Cesarean section increases the risk of placental ingrowth into the uterine walls. The Perinatal Center in Kyiv performs unique organ-preserving surgeries.
Cesarean delivery saves thousands of lives but also causes adverse effects on a woman’s body. One of the most dangerous is placenta accreta syndrome, which is occurring more frequently today as the number of C-sections increases. Advanced techniques and organ-preserving surgeries become particularly necessary in such circumstances.
What is Placenta Accreta Syndrome and How Does it Occur
Placenta accreta syndrome is an abnormal attachment of the placenta to the uterine wall, caused by a defect in the decidual and fibrinoid layers. In simple terms, the placenta, which normally detaches on its own after childbirth, grows into the uterine tissues, and sometimes into adjacent organs. Attempting to remove such a placenta can cause massive bleeding.
The overall incidence of placenta accreta is one in 500-700 births. The risk of developing the syndrome increases in cases of placenta previa. For women who have not had a C-section but have placenta previa, the risk is about 3%. However, a scar from a C-section significantly raises the risk of ingrowth even without other pathologies. This happens due to the formation of scar tissue at the site of the uterine incision and damage to the protective layer that previously prevented placental cells from adhering to the uterine tissues.
Each subsequent cesarean section increases the risk of the syndrome. As the Director of the Perinatal Center of Kyiv, Honored Doctor, obstetrician-gynecologist of the highest category, Doctor of Medical Sciences Dmytro Govseev, explained in an interview with UNN, there are few cases today where a woman opts for natural childbirth after a C-section.
“When I was studying, no one could show us this (placental ingrowth – ed.) – it almost didn’t happen. Previously, only 9% of births were by cesarean section. And we weren’t praised for it. Now it’s 30% of births. And it will be more. And not only because women want it, but also because the list of indications has expanded. And with the first scar, very few doctors opt for natural childbirth anymore. And this provokes the development of pathologies that I have already mentioned,” says Dmytro Govseev.
Organ-Preserving Surgery – Preserving Reproductive Health
However, medical science does not stand still. For example, the Perinatal Center of the capital performs a unique organ-preserving surgery in cases of placental ingrowth. In global practice, such operations are considered rare and extremely complex. Annually, the Perinatal Center of Kyiv performs up to 20 such highly specialized interventions.
This surgery has replaced the once-standard treatment for the syndrome – hysterectomy. Organ-preserving surgery is a fundamentally different approach. Surgeons do not attempt to detach the ingrown placenta but remove only the affected part of the uterus, preserving the organ as much as possible. This requires meticulous precision, excellent knowledge of vascular anatomy, and coordinated work of a multidisciplinary team.
In most cases, the syndrome is diagnosed during pregnancy, i.e., before childbirth. This allows for preparation for surgery, scheduling it for the optimal time. The surgery itself is performed by a team including obstetricians, vascular surgeons, urologists, and anesthesiologists.
However, as doctors note, there are also complex cases where the organ cannot be preserved. At the same time, techniques are constantly being improved. For instance, this year, the Perinatal Center of the capital performed a highly complex uterine-preserving surgery: a patient with her fifth pregnancy and scars from several C-sections had placenta previa and ingrowth. There was a high risk of the placenta growing into adjacent organs, including the bladder. The situation was critical, as massive bleeding could have occurred even before labor began.
In most clinics, similar situations result in operative delivery followed by hysterectomy, as the risk of uncontrollable blood loss is extremely high. However, the surgical team of the Perinatal Center performed a planned intervention using the unique organ-preserving technique developed by Doctor of Medical Sciences Dmytro Govseev, who personally operated on the patient. The patient gave birth to a child, and the medical team managed to preserve the uterus.
“I believe the technique is unique. And it needs to be passed on to future generations, as it can help a large number of women,” says Dmytro Govseev.