Cesarean section saves thousands of lives, but at the same time, it causes negative consequences for a woman's body. One of the most dangerous is placenta accreta spectrum, which is occurring more frequently today as the number of cesarean sections is increasing. Modern techniques and organ-preserving surgeries are becoming particularly necessary under such circumstances.
What is placenta accreta spectrum and how does it occur
Placenta accreta spectrum is an abnormal attachment of the placenta to the uterine wall, which occurs due to a defect in the decidual and fibrinoid layers. In simple terms, the placenta, which normally separates on its own after childbirth, grows into the uterine tissues and sometimes into adjacent organs. Attempting to remove such a placenta can cause massive hemorrhage.
The overall incidence of placenta accreta is one in 500-700 births. The risk of the syndrome increases in cases of placenta previa—for women who have not undergone a C-section but have previa, it is about 3%. However, a cesarean scar significantly increases the risk of accreta even in the absence of 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 fusing with uterine tissues.
Each subsequent cesarean section increases the risk of the syndrome. As explained in an interview with UNN by Dmytro Govseiev, Director of the Kyiv Perinatal Center, Honored Doctor, obstetrician-gynecologist of the highest category, and Doctor of Medical Sciences, there are currently few cases where a woman opts for natural labor after a C-section.
"When I was studying, no one could show us this (placenta accreta - ed.)—it almost didn't exist. 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. Not only because women want it, but also because the list of indications has been expanded. And with a first scar, few doctors now go for natural labor. This provokes the development of the pathologies I mentioned," says Dmytro Govseiev.
Organ-preserving surgery – preserving reproductive health
But medical science does not stand still; for example, the capital's Perinatal Center performs a unique organ-preserving surgery in cases of placenta accreta. In world practice, such operations are categorized as rare and extremely complex. Every year, the Kyiv Perinatal Center performs up to 20 such highly specialized interventions.
This operation has replaced what was once the standard treatment for the syndrome—hysterectomy (removal of the uterus). Organ-preserving surgery is a fundamentally different approach. Surgeons do not try to separate the ingrown placenta but remove only the affected area of the uterus—preserving the organ as much as possible. This requires surgical precision, excellent knowledge of vascular anatomy, and the coordinated work of a multidisciplinary team.
In most cases, the syndrome is diagnosed during pregnancy, i.e., before delivery. This makes it possible to prepare for the operation, planning 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 complex cases where the organ cannot be saved. At the same time, techniques are constantly being improved. For example, this year the capital's Perinatal Center performed an ultra-complex uterus-preserving operation: a patient with her fifth pregnancy and scars from several C-sections had placenta previa and accreta. There was a high risk of the placenta growing into adjacent organs, particularly the bladder. The situation was threatening, as massive bleeding could have occurred even before labor began.
In most clinics, such situations end in surgical delivery followed by the removal of the uterus, as the risk of uncontrolled blood loss is extremely high. However, the surgical team of the Perinatal Center performed a planned intervention using a unique organ-preserving technique by Doctor of Medical Sciences Dmytro Govseiev, who personally operated on the patient. The patient gave birth to a child, and the medical team managed to save 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 Govseiev.