 1.3 %.
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