Perinatal outcome of patients with placenta percreata

Abstract

Aim: Placental invasion anomalies are rare, but it causes serious fetomaternal morbidity and mortality. In our study, we aimed to evaluate the fetomaternal results of cases with Abnormal Invasive Placenta ( Placenta Percreata). Methods: Patients who underwent a peripartum hysterectomy or whose placenta was left in uterin cavity due to placenta percreata in our hospital were retrospectively analyzed. Data of 20 patients were noted. Results: The mean age of the patients was ± SD (min-max) 33 ± 5,704 (25-46) and 60% (n = 12) of the patients had additional diseases. Fifty five percent of patients (n=11) were operated in emergency conditions and 45% (n = 9) in elective conditions. Surgical complications were 65% (n = 13) bladder injuries, 30% (n = 6) disseminated intravascular coagulation (DIC), 20% (n = 4) infection, 15% (n = 3) relapartomy and 5% (n = 1) was pulmonary embolism. Mortality increased three times (OR; 3.003 (95% CI, 0.372-24.390) in patients with a comorbidity, while 4.7 times (OR; 4.784) in emergency operations. Operations under elective conditions and previously ultrasonographic diagnosis (Odd ratio values ; 0,219 (95% CI, 0,021-2,447) and 0,615 (95% CI, 0,043-8,695), recpectively) decreased maternal mortality. Conclusion: Prenatal diagnosis and performing elective surgeries in percreata cases are important to reduce maternal mortality. Although there are various surgical complications, we think that DIC development is important in mortality and massive transfusion does not decrease the mortality.

Keywords

• recurrent caesarean
• hysterectomy
• placenta percreata

Plasenta perkreatalı hastaların perinatal sonuçları

Öz

Amaç: Plasenta invazyon anomalileri nadir görülmesine rağmen ciddi fetometarnal morbidite ve mortaliteye sebep olmaktadır. Çalışmamızda plasenta invazyon anomalisi olan olguların perinatal sonuçlarını değerlendirmeyi amaçladık. Yöntemler: Hastanemizde 2012-2014 tarihleri arasında peripartum histerektomi yapılan ve intraoperatif plasentası uterin kavitede bırakılan hastalar retrospektif olarak incelendi. 20 hastanın verileri not edildi. Bulgular: Hastaların yaş ortalamaları ± SD (min-max) 33 ± 5,704. (25-46) saptandı. Hastaların % 60’ında (n=12) ek hastalıklar da vardı. Hastaların % 55’i (n=11) acil şartlarda ve % 45’i (n=9) elektif şartlarda opere edildi. Perkreta operasyonlarında oluşan cerrahi komplikasyonlar sıklığına göre sırasıyla % 65(n=13) mesane yaralanması, % 30 (n=6) dissemine intravaskülar kuagulasion (DIC), % 20 (n=4) enfeksiyöz komplikasyonlar ve % 5 (n=1) pulmoner emboli şeklindeydi. Maternal mortalite riskinin ek hastalığı olan hastalarda 3 kat (OR; 3,003 (95%CI, 0,372-24,390) ve acil şartlarda ameliyat olan hastalarda 4,7 kat (OR;4,784 (95%CI, 0,408-47,619) artığı saptandı. Hastaların elektif şartlarda ameliyat olması ve önceden ultrasonografik olarak tanı almış olmalarının da (OR; 0,219 (95%CI, 0,021-2,447), OR; 0,615 (95%CI, 0,043-8,695) maternal mortalite riskini azalttığı saptandı. Korelasyon analizinde maternal mortalite ile maternal yaş (0,473, p=0,035) ve masive kan transfüzyonunun (0,562, p=0,010) pozitif korelasyon, postoperatif hemoglobin değeri ile de negatif kolerasyon gösterdiği saptanmıştır (-0,723, p= 0,010). Sonuç: Plasenta perkreatalı hastalarda, prenatal tanı konulmuş olması ve hastaların elektif şartlarda opere edilmesi maternal mortalite riskinin azaltılması açısından önem arz etmektedir. Çeşitli cerrahi komplikasyonlar olmasına rağmen DIC tablosu mortalite açısından önemlidir ve bu tabloda masif transfüzyon da mortaliteyi azaltmamaktadır.

Anahtar Kelimeler

• Tekrarlayan sezaryen
• histerektomi
• plasenta perkreata

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