Abstract
Plasenta perkratada konservatif tedavi uygulanan iki olgu sunuldu. Kliniğimizde plasenta perkrata tanısı
konan iki olguya konservatif tedavi uygulandı. İlk olguda kanamadan dolayı tedavide istenilen başarı elde
edilemedi. İkinci olguda; abdominal orta hat ve uterin fundusda klasik insizyon, internal iliak arter
ligasyonu, profilaktik geniş spektrumlu antibiyotik kullanımı, menstruel siklus supresyonu, human koryonik
gonadotropin seviyesinde hızlı düşüş trendi elde edene kadar metotreksat uygulaması ve plasental atılım
gerçekleşene kadar hastanın haftalık izlemi ile başarılı bir sonuç elde edildi. Hemodinamik olarak stabil ve
fertilite isteği olan plasenta perkrata olgularında konservatif yaklaşım daha uygun bir seçenek olabilir.
References
- 1) Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005;192(5):1458-61. 2) Zepiridis L, Zafrakas M, Theodoridis TD, Assimakopoulos E, Tzevelekis P, Athanatos D, Bontis JN, Tarlatzis BC. Human placental lactogen and color Doppler in predicting expulsion of retained adherent placenta: a new clinical observation. Arch Gynecol Obstet 2009;280(6):1041-4. doi: 10.1007/s00404-009- 1045-9. 3) Hicks CW, Rome ES. Menstrual manipulation: options for suppressing the cycle. Cleve Clin J Med. 2010;77(7):445-53. doi: 10.3949/ccjm.77a.09128. 4) Clément D, Kayem G, Cabrol D. Conservative treatment of placenta percreta: a safe alternative. Eur J Obstet Gynecol Reprod Biol 2004;114(1):108-109. 5) Camuzcuoglu H, Toy H, Vural M, Yildiz F, Aydin H. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy.J Obstet Gynaecol Res 2010;36(3):538-43. doi: 10.1111/j.1447-0756.2010.01198.x. 6) Steins Bisschop CN, Schaap TP, Vogelvang TE, Scholten PC. Invasive placentation and uterus preserving treatment modalities: a systematic review. Arch Gynecol Obstet 2011;284(2):491-502. doi: 10.1007/s00404-011-1934-6. 7) Masuzaki H, Miura K, Yoshiura K, Yamasaki K, Miura S, Yoshimura S, Nakayama D, Mapendano CK, Niikawa N, Ishimaru T. Placental mRNA in maternal plasma and its clinical application to the evaluation of placental status in a pregnant woman with placenta previa-percreta. Clin Chem 2005;51(5):923-5. 8) Ferretti C, Bruni L, Dangles-Marie V, Pecking AP, Bellet D. Molecular circuits shared by placental and cancer cells, and their implications in the proliferative, invasive and migratory capacities of trophoblasts. Hum Reprod Update 2006;13(2):121-41. 9) Tseng JJ, Hsu SL, Ho ES, Hsieh YT, Wen MC, Chou MM. Differential expression of angiopoietin-1, angiopoietin-2, and Tie receptors in placentas from pregnancies complicated by placenta accreta. Am J Obstet Gynecol 2006;194(2):564-71. 10) Wehrum MJ, Buhimschi IA, Salafia C, Thung S, Bahtiyar MO, Werner EF, Campbell KH, Laky C, Sfakianaki AK, Zhao G, Funai EF, Buhimschi CS. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2 0 1 1 ; 2 0 4 ( 5 ) : 4 1 1 . e 1 - 4 1 1 . e 1 1 . d o i : 10.1016/j.ajog.2010.12.027.
Abstract
To present two cases of placenta percreta which were treated with conservative management in our clinic.
Two cases of retained placenta percreta are presented. Treatment was failed in the first case because of
haemorrhage. The second one was treated successfully with the procedures which consisted of caesarean
section with midline abdominal and classic incision in the uterine fundus, internal iliac artery ligation,
prophylactic broad-spectrum antibiotic treatment, suppression of menstrual cycle, use of methotrexate until
the achievement of rapid downtrend of human chorionic gonadotropin, and monitoring the patient until
spontan expulsion or resorbtion of placenta. It may be better to treat the cases of placenta percreta with
conservative management, if the patients are hemodynamically stable and desirable for future fertility.
References
- 1) Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005;192(5):1458-61. 2) Zepiridis L, Zafrakas M, Theodoridis TD, Assimakopoulos E, Tzevelekis P, Athanatos D, Bontis JN, Tarlatzis BC. Human placental lactogen and color Doppler in predicting expulsion of retained adherent placenta: a new clinical observation. Arch Gynecol Obstet 2009;280(6):1041-4. doi: 10.1007/s00404-009- 1045-9. 3) Hicks CW, Rome ES. Menstrual manipulation: options for suppressing the cycle. Cleve Clin J Med. 2010;77(7):445-53. doi: 10.3949/ccjm.77a.09128. 4) Clément D, Kayem G, Cabrol D. Conservative treatment of placenta percreta: a safe alternative. Eur J Obstet Gynecol Reprod Biol 2004;114(1):108-109. 5) Camuzcuoglu H, Toy H, Vural M, Yildiz F, Aydin H. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy.J Obstet Gynaecol Res 2010;36(3):538-43. doi: 10.1111/j.1447-0756.2010.01198.x. 6) Steins Bisschop CN, Schaap TP, Vogelvang TE, Scholten PC. Invasive placentation and uterus preserving treatment modalities: a systematic review. Arch Gynecol Obstet 2011;284(2):491-502. doi: 10.1007/s00404-011-1934-6. 7) Masuzaki H, Miura K, Yoshiura K, Yamasaki K, Miura S, Yoshimura S, Nakayama D, Mapendano CK, Niikawa N, Ishimaru T. Placental mRNA in maternal plasma and its clinical application to the evaluation of placental status in a pregnant woman with placenta previa-percreta. Clin Chem 2005;51(5):923-5. 8) Ferretti C, Bruni L, Dangles-Marie V, Pecking AP, Bellet D. Molecular circuits shared by placental and cancer cells, and their implications in the proliferative, invasive and migratory capacities of trophoblasts. Hum Reprod Update 2006;13(2):121-41. 9) Tseng JJ, Hsu SL, Ho ES, Hsieh YT, Wen MC, Chou MM. Differential expression of angiopoietin-1, angiopoietin-2, and Tie receptors in placentas from pregnancies complicated by placenta accreta. Am J Obstet Gynecol 2006;194(2):564-71. 10) Wehrum MJ, Buhimschi IA, Salafia C, Thung S, Bahtiyar MO, Werner EF, Campbell KH, Laky C, Sfakianaki AK, Zhao G, Funai EF, Buhimschi CS. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2 0 1 1 ; 2 0 4 ( 5 ) : 4 1 1 . e 1 - 4 1 1 . e 1 1 . d o i : 10.1016/j.ajog.2010.12.027.
Details
| Primary Language | English |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | December 15, 2014 |
| Submission Date | October 1, 2013 |
| Acceptance Date | October 25, 2013 |
| Published in Issue | Year 2014 Volume: 11 Issue: 3 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty