Plasenta Perkretalı Hastalarda Sezaryen Sayısının Maternal ve Neonatal Mortalite ve Morbidite ile İlişkisinin Değerlendirilmesi

Abstract

Amaç: Plasental yapışma anomalileri (PYA), özellikle plasenta perkreta gibi durumlarda anne ve bebek sağlığı açısından ciddi riskler taşımaktadır. Bu anomaliler kanama, transfüzyon ihtiyacı ve çoklu organ yetmezliği gibi komplikasyonlarla ilişkilidir. Bu çalışmanın temel amacı, plasenta perkreta tanılı gebelerde geçirilmiş sezaryen sayısının maternal ve neonatal sonuçlar üzerindeki etkisini incelemektir.
Materyal ve metod: Ocak 2021 ile Ocak 2023 tarihleri arasında Harran Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı'na başvuran ve plasenta perkreta tanısı konulan 150 gebe çalışmaya dahil edildi. Hastalar, geçirilmiş sezaryen sayısına göre üç gruba ayrıldı: 1-2 sezaryen (Grup 1), 3-4 sezaryen (Grup 2) ve 5 veya daha fazla sezaryen (Grup 3). Gruplar arasında maternal (preoperatif hemoglobin düzeyi, hastanede kalış süresi, transfüzyon sıklığı, postoperatif komplikasyonlar) ve neonatal sonuçlar (preterm doğum, APGAR skorları, yenidoğan yoğun bakım ünitesine kabul) karşılaştırıldı.
Bulgular: Ortalama yaş 33,3±4,9 yıl, ortalama gestasyonel hafta ise 34,5±2,0 hafta idi. Preterm doğum oranı, Grup 1'e (%16) kıyasla Grup 3'te (%34) anlamlı düzeyde daha yüksekti (p=0,038). Histerektomi oranı Grup 1'de %10 iken, Grup 3'te %58'e yükseldi (p<0,001). Komplikasyon oranı da Grup 1'e göre Grup 3'te daha yüksekti (p=0,021). Neonatal sonuçlar (APGAR skorları ve yoğun bakım ünitesine kabul) açısından gruplar arasında anlamlı bir fark saptanmadı. Histerektomi uygulanan hastaların hastanede kalış sürelerinin daha uzun, komplikasyon oranlarının ve yenidoğan yoğun bakım ünitesine kabul oranlarının daha yüksek olduğu görüldü.
Sonuç: Plasenta perkreta vakalarında, artan geçirilmiş sezaryen sayısı; histerektomi, preterm doğum ve maternal-neonatal morbidite riskini artırmaktadır. Bu bulgular, gereksiz sezaryen doğumların önlenmesinin, PYA insidansını azaltabileceğini ve bu tür vakalarda anne ve bebek sağlığı açısından olumlu sonuçlar doğurabileceğini düşündürmektedir.
 

Keywords

• Plasenta Perkreta
• Sezaryen
• Maternal Morbidite

Ethical Statement

Ethical approval was obtained from the Harran University Clinical Research Ethics Committee (approval no: HRÜ/23.05.10, date: March 27, 2023).

Evaluation of the Relationship Between the Number of Cesarean Sections and Maternal and Neonatal Mortality and Morbidity in Patients with Placenta Percreta

Abstract

Background: Placental adhesion disorders (PAS), especially in cases such as placenta percreta, carry serious risks for maternal and infant health. These disorders are associated with complications such as bleeding, transfusion requirement and multiple organ failure. The main aim of this study was to examine the effect of the number of previous cesarean sections on maternal and neonatal outcomes in pregnant women with placenta percreta.
Materials and Methods: Between January 2021 and January 2023, 150 pregnant women admitted to Harran University Faculty of Medicine, Department of Obstetrics and Gynecology and diagnosed with placenta percreta were included in the study. Patients were divided into three groups according to the number of previous cesarean sections: 1-2 cesarean sections (Group 1), 3-4 cesarean sections (Group 2) and 5 or more cesarean sections (Group 3). Maternal (preoperative hemoglobin level, length of hospital stay, frequency of transfusion, postoperative complications) and neonatal outcomes (preterm delivery, APGAR scores, neonatal intensive care unit admission) were compared between the groups.
Results: The mean age was 33.3±4.9 years and the mean gestational age was 34.5±2.0 weeks. The preterm delivery rate was significantly higher in Group 3 (34%) compared to Group 1 (16%) (p=0.038). Hysterectomy rate increased from 10% in Group 1 to 58% in Group 3 (p<0.001). The complication rate was also higher in Group 3 compared to Group 1 (p=0.021). There was no significant difference between the groups in terms of neonatal outcomes (APGAR scores and intensive care unit admission). Patients who underwent hysterectomy had a longer hospital stay, higher complication rates, and higher rates of neonatal intensive care unit admission.
Conclusions: In cases of placenta percreta, an increasing number of previous cesarean sections increases the risk of hysterectomy, preterm delivery and maternal-neonatal morbidity. These findings suggest that preventing unnecessary cesarean deliveries may reduce the incidence of PAS and may have favorable maternal and infant health outcomes in such cases.
 

Keywords

• Placenta Percreta
• Cesarean Section
• Maternal Morbidity

Ethical Statement

Ethical approval was obtained from the Harran University Clinical Research Ethics Committee (approval no: HRÜ/23.05.10, date: March 27, 2023).

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