IMPROVING THE MANAGEMENT OF PREGNANCY AND DELIVERY IN CASES OF PLACENTAL LOCALIZATION IN THE AREA OF A UTERINE SCAR AFTER CESAREAN SECTION AND PREVENTION OF COMPLICATIONS
Abstract
Placental tissue attached to the area of a scar defect in the uterine wall formed after a cesarean section is considered a high-risk obstetric condition. The risk is particularly significant when the placenta is low-lying, placenta previa is present, or ultrasound examination reveals signs of placenta accreta spectrum (PAS). The main threats include antenatal and intraoperative hemorrhage, preterm delivery, a substantial need for blood transfusion, injury to adjacent organs, and emergency hysterectomy.This study systematizes current approaches to the management of pregnant women with this type of placental localization. It emphasizes the importance of early risk assessment based on obstetric history and high-quality ultrasound examination with color Doppler imaging. In equivocal cases, additional diagnostic methods may be required. A scheme for referral to an appropriate medical facility, delivery planning, and prevention of hemorrhagic and surgical complications is described.Improvement of management strategy involves repeated risk reassessment, timely transfer of high-risk patients to specialized centers, participation of a multidisciplinary team, preparation of adequate blood supplies, and individualized selection of the timing and mode of delivery for each woman.