Ukrainian Journal Health of Woman. 2026. 3(184): 97-105. doi: 10.15574/HW.2026.3(184).97105
Kaminsky V. V.¹, Lakatosh P. V.², Lakatosh V. P.³, Kostenko O. Y.³, Lakatosh A. M.⁴, Melnyk Y. M.¹, Antonyuk M. I.^1
1Shupyk National Healthcare University of Ukraine, Kyiv
²Kyiv Perinatal Center, Ukraine
³Bogomolets National Medical University, Kyiv, Ukraine
⁴Kyiv City Center of Reproductive and Perinatal Medicine, Ukraine

For citation: Kaminsky VV, Lakatosh PV, Lakatosh VP, Kostenko OY, Lakatosh AM, Melnyk YM, Antonyuk MI. (2026). Modern approaches to diagnosis and surgical delivery management in women with placenta previa after cesarean section depending on the presence of placenta accreta spectrum. Ukrainian Journal Health of Woman. 3(184): 97-105. doi: 10.15574/HW.2026.3(184).97105
Article received: Apr 06, 2026. Accepted for publication: Jun 01, 2026.

Placenta previa (PP) after cesarean section (CS), when combined with placenta accreta spectrum (PAS), is associated with a high risk of blood loss, blood transfusion, and peripartum hysterectomy.
Aim – to evaluate prenatal diagnosis of PAS in pregnant women with PP and a uterine scar after CS and to compare the outcomes of staged organ-preserving surgical intervention (CLAP) and peripartum hysterectomy.
Materials and methods. Between 2022 and 2026, 145 pregnant women with PP after CS were examined: 66 with PP+PAS and 79 with PP without PAS. Risk factors and ultrasound (US) and magnetic resonance imaging (MRI) findings were assessed. The PP+PAS group was divided into the peripartum hysterectomy (n=36) and CLAP (n=30) subgroups. CLAP included CS above the placenta, bilateral internal iliac artery ligation, resection of the invasive area with metroplasty, and lower uterine segment compression using the KONIS suture. Blood loss, transfusion rates, and early neonatal outcomes were compared.
Results. In the PP+PAS group, a history of hysteroscopy (22.7%), uterine curettage/vacuum aspiration (42.4%), and assisted reproductive technologies (13.6%) were more common. Loss of the retroplacental clear zone on US was detected in 87.9% of cases, while T2 dark bands on MRI were observed in 81.8%. CLAP reduced intraoperative blood loss (2437±562 mL vs. 3328±720 mL) and the transfusion rate (60.0% vs 86.1%) without worsening early neonatal
outcomes.
Conclusions. Comprehensive assessment of risk factors and US and MRI findings facilitates timely diagnosis of PAS. CLAP reduces blood loss and transfusion requirements, enables uterine preservation, and does not adversely affect early neonatal outcomes.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent from women was obtained for the study.
The authors declare that there is no conflict of interest.
Keywords: placenta previa, placenta accreta spectrum, uterine scar, ultrasound, magnetic resonance imaging, CLAP, peripartum hysterectomy, cesarean section.

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