Early diagnosis of abnormally deep invasion of the chorion as a predictor of invasive placentation
- Authors: Volkov A.E.1, Solonchenko A.S.2, Rymashevsky A.N.1, Voloshin V.V.1, Khloponina A.V.1, Kantsurova M.R.1
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Affiliations:
- Rostov State Medical University, Ministry of Health of Russia
- Perinatal Center
- Issue: No 3 (2024)
- Pages: 180-186
- Section: Clinical Notes
- URL: https://journals.rcsi.science/0300-9092/article/view/258790
- DOI: https://doi.org/10.18565/aig.2024.33
- ID: 258790
Cite item
Abstract
Background: Placenta accreta spectrum (PAS) is an advanced invasive placentation, which is a serious condition associated with high maternal mortality due to massive uterine hemorrhages. These complications can be reduced by early diagnosis of PAS.
Case report: A 35-year-old multiparous patient with a burdened obstetric and gynecological history had indirect signs of abnormally deep invasion of the chorion which were revealed during ultrasound examination at 7+1 weeks gestation. The ultrasound scan showed a heterogeneous structure with the expansion of lacunar spaces and areas of hypervascularization of the myometrium of the anterior uterine wall. The diagnosis of abnormal placental attachment was confirmed by dynamic echography with stereoscopic blood flow imaging (LumiFlow). A planned cesarean section by transverse uterine fundal incision was performed at 37+2 weeks. Metroplasty was performed on both sides after ligation of the internal iliac and ovarian arteries. The diagnosis of PAS was confirmed by a pathology study, and placenta increta (PAS 3a) was verified.
Conclusion: The presented clinical observation clearly demonstrates the real possibility of early ultrasound diagnosis of advanced invasive placentation. The detection of signs of advanced invasive placentation at the earliest possible time of gestation suggests that patients can be referred to a high-risk PAS group for the subsequent search for specific signs of this placental pathology and optimal planning of organ-preserving methods of delivery in these patients.
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##article.viewOnOriginalSite##About the authors
Andrey E. Volkov
Rostov State Medical University, Ministry of Health of Russia
Author for correspondence.
Email: avolkov@aaanet.ru
ORCID iD: 0000-0002-5899-1252
PhD (Med.), Associate Professor, Department of Obstetrics and Gynecology No. 1
Russian Federation, Rostov-on-DonAlexey S. Solonchenko
Perinatal Center
Email: a-solonchenko@mail.ru
ORCID iD: 0009-0000-9971-5521
ultrasound diagnostics doctor at the Department of Antenatal Fetal Protection
Russian Federation, Rostov-on-DonAlexander N. Rymashevsky
Rostov State Medical University, Ministry of Health of Russia
Email: rymashevskyan@mail.ru
ORCID iD: 0000-0003-3349-6914
Dr. Sci. (Med.), Professor, Head of the Department of Obstetrics and Gynecology No. 1
Russian Federation, Rostov-on-DonVladimir V. Voloshin
Rostov State Medical University, Ministry of Health of Russia
Email: voloshinvv2006@yandex.ru
ORCID iD: 0000-0001-8632-082X
PhD (Med.), Associate Professor
Russian Federation, Rostov-on-DonAnna V. Khloponina
Rostov State Medical University, Ministry of Health of Russia
Email: annakhloponina@yandex.ru
ORCID iD: 0000-0002-2056-5231
Dr. Sci. (Med.), Head of the Department of Ultrasound Diagnostics of NIIAP
Russian Federation, Rostov-on-DonMaria R. Kantsurova
Rostov State Medical University, Ministry of Health of Russia
Email: madlax_san@mail.ru
ORCID iD: 0000-0003-4916-8042
Assistant at the Department of Obstetrics and Gynecology No. 1
Russian Federation, Rostov-on-DonReferences
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