Modern approach to transfusion therapy of massive hemorrhage due to abnormally invasive placenta

Abnormally invasive placenta (AIP), or according to modern terminology PAS (placenta accrete spectrum disorders), is one of the most dangerous obstetric pathologies of pregnancy. It is quite often accompanied by massive blood loss during childbirth. Indicators of placenta accretion are increasing sharply, taking into account the frequency of delivery by cesarean section (CS).The objective: to determine the effectiveness of the blood loss recovery program in the case of delivery of pregnant women with AIP according to modern principles of transfusion therapy of massive blood loss with the use of innovative methods of surgical hemostasis.Materials and methods. At the clinical bases of the Department of Obstetrics and Gynecology N 1 of the Shupyk National Healthcare University of Ukraine during 2018–2023, 49 pregnant women with Placenta рercreta 3a,b were operated by fundal SC.The main group included 19 pregnant women with antenatally diagnosed Placenta percreta, who were delivered by fundal SC followed by hysterectomy with fallopian tubes and restoration of blood loss according to the principles of Damage Control Resuscitation – DCR (during 2021–2023) with priority given to transfusion with blood products with minimization infusion therapy; the comparison group included 30 pregnant women with a similar diagnosis and surgical approach, who had the recovery of massive blood loss in accordance with order No. 205 of the Ministry of Health of Ukraine “Obstetric bleeding” with the priority of rapid infusion therapy with crystalloids (2018-2020).Results. All pregnant women from Pl. percreta were delivered by CS and had hysterectomy at 35–37 weeks of pregnancy with lower median laparotomy and endotracheal anesthesia. The study groups did not differ in terms of the volume of surgery, but differed in the program of transfusion therapy to restore blood loss.In the main group, in which the early start of transfusion therapy using single-group fresh-frozen plasma and erythrocyte mass was applied, a significantly lower frequency of the development of the syndrome of disseminated intravascular blood coagulation, relaparotomy, cases of severe postoperative anemia and a shorter length of stay in the obstetric hospital were determined (p<0.05).Conclusions. The use of innovative surgical technologies, tranexamic acid preparations and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion, according to the Damage Control Resuscitation strategy, in the development of massive intraoperative bleeding in cases of Placenta percreta allows to reduce the volume of blood loss and to prevent severe intra- and postoperative complication.