Due to a noticeable increase in the number of cesarean section births in Ukraine and worldwide, the frequency of such a complex obstetric pathology as placenta accreta has increased. However, capital city doctors have learned to perform ultra-complex organ-preserving surgeries for women who have encountered it. Vasyl Beniuk, obstetrician-gynecologist, Doctor of Medical Sciences, Professor, and Head of the Department of Faculty Obstetrics and Gynecology at the Bogomolets National Medical University, spoke about where such operations are performed in an interview with UNN.
"Cesarean section is indeed associated with an increased risk of placenta accreta — it is one of the main risk factors. The pathology is called placenta accreta spectrum (PAS): the placenta attaches too deeply or grows into the uterine wall.
After a cesarean, a scar remains on the uterus. In a subsequent pregnancy, the placenta can implant exactly in the scar area, where the normal layer between the placenta and the uterine muscle is disrupted," the professor explains.
According to Beniuk, the risk increases especially if there have been several cesarean sections (with the first scar it is about 0.3%, with the third — already over 6%), if there is placenta previa, or if there were other surgeries on the uterus (myomectomy, curettage, etc.).
The main danger entailed by such a pathology is massive bleeding during childbirth or attempts to detach the placenta. In some cases, to save the woman's life, the necessity of removing the uterus arises.
"In severe forms of PAS, removal of the uterus is often the standard of treatment, as it is the safest way to stop bleeding. At the same time, in milder or localized forms, it is possible to save the uterus. This depends on the depth of penetration, the localization of the placenta, the volume of bleeding, the experience of the center, and the woman's reproductive plans," says Professor Beniuk.
But in Ukraine, the field of organ-preserving surgeries has been actively developing in recent years.
"One of the leading centers in Kyiv performing complex organ-preserving surgeries is the Kyiv Perinatal Center under the leadership of Professor Dmytro Govseiev. Every year, the perinatal center performs more than 20 organ-preserving surgeries on patients with placenta accreta. In particular, in 2024, the doctors of the Kyiv Perinatal Center managed to preserve the uterus even for a patient after several cesarean sections with placenta previa and accreta.
In general, pregnant women from the city of Kyiv with complicated pregnancies and premature births before the 34th week of gestation are referred to the Kyiv Perinatal Center, and our colleagues demonstrate good obstetric and perinatal results," Professor Beniuk said.
Staff members of the Department of Faculty Obstetrics and Gynecology at the O.O. Bogomolets National Medical University, headed by Professor Beniuk, also provide assistance for complications related to placenta accreta. We have two bases for providing assistance to pregnant women and new mothers – the Mother and Child Center of the KNP 'Kyiv City Hospital No. 5' and the KNP 'Kyiv City Hospital No. 3'.
"In particular, I must say that in 2024, together with Professor Dmytro Govseiev, we published the monograph 'Obstetric Hemorrhages,' which, among other things, discusses organ-preserving surgeries for complications of the placenta accreta spectrum. The experience of organ-preserving treatment for placenta accreta is a combination of thorough preoperative preparation, a multidisciplinary team (obstetricians, vascular surgeons, anesthesiologists, transfusiologists), and a clear protocol of action.
Techniques such as balloon vascular occlusion, vascular embolization, local resection, leaving part of the placenta under control, staged uterine devascularization, and multidisciplinary interventions involving vascular surgeons and urologists are used," the professor describes the methodology.
Beniuk emphasizes that for a woman with suspected placenta accreta, the choice of the place of delivery is a critically important decision.
"But it is important to understand several things: organ-preserving surgery is not possible in all cases, the decision is often made during the operation itself, the main priority is the safety of the woman's life and bleeding control; in cases of placenta percreta (especially with penetration into the bladder), hysterectomy is still often the safest option.
The best results usually occur when the diagnosis is established during pregnancy – ultrasound and MRI provide us with this opportunity, the birth is planned in advance, and the operation is performed in a center that has experience in surgeries for placenta accreta, a blood bank, intensive care, and a multidisciplinary team," the professor concluded.