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

Abstract

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

Keywords

• plasenta previa
• plasenta akreata spektrumu
• sezaryen
• prematurite

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

Abstract

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.

Keywords

• placenta previa
• cesarian
• prematurity
• placenta accreata spectrum

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