The features of conservative management placenta accreta

Abstract

Aim. To investigate of effectiveness new conservative management by intraumbilical terlipressin in pregnant women with placenta accreta. Material and Methods. The study was performed at the National Pirogov Memorial Medical University, Vinnytsya, Ukraine, under budget grant No. 0121 U109141. This prospective clinical study included 32 women diagnosed with PA disorders admitted to Vinnytsia Regional Pirogov Clinical Hospital, Perinatal Center between March 2018 to May 2020. These cases were categorized into two groups according to the used approach for management: group (A), normotensive singleton women (n = 18) underwent cesarean section (CS) with resective-constructive surgery, group (B), normotensive singleton women (n = 14) underwent cesarean section (CS) with using intraumbilical terlipressin acetate (dilute 0.4 mg terlipressin acetate up to 20 mL with sodium chloride 0,9%). All pregnant women received informed consent to the extended examination algorithm provided for by the scientific investigation performed. In addition, the study was approved by the local ethics committee. Results. Previous C.S. (75,0%), multiparity more than two (68,75%), assisted reproductive technology (43,75%) and previous artificial abortions (81.25%) were significant risk factors for development of PA. The multiple logistic regression analysis showed that using intraumbilical terlipressin acetate (0.4 mg=4 ml diluted by 20 ml isotonic solution) allowed decreased intaoperative blood loss, ml (Difference (D) -433.33, Standard error (SE) 55.205, confidence interval [CI] -546.0726 to -320.5874, P < 0.001); CS time, min (D: -48.14, SE 4.63, 95% CI -57.5923 to -38.6877, P < 0.001); cases of postpartum anemia (adjusted odds ratio [aOR]: 2.53, 95% confidence interval [CI] 1.05–6.07, P=0.04); cases of puerperal septic complications (aOR: 2.33, 95% CI 0.55–9.85, P = 0.25); time of hospital discharge, days (D: -2.0, SE 0.26, 95% CI -2.5329 to -1.4671, P < 0.001). There was no case of maternal death. Conclusions. The management of PA disorders should be individualized. Patients with PA keen to preserve the uterus could be offered the option of using intraumbilical terlipressin acetate ((dilute 0.4 mg terlipressin acetate up to 20 mL with sodium chloride 0,9%)aiming at conservative management after proper counseling. This strategy allowed significant decreased intraoperative and postoperative blood losses, time of CS, cases of postpartum anemia, and time of hospital discharge.