Medical news
of the North Caucasus
Scientific journal
Mass media registration certificate dated December 7, 2006.
Series ПИ #ФС 77-26521.
Federal service for surveillance over non-violation of the legislation in the sphere of mass communications and protection of cultural heritage.
ISSN 2073-8137

Site search

Correspondence address
310 Mira Street, Stavropol, Russia, 355017

+7 865 2352511, +7 865 2353229.


Some aspects of the diagnosis and delivery in pregnant women with placenta accreta

Artem Lukashevich; Victor Aksenenko;

The contemporary view on pathophysiological mechanisms of placenta accreta, time of delivery, operative treatment of this pathology has been described. Risk factors of placenta accreta are highlighted. The algorithm of outpatient and inpatient management of pregnant women with placenta accreta has been presented. Understanding the pathogenesis, knowledge of risk factors and modern methods of delivery, timely diagnosis and staged hospitalization in hospitals of the 3rd degree of risk, will reduce the number of vitally dangerous complications caused by bleeding during placental ingrowth, the proportion of obstetric hemorrhages in the structure of causes of severe obstetric injuries and maternal mortality.


1. Heller D. S. Placenta accreta and percreta. Surgical Pathology Clinics. 2013;6(1):181-197. https://doi.org/10.1016/j.path.2012.10.003
2. Savel’eva G. M., Kurcer M. A., Breslav I. Ju. Placenta previa of the placenta accreta in patients with a scar on the uterus after a cesarean section. Clinical and morphological comparison. Akusherstvo i ginekologija. – Obstetrics and gynecology. 2015;11:41-45. (In Russ.).
3. Mogos M. F., Salemi J. L., Ashley M., Whiteman V. E., Salihu H. M. Recent trends in placenta accreta in the United States and its impact on maternal-fetal morbidity and healthcare-associated costs, 1998-2011. J. Matern. Fetal Neonatal Med. 2016;29:1077-1082. https://doi.org/10.3109/14767058.2015.1034103
4. Bowman Z. S., Eller A. G., Bardsley T. R., Greene T., Varner M. W., Silver R. M. Risk factors for placenta accreta: a large prospective cohort. Am. J. Perinatol. 2014;31:799-804. https://doi.org/10.1055/s-0033-1361833
5. Palacios-Jaraquemada J. M. Caesarean section in cases of placenta praevia and accreta. Best Practice Res. Clin. Obstet. Gynaecol. 2013;27(2):221-232. https://doi.org/10.1016/j.bpobgyn.2012.10.003
6. Pan X. Y. A marked increase in obstetric hysterectomy for placenta accreta. Chin. Med. J. 2015;128(16):2189-2193. https://doi.org/10.4103/0366-6999.162508
7. Jauniaux E., Collins S., Burton G. J. Placenta accrete spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am. J. Obstet. Gynecol. 2018;218:75-87. https://doi.org/10.1016/j.ajog.2017.05.067
8. Robert M. S., Kelli D. B. Placenta accreta spectrum: accreta, increta, and percreta. Obstetrics and Gynecology Clinics of North America. 2015;42(2):381-402. https://doi.org/10.1016/j.ogc.2015.01.014
9. Eller A. G., Bennett M. A., Sharshiner M., Masheter C., Soisson A. P., Dodson M. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet. Gynecol. 2011;117:331-337. https://doi.org/10.1097/aog.0b013e3182051db2
10. Duzyj C. M., Cooper A., Mhatre M., Han C. S., Paidas M. J. [et al.]. Placenta accreta: a spectrum of predictable risk, diagnosis, and morbidity. Am. J. Perinatol. 2018;11:30-30. https://doi.org/10.1055/s-0038-1676111
11. Eshkoli T., Weintraub A. Y., Sergienko R., Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am. J. Obstet. Gynecol. 2013;208:219.e1-219e7. https://doi.org/10.1016/j.ajog.2012.12.037
12. Bowman Z. S., Eller A. G., Bardsley T. R., Greene T., Varner M. W., Silver R. M. Risk factors for placenta accreta: a large prospective cohort. Am. J. Perinatol. 2014;31:799-804. https://doi.org/10.1055/s-0033-1361833
13. Wang Y., Zeng L., Niu Z., Chong Y., Zhang A. [et al.]. An observation study of the emergency intervention in placenta accreta spectrum. Arch. Gynecol. Obstet. 2019;4:5-5. https://doi.org/10.1007/s00404-019-05136-6
14. Garmi G., Salim R. Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet. Gynecol. Int. 2012;2012:7-7. https://doi.org/10.1155/2012/873929
15. Baldwin H. J., Patterson J. A., Nippita T. A., Torvaldsen S., Ibiebele I., Simpson J. M. Antecedents of abnormally invasive placenta in primiparous women: risk associated with gynecologic procedures. Obstet. Gynecol. 2018;131:227-233. https://doi.org/10.1097/AOG.0000000000002434
16. Shamshirsaz A. A., Fox K. A., Salmanian B., Diaz-Arrastia C. R., Lee W., Baker B. W. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am. J. Obstet. Gynecol. 2015;212:218.e1-218e9. https://doi.org/10.1016/j.ajog.2014.08.019
17. Collins S. L., Ashcroft A., Braun T., Calda P., Langhoff-Roos J., Morel O. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). European Working Group on Abnormally Invasive Placenta, (EW-AIP). Ultrasound Obstet. Gynecol. 2016;47:271-275. https://doi.org/10.1002/uog.14952
18. Cali G., Forlani F., Lees C., Timor-Tritsch I., Palacios-Jaraquemada J. [et al.]. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet. Gynecol. 2019;3:4-4. https://doi.org/10.1002/uog.20246
19. Zhang H. J., Dou R. C., Lin L., Wang Q. Y., Huang B. E. [et al.]. Risk factors and sonographic findings associated with the type of placenta accreta spectrum disorders. Zhonghua Fu Chan Ke Za Zhi. 2019;54(1):27-32. https://doi.org/10.3760/cma.j.issn.0529-5675.2019.01.007
20. Comstock C. H., Bronsteen R. A. The antenatal diagnosis of placenta accreta. BJOG. 2014;121(2):171-181. https://doi.org/10.1111/1471-0528.12557
21. Jauniaux E., Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2017;217(1):27-36. https://doi.org/10.1016/j.ajog.2017.02.050
22. Bowman Z. S., Eller A. G., Kennedy A. M. [et al.]. Accuracy of ultrasound for the prediction of placenta accreta. Am. J. Obstet. Gyneol. 2014;211:177.e1-177e7. https://doi.org/10.1016/j.ajog.2014.03.029
23. Rac M. W. F., Dashe J. S., Wells C. E. [et al.]. Ultrasound predictors of placental invasion: the Placenta Accreta Index. Am. J. Obstet. Gynecol. 2015;212:343.e1-343e7. https://doi.org/10.1016/j.ajog.2014.10.022
24. D’Antonio F., Iacovella C., Bhide A. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2014;44(1):8-16. https://doi.org/10.1002/uog.13327
25. Einerson B. D., Rodriguez C. E., Kennedy A. M., Woodward P. J., Donnelly M. A., Silver R. M. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am. J. Obstet. Gynecol. 2018;218:618e1-618e7. https://doi.org/10.1016/j.ajog.2018.03.013
26. Tanimura K., Yamasaki Y., Ebina Y., Deguchi M., Ueno Y. [et al.]. Prediction of adherent placenta in pregnancy with placenta previa using ultrasonography and magnetic resonance imaging. Eur. J. Obstet. Gynecol. Reprod. Biol. 2015;187:41-44. https://doi.org/10.1016/j.ejogrb.2015.02.017
27. Lim G., Horowitz J. M., Berggruen S., Ernst L. M., Linn R. L. [et al.]. Correlation of probability scores of placenta accreta on magnetic resonance imaging with hemorrhagic morbidity. J. Clin. Anesth. 2016;34:261-269. https://doi.org/10.1016/j.jclinane.2016.04.046
28. Familiari A., Liberati M., Lim P., Pagani G., Cali G. [et al.]. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis. Acta Obstet. Gynecol. Scand. 2018;97(5):507-520. https://doi.org/10.1111/aogs.13258
29. Cahill A. G., Beigi R., Heine R. P., Silver R. M., Wax J. R. Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. Placenta accreta spectrum. Am. J. Obstet. Gynecol. 2018;219(6):B2-B16. https://doi.org/10.1016/j.ajog.2018.09.042
30. Kurtser M. A., Breslav I. Yu., Latyshkevich O. A., Grigor’yan A. M.Temporary balloon occlusion of the common iliac arteries in patients with a scar on the uterus after cesarean section and placenta accreta. Benefits and possible complications. Akusherstvo i ginekologija. – Obstetrics and Gynecology. 2016;12:70-75. (In Russ.). https://dx.doi.org/10.18565/aig.2016.12.70-5
31. Chandraharan E., Rao S., Belli A. M. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Inter. J. Gynaecol. Obstetrics. 2012;117(2):191-194. https://doi.org/10.1016/j.ijgo.2011.12.005
32. Silver R. M., Fox K. A., Barton J. R. Center of excellence for placenta accreta. Am. J. Obstetrics Gynecol. 2015;212(5):561-568. https://doi.org/10.1016/j.ajog.2014.11.018
33. Strizhakov A. N., Davydov A. I., Budanov P. V. Necrosis of the uterus after the imposition of compression stitches for postpartum hypotonic bleeding. Voprosy ginekologii, akusherstva i perinatologii. – Gynecology, Obstetrics and Perinatology Issues. 2013;3:76-79. (In Russ.).
34. Koyama E., Naruse K., Shigetomi H. Combination of B-Lynch brace suture and uterine artery embolization for atonic bleeding after cesarean section in a patient with placenta previa accreta. J. Obstet. Gynaecol. Res. 2012;38(1):345-348. https://doi.org/10.1111/j.1447-0756.2011.01699.x
35. Tskhai V. B., Pavlov A. V., Garber Yu. G. Evaluation of the effectiveness of uterine artery embolization in reducing intraoperative blood loss in pregnant women with full placenta previa. Akusherstvo i ginekologija. – Obstetrics and Gynecology. 2015;8:59-64. (In Russ.).
36. D’Souza D. L., Kingdom J. C., Amsalem H. Conservative management of invasive placenta using combined prophylactic internal iliac artery balloon occlusion and immediate postoperative uterine artery embolization. Can. Association Radiol. J. 2015;66(2):179-184. https://doi.org/10.1016/j.carj.2014.08.002
37. Liu J., Wang Y., Jiao D., Zhang W., Han X. Prophylactic occlusion balloon placement in the abdominal aorta combined with uterine or ovarian artery embolization for the prevention of cesarean hysterectomy due to placenta ac creta: a retrospective study. Cardiovasc. Intervent. Radiol. 2019;42(6):829-834. https://doi.org/10.1007/s00270-019-02170-4
38. Tskhai V. B., Yametov P. K., Brezhneva N. V. The effectiveness of endovascular occlusion of arterial vessels in reducing intraoperative blood loss in pregnant women with placenta previa. Akusherstvo i ginekologija. – Obstetrics and Gynecology. 2015;10:5-10. (In Russ.).
39. Mei Y., Zhao H., Zhou H., Jing H., Lin Y. Comparison of infrarenal aortic balloon occlusion with internal iliac artery balloon occlusion for patients with placenta accreta. BMC Pregnancy Childbirth. 2019;19(1):147-147. https://doi.org/10.1186/s12884-019-2303-x
40. Chen M., Lv B., He G., Liu X. Internal iliac artery balloon occlusion during cesarean hysterectomy in women with placenta previa accreta. Int. J. Gynaecol. Obstet. 2019 Apr;145(1):110-115. https://doi.org/10.1002/ijgo.12763
41. Zhou X., Sun X., Wang M., Huang L., Xiong W. The effectiveness of prophylactic internal iliac artery balloon occlusion in the treatment of patients with pernicious placenta previa coexisting with placenta accreta. J. Matern. Fetal Neonatal Med. 2019;9:1-6. https://doi.org/10.1080/14767058.2019.1599350
42. Vinitskii A. A., Shmakov R. G., Chuprynin V. D. Comparative evaluation of the effectiveness of methods of surgical hemostasis in organ-preserving delivery in patients with placenta ingrowth. Akusherstvo i ginekologija. – Obstetrics and Gynecology. 2017;7:68-74. (In Russ.). https://doi.org/10.18565/aig.2017.7.68-74

Keywords: placenta accreta, metroplasty, uterine artery embolization, balloon occlusion of common iliac arteries

Stavropol State Medical Academy
Pyatigorsk State Research Institute of Balneotherapeutics
Pyatigorsk State Pharmaceutical Academy