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Plasenta Yerleşim Ve İnvazyon Anomalisi Olan Hastalarda Acil Ve Elektif Sezaryenin Fetomaternal Sonuçlara Etkisi

Yıl 2023, Cilt: 7 Sayı: 2, 89 - 96, 30.08.2023
https://doi.org/10.34084/bshr.1269500

Öz

Amaç: Plasenta previa; plasentanın alt uterin segmente yerleşip internal osu kısmen veya tamamen kapatması durumudur. Planlı sezaryene alınan plasenta previa ve plasenta akreata spektrumu (PAS) şüphesi olan hastalarda daha iyi fetomaternal sonuçlar elde edilmektedir. Çalışmamızda acil ve elektif sezaryene alınan hasta gruplarını fetomaternal sonuçlarını karşılaştırmayı amaçladık.
Yöntem: Çalışmamıza Ocak 2011-Aralık 2015 tarihleri arasında hastanemizde plasenta previa ve PAS tanısıyla sezaryene alınan 236 hasta dâhil edildi. Hastaların demografik verileri, jinekolojik ve obstetrik öyküleri, laboratuar parametreleri, , kan ürünü transfüzyon miktarı, vakanın alınma şekli(acil/elektif), gelişen intraoperatif ve postoperatif komplikasyonlar, kullanılan ek cerrahi yöntemler, histerektomi varlığı, doğum haftası ve ağırlığı, yenidoğan APGAR skoru, yoğun bakım ihtiyacı, yatış süresi ve gelişen komplikasyon verilerine ulaşıldı. Hastalar acil ve elektif olmak üzere iki gruba ayrılarak fetomaternal verileri karşılaştırıldı.
Bulgular: Hastalar vakaya alınma şekillerine göre karşılaştırıldığında intraoperatif komplikasyon, peripartum histerektomi, ek cerrahi yöntem kullanımı, invazyon anomalisi, postoperatif 6. saat hemoglobin değerleri arasında bir fark bulunmadı. Fakat acil alınan grupta postoperatif yatış süresi, transfüzyon ihtiyacı daha fazla iken, 2. saat hemoglobin (Hgb) düzeyi daha düşük bulundu. Acil alınan gruptaki yenidoğanlarda, doğum ağırlığı ve APGAR skoru daha düşük iken, yoğun bakım ihtiyacı, yatış süresi ve komplikasyon oranının daha yüksek olduğu tespit edildi.
Sonuç: Hastalar multidisipliner yaklaşımın sunulabileceği, kan bankası ünitesi, erişkin yoğun bakım ve yeni doğan yoğun bakım ünitesi yeterli olan tersiyer merkezlere sevk edilmelidir. Olguların elektif olarak operasyona alınmasının fetomaternal morbidite ve mortalitenin azaltılmasında veya önlenmesinde önemli bir etkendir

Kaynakça

  • 1. Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014; 123:1070. 2. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003; 13(3):175-190.
  • 3. American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259-e275. doi:10.1097/AOG.0000000000002983
  • 4. Neilson JP. Interventions for suspected placenta praevia. Cochrane Database Syst Rev 2003; :CD001998.
  • 5. Lam CM, Wong SF, Chow KM,et al. Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery. J Obstet Gynaecol 2000; 20:27.
  • 6. Love CD, Fernando KJ, Sargent L, et al. Major placenta praevia should not preclude out-patient management. Eur J Obstet Gynecol Reprod Biol 2004; 117:24.
  • 7. Rosen DM, Peek MJ. Do women with placenta praevia without antepartum haemorrhage require hospitalization? Aust N Z J Obstet Gynaecol 1994; 34:130.
  • 8. Yoong W, Karavolos S, Damodaram M, et al. Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals? Arch Gynecol Obstet 2010; 281:207. 9. McCormick ML, Sanghvi HC, McIntosh N: Preventing postpartum hemorrhage in low-resource settings. Int J Gynaecol Obstet 2002; 77:267.
  • 10. Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet. Gynecol 2002;99.976-80. 26.
  • 11. Tuzovic L, Djelmis J, Ilijic M. Obstetric risk factors associated with placenta previa development: Case-control study. Croat. Med J 2003;44:728-33. 20.
  • 12. Madazlı R. “Plasenta Yapışma Anomalilleri”, Plasenta. Nobel Tıp, İstanbul, 2008, 23, ss. 329-336.
  • 13.14.Armstrong CA, Harding S, Matthews T, Dickinson JE. Is placenta accreta catching up with us? Aust New Zealand J Obstet and Gynaecol, 44: 210-3.
  • 14. Usta IM, Hobeika EM, Abu Musa AA, Gabriel GE, Nassar AH. Placenta previaaccreta: Risk factors and complications. Am J Obstet Gynecol, 193: 1045-9.
  • 15.Lavery JP: Placenta previa.Clin Obstet Gynecol 1990; 33:414.
  • 16.Seago Dp, Roberts WE, Johnson VK, et al. Planned cesarean hysterctomy: A preffered alternative to seperate operations. Am J Obstet Gynecol 1999; 180: 1385-93.
  • 17.Rosenberg T, Pariente G, Sergienko R, et al. Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet 2011; 284:47.
  • 18.Salihu HM, Li Q, Rouse DJ, et al. Placenta previa: neonatal death after live births in the United States. Am J Obstet Gynecol 2003; 188:1305.
  • 19. Kassem GA, Alzahrani AK. Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach. Int J Womens Health. 2013;5:803-810. Published 2013 Nov 28. doi:10.2147/IJWH.S53865
  • 20. Asıcıoglu O, Şahbaz A, Güngördük K, Yildirim G, Asıcıoglu BB, Ülker V. Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey. J Obstet Gynaecol 2014;34:462-6.
  • 21. Taşgöz FN, Yenigül NN, Kender Ertürk N, Kırşan İleri E, Yaşa FN. Maternal and neonatal outcomes comparison between emergency and planned cesarean deliveries in women with placenta previa. Eur Res J 2022;8(3):359-367. DOI: 10.18621/eurj.994368

The Effect Of Emergency And Electıve Cesarean Section On Fetomaternal Results In Patıents Wıth Placent Placement And Invasıon Anomaly

Yıl 2023, Cilt: 7 Sayı: 2, 89 - 96, 30.08.2023
https://doi.org/10.34084/bshr.1269500

Öz

Objective: Placenta previa is the situation where the placenta settles in the lower uterine segment and partially or completely covers the internal os. Better fetomaternal results are obtained in patients with suspected placenta previa and plasenta accreta spectrum (PAS) undergoing planned cesarean section. In our study, we aimed to compare the fetomaternal outcomes of patient groups who underwent emergency and elective cesarean section.
Study Design: Our study included 236 patients who underwent cesarean section with the diagnosis of placenta previa and PAS in our hospital between January 2011 and December 2015. Demographic data of patients, gynecological and obstetric histories, laboratory parameters, amount of blood product transfusion, method of taking the case (emergency/elective), developing intraoperative and postoperative complications, additional surgical methods used, presence of hysterectomy, gestational week and weight, newborn APGAR score the data on the need for intensive care, length of hospital stay and complications were obtained. The patients were divided into two groups as emergency and elective, and fetomaternal data were compared.
Results: When the patients were compared according to the way they were recruited, no difference was found between intraoperative complications, peripartum hysterectomy, use of additional surgical methods, invasion anomaly, and postoperative 6th hour hemoglobin values. However, while the postoperative hospital stay and the need for transfusion were higher in the emergency group, 2. hour hemoglobin (Hgb) level was found to be lower. While the birth weight and APGAR score were lower in the newborns in the emergency group, the need for intensive care, length of hospital stay and complication rates were found to be higher.
Conclusion: Patients should be referred to tertiary centers where a multidisciplinary approach can be offered and blood bank units, adult intensive care units and neonatal intensive care units are sufficient.

Kaynakça

  • 1. Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014; 123:1070. 2. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003; 13(3):175-190.
  • 3. American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259-e275. doi:10.1097/AOG.0000000000002983
  • 4. Neilson JP. Interventions for suspected placenta praevia. Cochrane Database Syst Rev 2003; :CD001998.
  • 5. Lam CM, Wong SF, Chow KM,et al. Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery. J Obstet Gynaecol 2000; 20:27.
  • 6. Love CD, Fernando KJ, Sargent L, et al. Major placenta praevia should not preclude out-patient management. Eur J Obstet Gynecol Reprod Biol 2004; 117:24.
  • 7. Rosen DM, Peek MJ. Do women with placenta praevia without antepartum haemorrhage require hospitalization? Aust N Z J Obstet Gynaecol 1994; 34:130.
  • 8. Yoong W, Karavolos S, Damodaram M, et al. Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals? Arch Gynecol Obstet 2010; 281:207. 9. McCormick ML, Sanghvi HC, McIntosh N: Preventing postpartum hemorrhage in low-resource settings. Int J Gynaecol Obstet 2002; 77:267.
  • 10. Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet. Gynecol 2002;99.976-80. 26.
  • 11. Tuzovic L, Djelmis J, Ilijic M. Obstetric risk factors associated with placenta previa development: Case-control study. Croat. Med J 2003;44:728-33. 20.
  • 12. Madazlı R. “Plasenta Yapışma Anomalilleri”, Plasenta. Nobel Tıp, İstanbul, 2008, 23, ss. 329-336.
  • 13.14.Armstrong CA, Harding S, Matthews T, Dickinson JE. Is placenta accreta catching up with us? Aust New Zealand J Obstet and Gynaecol, 44: 210-3.
  • 14. Usta IM, Hobeika EM, Abu Musa AA, Gabriel GE, Nassar AH. Placenta previaaccreta: Risk factors and complications. Am J Obstet Gynecol, 193: 1045-9.
  • 15.Lavery JP: Placenta previa.Clin Obstet Gynecol 1990; 33:414.
  • 16.Seago Dp, Roberts WE, Johnson VK, et al. Planned cesarean hysterctomy: A preffered alternative to seperate operations. Am J Obstet Gynecol 1999; 180: 1385-93.
  • 17.Rosenberg T, Pariente G, Sergienko R, et al. Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet 2011; 284:47.
  • 18.Salihu HM, Li Q, Rouse DJ, et al. Placenta previa: neonatal death after live births in the United States. Am J Obstet Gynecol 2003; 188:1305.
  • 19. Kassem GA, Alzahrani AK. Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach. Int J Womens Health. 2013;5:803-810. Published 2013 Nov 28. doi:10.2147/IJWH.S53865
  • 20. Asıcıoglu O, Şahbaz A, Güngördük K, Yildirim G, Asıcıoglu BB, Ülker V. Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey. J Obstet Gynaecol 2014;34:462-6.
  • 21. Taşgöz FN, Yenigül NN, Kender Ertürk N, Kırşan İleri E, Yaşa FN. Maternal and neonatal outcomes comparison between emergency and planned cesarean deliveries in women with placenta previa. Eur Res J 2022;8(3):359-367. DOI: 10.18621/eurj.994368
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Emin Levent Aksoy 0000-0002-4862-1231

Ali Çağlar 0000-0002-7022-3029

Erken Görünüm Tarihi 3 Eylül 2023
Yayımlanma Tarihi 30 Ağustos 2023
Kabul Tarihi 12 Haziran 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 7 Sayı: 2

Kaynak Göster

AMA Aksoy EL, Çağlar A. Plasenta Yerleşim Ve İnvazyon Anomalisi Olan Hastalarda Acil Ve Elektif Sezaryenin Fetomaternal Sonuçlara Etkisi. J Biotechnol and Strategic Health Res. Ağustos 2023;7(2):89-96. doi:10.34084/bshr.1269500
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