TERSİYER BİR MERKEZİN 5 YILLIK VERİLERİNİN RETROSPEKTİF ANALİZİ: PLASENTAL İNVAZYON DERECESİ OPERATİF TEKNİĞİ ETKİLİYOR MU?
Abstract
Amaç: Çalışmanın amacı plasenta invazyon derecesi ile tedavide kullanılan cerrahi yöntemlerin ilişkisinin incelenmesiydi.
Yöntem: Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde 2017-2022 yılları arasında sezaryen yapılan ve histopatolojik inceleme sonrası plasenta akreata spekturumu (PAS) tanısı alan olgular çalışmaya dahil edildi. Olguların yaşı, gebelik sayısı, daha önce geçirdikleri sezaryen sayısı, uygulanan cerrahi yöntem, eritrosit transfüzyon ihtiyaçları ve histopatolojik inceleme sonuçları elektronik ve basılı hasta dosyalarından elde edilerek olgu formuna kaydedildi. Vakaların yönetiminde kullanılan operatif teknikler, sezaryen+bilateral uterin arter ligasyonu, sezaryen+segmental rezeksiyon, sezaryen+bilateral uterin arter ligasyonu+segmental rezeksiyon+bilateral internal iliak arter ön dal ligasyonu ve son olarak sezaryen+histerektomi şeklinde belirlendi.
Bulgular: Dahil edilme kriterlerini karşılayan 109 olgu retrospektif çalışmaya alındı. Olguların medyan yaşı 33 (IQR:7), geçirilmiş sezaryen sayısı ise 2 (IQR:1) olarak bulundu. Yapılan analizlerde sezaryen sayısı ile invazyon derecesi arasında pozitif korelasyon saptandı. (p<.001). 52 (%48.6) olguda organ koruyucu cerrahi, 55 (%51.4) olguda ise sezaryen histerektomi operasyonu uygulandı. Histopatolojik incelemeler sonucunda 45 (%42.2) olguda PAS grade 1, 40 (%37.3) olguda PAS grade 2 ve 22 (%20.5) olguda PAS grade 3 saptandı. Uygulanan operatif yöntemler ile histopatolojik sonuçlar arasında bir korelasyon gösterilemedi (p=.394). Yine aynı şekilde cerrahi yöntemler ile daha önceden geçirilmiş sezaryen sayısı arasında bir korelasyon saptanmadı (p=.652). Olgular için gerekli olan eritrosit transfüzyon sayıları ile plasental invazyon derecesi arasında bir korelasyon gösterilmedi (p=.151).
Sonuç: Plasental invazyon derecesi daha önce geçirilmiş sezaryen sayısı ile orantılı şekilde artmaktadır. Operasyon tipi ve eritrosit transfüzyon sayıları ile invazyon derecesi arasında ilişki yoktur.
Keywords
References
- Chantraine F, Langhoff-Roos J. Abnormally invasive placenta-AIP. Awareness and pro-active management is necessary. Acta Obstet Gynecol Scand. 2013;92(4):369-371.
- Kapoor H, Hanaoka M, Dawkins A, Khurana A. Review of MRI imaging for placenta accreta spectrum: Pathophysiologic insights, imaging signs, and recent developments. Placenta. 202;104:31-39.
- Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders, International Journal of Gynecology & Obstetrics. 2019;146(1):20-24.
- Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177(1):210-214.
- Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458-1461.
- Jauniaux E, Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta. 2012;33(4):244-251.
- Kanter G, Packard L, Sit AS. Placenta accreta in a patient with a history of uterine artery embolization for postpartum hemorrhage. J Perinatol. 2013;33(6):482-483.
- Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine; Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Placenta Accreta Spectrum. Am J Obstet Gynecol. 2018;219(6):B2-B16.
- Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med. 2011;24(11):1341-1346.
- Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-1232.
- Palacios Jaraquemada JM, Pesaresi M, Nassif JC, Hermosid S. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand. 2004;83(8):738-744.
- Polat I, Yücel B, Gedikbasi A, Aslan H, Fendal A. The effectiveness of double incision technique in uterus preserving surgery for placenta percreta. BMC Pregnancy Childbirth. 2017;17(1).
- Turan OM, Shannon A, Asoglu MR, Goetzinger KR. A novel approach to reduce blood loss in patients with placenta accreta spectrum disorder. J Matern Fetal Neonatal Med. 2021;34(13):2061-2070.
- Abo-Elroose AAE, Ahmed MR, Shaaban MM, Ghoneim HM, Mohamed TY. Triple P with T-shaped lower segment suture; an effective novel alternative to hysterectomy in morbidly adherent anterior placenta previa. J Matern Fetal Neonatal Med. 2021;34(19):3187-3191.
- Cırpan T, Akdemir A, Okmen F, Hortu I, Ekici H, Imamoglu M. Effectiveness of segmental resection technique in the treatment of placenta accreta spectrum. J Matern Fetal Neonatal Med. 2021;34(19):3227-3233.
- Carusi DA. The placenta accreta spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018;61(4):733-742.
- Acar A, Ercan F, Pekin A, et al. Conservative management of placental invasion anomalies with an intracavitary suture technique. Int J Gynaecol Obstet. 2018;143(2):184-190.
- Kilicci C, Ozkaya E, Eser A, et al. Planned cesarean hysterectomy versus modified form of segmental resection in patients with placenta percreta. J Matern Fetal Neonatal Med. 2018;31(22):2935-2940.
- Karaçor T, Bülbül M, Nacar MC, et al. The parameters affecting the success of uterus-sparing surgery in cases of placenta adhesion spectrum disorder. J Matern Fetal Neonatal Med. 2021;34(7):1091-1098.
- Sezgin B, Kasap B, Şahin EA, Camuzcuoğlu A, Camuzcuoğlu H. Comparison of conservative and radical surgery in the management of placenta previa percreta. Perinatal Journal. 2021;29(1):46-53.
- Shabana A, Fawzy M, Refaie W. Conservative management of placenta percreta: a stepwise approach. Arch Gynecol Obstet. 2015;291(5):993-998.
- Comstock CH, Lee W, Vettraino IM, Bronsteen RA. The early sonographic appearance of placenta accreta. J Ultrasound Med. 2003;22(1):19-23.
- Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol. 2005;26(1):89-96.
- Mazouni C, Gorincour G, Juhan V, Bretelle F. Placenta accreta: a review of current advances in prenatal diagnosis. Placenta. 2007;28(7):599-603.
- Hayes E, Ayida G, Crocker A. The morbidly adherent placenta: diagnosis and management options. Curr Opin Obstet Gynecol. 2011;23(6):448-453.
- Chalubinski KM, Pils S, Klein K, et al. Prenatal sonography can predict degree of placental invasion. Ultrasound Obstet Gynecol. 2013;42(5):518-524.
RETROSPECTIVE ANALYSIS OF 5-YEAR DATA FROM A TERTIARY CENTER: DOES DEGREE OF PLACENTAL INVASION AFFECT OPERATIVE TECHNIQUE?
Abstract
Objective: The aim of the study is to determine the relationship between the degree of placental invasion and the surgical methods used in the treatment.
Method: Cases who underwent cesarean section between 2017-2022 and were diagnosed with placenta accreta spectrum (PAS) after histopathological examination were included in the study. Age, number of pregnancies, number of previous cesarean sections, surgical method, need for erythrocyte transfusion and histopathological examination results were obtained from electronic and printed patient files. The operative techniques used in the management of the cases were determined as cesarean section+bilateral uterine artery ligation, cesarean section+segmental resection, cesarean section+bilateral uterine artery ligation+segmental resection+bilateral internal iliac artery anterior branch ligation and finally cesarean section+hysterectomy.
Results: A total of 109 cases that met the inclusion criteria were included in the retrospective study. The median age of the cases was found to be 33 (IQR:7), and the number of previous cesarean sections was 2 (IQR:1). Positive correlation was found between the number of cesarean sections and the degree of invasion in the analyses conducted (p<.001). Organ-preserving surgery was performed in 52 (48.6%) cases, and cesarean hysterectomy was performed in 55 (51.4%) cases. Histopathological examination revealed PAS grade 1 in 45 (42.2%) cases, PAS grade 2 in 40 (37.3%) cases, and PAS grade 3 in 22 (20.5%) cases. No correlation was found between the surgical methods and histopathological results (p=.394). Similarly, no correlation was found between the surgical methods and the number of previous cesarean sections (p=.652). There was no correlation between the number of erythrocyte transfusions required for the cases and the degree of placental invasion (p=.151).
Conclusion: The degree of placental invasion increases in proportion to the number of previous cesarean sections. There is no relationship between the type of operation and the number of erythrocyte transfusions and the degree of invasion.
References
- Chantraine F, Langhoff-Roos J. Abnormally invasive placenta-AIP. Awareness and pro-active management is necessary. Acta Obstet Gynecol Scand. 2013;92(4):369-371.
- Kapoor H, Hanaoka M, Dawkins A, Khurana A. Review of MRI imaging for placenta accreta spectrum: Pathophysiologic insights, imaging signs, and recent developments. Placenta. 202;104:31-39.
- Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders, International Journal of Gynecology & Obstetrics. 2019;146(1):20-24.
- Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177(1):210-214.
- Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458-1461.
- Jauniaux E, Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta. 2012;33(4):244-251.
- Kanter G, Packard L, Sit AS. Placenta accreta in a patient with a history of uterine artery embolization for postpartum hemorrhage. J Perinatol. 2013;33(6):482-483.
- Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine; Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Placenta Accreta Spectrum. Am J Obstet Gynecol. 2018;219(6):B2-B16.
- Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med. 2011;24(11):1341-1346.
- Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-1232.
- Palacios Jaraquemada JM, Pesaresi M, Nassif JC, Hermosid S. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand. 2004;83(8):738-744.
- Polat I, Yücel B, Gedikbasi A, Aslan H, Fendal A. The effectiveness of double incision technique in uterus preserving surgery for placenta percreta. BMC Pregnancy Childbirth. 2017;17(1).
- Turan OM, Shannon A, Asoglu MR, Goetzinger KR. A novel approach to reduce blood loss in patients with placenta accreta spectrum disorder. J Matern Fetal Neonatal Med. 2021;34(13):2061-2070.
- Abo-Elroose AAE, Ahmed MR, Shaaban MM, Ghoneim HM, Mohamed TY. Triple P with T-shaped lower segment suture; an effective novel alternative to hysterectomy in morbidly adherent anterior placenta previa. J Matern Fetal Neonatal Med. 2021;34(19):3187-3191.
- Cırpan T, Akdemir A, Okmen F, Hortu I, Ekici H, Imamoglu M. Effectiveness of segmental resection technique in the treatment of placenta accreta spectrum. J Matern Fetal Neonatal Med. 2021;34(19):3227-3233.
- Carusi DA. The placenta accreta spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018;61(4):733-742.
- Acar A, Ercan F, Pekin A, et al. Conservative management of placental invasion anomalies with an intracavitary suture technique. Int J Gynaecol Obstet. 2018;143(2):184-190.
- Kilicci C, Ozkaya E, Eser A, et al. Planned cesarean hysterectomy versus modified form of segmental resection in patients with placenta percreta. J Matern Fetal Neonatal Med. 2018;31(22):2935-2940.
- Karaçor T, Bülbül M, Nacar MC, et al. The parameters affecting the success of uterus-sparing surgery in cases of placenta adhesion spectrum disorder. J Matern Fetal Neonatal Med. 2021;34(7):1091-1098.
- Sezgin B, Kasap B, Şahin EA, Camuzcuoğlu A, Camuzcuoğlu H. Comparison of conservative and radical surgery in the management of placenta previa percreta. Perinatal Journal. 2021;29(1):46-53.
- Shabana A, Fawzy M, Refaie W. Conservative management of placenta percreta: a stepwise approach. Arch Gynecol Obstet. 2015;291(5):993-998.
- Comstock CH, Lee W, Vettraino IM, Bronsteen RA. The early sonographic appearance of placenta accreta. J Ultrasound Med. 2003;22(1):19-23.
- Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol. 2005;26(1):89-96.
- Mazouni C, Gorincour G, Juhan V, Bretelle F. Placenta accreta: a review of current advances in prenatal diagnosis. Placenta. 2007;28(7):599-603.
- Hayes E, Ayida G, Crocker A. The morbidly adherent placenta: diagnosis and management options. Curr Opin Obstet Gynecol. 2011;23(6):448-453.
- Chalubinski KM, Pils S, Klein K, et al. Prenatal sonography can predict degree of placental invasion. Ultrasound Obstet Gynecol. 2013;42(5):518-524.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | April 30, 2023 |
| Submission Date | January 3, 2023 |
| Published in Issue | Year 2023 Volume: 4 Issue: 1 |
This material is licensed by Creative Commons Attribution-NonCommercial-No Derivative 4.0 International License.