Blood saving possibilities in delivering patients with placenta increta

Abstract

According to the results of systematic reviews of WHO, maternal mortality associated with massive bleeding almost reached 30% and has no tendency to decrease. Among the causes of massive obstetric hemorrhage, the most challenging ones are uterine hypotension and morbidity adherence placenta. Most severe complication for placentation is placenta increta in the uterine wall. Over the past 50 years, the number of cases with morbidity adherence placenta has increased tenfold. By all indications, this pathology has taken on the character of an epidemic and is one of the main causes for massive blood loss and blood transfusion, as well as peripartum hysterectomy. For surgical hemostasis in this pathology we apply X-ray vascular methods (temporary balloon occlusion of large vessels, vascular embolization), ligation of the iliac, uterine, ovarian arteries, various versions of distal hemostasis, including the use of uterine turnstiles, intrauterine and vaginal cylinders, compression sutures. However, data confirming the advantage of any specified methods are not enough. The risk of massive bleeding is high while using any of these methods. The article analyzes the blood saving methods existing at the present stage and possibility of these methods usage in obstetrics. Besides, we describe efficacy and safety of their use in massive blood loss, including the surgical treatment of morbidity adherence placenta.

Keywords

• placenta increta
• massive blood loss
• blood saving methods