urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2023-22-1-4-13urmj-1186Research ArticleОригинальные статьи | Original articlesOriginal articlesПредлежание плаценты: факторы риска, материнские и перинатальные исходыPlacenta previa: risk factors, maternal and perinatal outcomeshttps://orcid.org/0000-0001-5507-9471ЧулановаЮ. С.ChulanovaYu. S.

Юлия Сергеевна Чуланова 

Челябинск

Yulija S. Chulanova 

Chelyabinsk

y.chul@mail.ruhttps://orcid.org/0000-0001-9535-1871СюндюковаЕ. Г.SyundyukovaE. G.

Елена Геннадьевна Сюндюкова – доктор медицинских наук, доцент 

Челябинск

Elena G. Syundyukova – Doctor of Science (Medicine), Associate Professor 

Chelyabinsk

seg269@mail.ruhttps://orcid.org/0000-0002-6007-1041СашенковС. Л.SashenkovS. L.

Сергей Львович Сашенков – доктор медицинских наук, профессор 

Челябинск

Sergey L. Sashenkov – Doctor of Science (Medicine), Professor 

Chelyabinsk

sashensl@yandex.ruhttps://orcid.org/0000-0002-0952-6856ЧулковВ. С.ChulkovV. S.

Василий Сергеевич Чулков – доктор медицинских наук, доцент 

Челябинск

Vasilij S. Chulkov – Doctor of Science (Medicine), Associate Professor 

Chelyabinsk

vschulkov@rambler.ruУшаковаК. А.UshakovaK. A.

Ксения Александровна Ушакова 

Челябинск

Ksenija A. Ushakova 

Chelyabinsk

usksu@ya.ruТомиловаА. Г.TomilovaA. G.

Арина Григорьевна Томилова 

Челябинск

Arina G. Tomilova 

Chelyabinsk

burmistrovaarinaa@yandex.ruФилипповаН. А.FilippovaN. A.

Наталия Александровна Филиппова – кандидат медицинских наук 

Челябинск

Natalija A. Filippova – Ph.D. in medicine 

Chelyabinsk

filnat_69@mail.ruТарасоваЛ. Б.TarasovaL. B.

Людмила Бернардовна Тарасова – кандидат медицинских наук, доцент 

Челябинск

Ljudmila B. Tarasova – Ph.D. in medicine, Associate Professor 

Chelyabinsk

tarasovalb12@gmail.comЯковлеваЮ. А.YakovlevaYu. A.

Юлия Александровна Яковлева – кандидат медицинских наук, доцент 

Челябинск

Yulija A. Yakovleva – Ph.D. in medicine, Associate Professor 

Chelyabinsk

yakovlevoi@mail.ruЮжно-Уральский государственный медицинский университетРоссияSouth Ural State Medical UniversityRussian Federation202314032023221413Copyright © Чуланова Ю.С., Сюндюкова Е.Г., Сашенков С.Л., Чулков В.С., Ушакова К.А., Томилова А.Г., Филиппова Н.А., Тарасова Л.Б., Яковлева Ю.А., 20232023Чуланова Ю.С., Сюндюкова Е.Г., Сашенков С.Л., Чулков В.С., Ушакова К.А., Томилова А.Г., Филиппова Н.А., Тарасова Л.Б., Яковлева Ю.А.Chulanova Y.S., Syundyukova E.G., Sashenkov S.L., Chulkov V.S., Ushakova K.A., Tomilova A.G., Filippova N.A., Tarasova L.B., Yakovleva Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1186

Предлежание плаценты (ПП), особенно инвазивные формы (placenta accreta spectrum PAS), одна из ведущих причин материнской и перинатальной заболеваемости и смертности. Цель исследования – выделить основные факторы риска предлежания плаценты на основании изучения особенностей анамнеза, исходов беременности и родов для матери и плода. Материалы и методы. Ретроспективное когортное исследование методом сплошной выборки: 1 группа – 64 пациентки с ПП, 2 группа – 30 женщин с нормальными родами. Изучены анамнез женщин, исходы беременности. Статистические расчеты: критерии Манна-Уитни, χ2 Пирсона, показателя отношение шансов (ОШ). Результаты. Вероятность ПП повышает наличие в анамнезе женщины операций кесарева сечения (ОШ 20,53 (7,2–58,53), p < 0,001), преждевременных родов (ОШ 4,29 (1,45–12,68), р = 0,04), аборта (ОШ 3,77 (2,32–6,12), р = 0,004), в том числе искусственного (ОШ 14,16 (4,95–40,53), р = 0,001) и самопроизвольного (ОШ 3,65 (2,01–6,62), р = 0,02), а также соматические заболевания (ОШ 6,17 (3,8–10,02), p < 0,001), особенно наличие анемии (ОШ 19,84 (6,95–56,61), p < 0,001), заболеваний ЖКТ (ОШ 13,18 (4,6–37,75), р = 0,002), избыточной массы тела / ожирения (ОШ 6,23 (2,14–18,14), р = 0,015), варикозной болезни (ОШ 5,37 (1,84–15,72), р = 0,005). Угроза невынашивания (р = 0,012), плацентарные нарушения (р = 0,012), анемия (р = 0,026), генитальная инфекция (р = 0,023) регистрировались чаще у женщин с предлежанием плаценты. Все женщины с ПП были родоразрешены кесаревым сечением, часто преждевременно (45,3 %; р < 0,001), экстренно (45,3 %, р < 0,001) по поводу кровотечения (37,5 %, р < 0,001). Расширение объема операции потребовалось в 37,5 % случаях, гемотрансфузия – 50,0 %. Морфофункциональные показатели (масса, рост, оценки по шкале Апгар) детей от матерей с ПП были достоверно меньше, а частота асфиксии, респираторного дистресс-синдрома, ИВЛ больше, чем в группе контроля. Обсуждение. ПП и PAS – потенциально опасные патологии для жизни и здоровья женщины и ребенка, что подтверждают результаты настоящего исследования. Однако на амбулаторном этапе выявлены проблемы диагностики данной патологии. Кроме общеизвестных факторов риска аномальной плацентации, обсуждаются ассоциации ПП с низким социально-экономическим статусом женщины и рядом соматических нозологий , таких как ожирение, анемия, заболевания желудочно-кишечного тракта, варикозная болезнь, влияние которых, вероятно, опосредованное. Частота прогестероновой поддержки при предлежании плаценты оказалась выше в сравнении с контролем (р = 0,005), поэтому нельзя исключить связь избыточного использования гестагенов с аномальной плацентацией . Заключение. Факторами риска ПП оказались наличие в анамнезе кесарева сечения, абортов, преждевременных родов, низкий социально-экономический статус, соматическая патология (избыточная масса тела / ожирение, анемия, заболевания ЖКТ, варикозная болезнь). ПП ассоциировано с высокой частотой угрозы невынашивания, плацентарных нарушений , генитальной инфекции, преждевременных родов, операций кесарево сечение, кровотечений , снижением морфофункциональных показателей новорожденных, перинатальной заболеваемостью и смертностью.

Introduction. Placenta previa (PP), especially invasive forms (placenta accreta spectrum PAS), is one of the leading causes of maternal and perinatal morbidity and mortality. The aim of the study is to study the features of the anamnesis, pregnancy and childbirth outcomes for the mother and fetus with placenta previa, and to identify the main risk factors for this pathology. Materials and methods. Retrospective cohort study by continuous sampling method: Group 1 – 64 patients with PP, 2 – 30 women with normal childbirth. The anamnesis of women and pregnancy outcomes were studied. Statistical calculations: Mann-Whitney criteria, χ2 Pearson, odds ratio indicator (OSH). Results. The probability of PP increases in a woman's history with cesarean section in anamnesis (OR 20.53 (7.2–58.53), p < 0.001), premature birth (OR 4.29 (1.45–12.68), p = 0.04), abortion (OR 3.77 (2.32– 6.12), p = 0.004), including induced (OR 14.16 (4.95–40.53), p = 0.001) and spontaneous (OR 3.65 (2.01–6.62), p = 0.02), as well as somatic diseases (OR 6.17 (3.8–10.02), p < 0.001), especially the presence of anemia (OR 19.84 (6.95–56.61), p < 0.001), gastrointestinal diseases (OR 13.18 (4.6–37.75), p = 0.002), overweight/obesity (OR 6.23 (2.14–18.14), p = 0.015), varicose veins (OR 5.37 (1.84–15.72), p = 0.005). The threat of miscarriage (p = 0.012), placental disorders (p = 0.012), anemia (p = 0.026), genital infection (p = 0.023) were recorded more often in women with placenta previa. All women with PP were delivered by operation caesarean section, often prematurely (45.3 %; p < 0.001), urgently (45.3 %, p < 0.001) because of bleeding (37.5 %, p < 0.001). The expansion of the volume of surgery was required in 37.5 % of cases, hemotransfusion – 50.0 %. Morphofunctional indicators of children from mothers with PP were significantly lower, and the frequency of asphyxia, respiratory distress syndrome, аrtificial lung ventilation was higher than in the control group. Discussion. PP and PASS are potentially dangerous pathologies for the life and health of women and children, which is confirmed by the results of this study. However, problems of diagnosis of this pathology were revealed at the outpatient stage. In addition to the well-known risk factors for abnormal placentation, associations of PP with a low socio-economic status of a woman and a number of somatic nosologies, such as obesity, anemia, gastrointestinal tract diseases, varicose veins, the influence of which is probably indirect. The association of abnormal placentation with excessive use of gestogens during pregnancy cannot be ruled out. Conclusions. The risk factors for PP were the presence of a history of cesarean section, abortions, premature birth, low socio-economic status, somatic pathology (overweight / obesity, anemia, gastrointestinal diseases, varicose veins). PP is associated with a high frequency of the threat of miscarriage, placental disorders, genital infection, premature birth, cesarean section operations, bleeding, decreased morphofunctional indicators of newborns, perinatal morbidity and mortality

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The authors declare that there are no conflicts of interest present.