PLASENTA DEKOLMANI VE PERİNATAL SONUÇLAR: SEZARYEN YAPILAN 89 OLGUNUN RETROSPEKTİF ANALİZİ

Abstract

Plasenta dekolmanı nedeniyle sezaryen yapılan hastaların maternal karekteristikleri ve perinatal sonuçlarının değerlendirilmesi Plasenta dekolmanı tanısıyla sezaryen yapılmış 89 hasta ve elektif sezaryen yapılmış 100 hastanın verileri retrospektif olarak incelendi. Hastaların demografik özellikleri, yaşı, gravidası, paritesi, doğum haftası ve laboratuvar bulguları saptandı. Plasenta dekolmanı olan hastaların hipertansif hastalıklar, diyabet, oligohidramnioz, polihidramnioz ve travma gibi risk faktörleri kayıt edildi. Operasyondaki dekolman büyüklüğü, fetüse ait özellikler, kan ürünleri transfüzyon miktarları ve hastanede kalış süreleri değerlendirildi. Dekolman plasenta ve elektif sezaryen yapılan hastalar sezaryen haftaları, fetal ağırlık, apgar skorları ve hastanede kalış süreleri açısından karşılaştırıldı. Dekolman ve elektif sezaryen olan hastaların sırasıyla ortalama yaşları 26.9±6.2 ve 28.1±5.2, gravidaları 2.1±1.2 ve 2.5±1.6, pariteleri 0.8±1.0 ve 1.0±1.1’dir. İki grup arasında doğum haftaları, gravida, fetal ağırlık, 1. ve 5. dakika apgar skorları, hastanede kalış süreleri arasında istatistiksel olarak anlamlı fark vardı p

Keywords

• Plasenta dekolmanı,risk faktörleri,perinatal sonuçlar

PLACENTAL ABRUPTION AND PERINATAL OUTCOMES: RETROSPECTIVE ANALYSIS OF 89 CASES WHO HAD CESAREAN SECTION

Abstract

Our aim is to evaluate the maternal characteristics and perinatal outcomes of the patients who had Cesarean sections due to placenta abruptio. The data of 89 patients who had Cesarean sections due to the diagnosis of placenta abruptio and 100 patients who had elective Cesarean sections were retrospectively analyzed. The demographics, age, gravida, parity, delivery week, and the laboratory findings of the patients were established. The risk factors for the patients with placenta abruptio such as hypertensive diseases, oligohydramnios, polyhydramnios, and trauma were recorded. The size of the abruption at the operation, fetal characteristics, amount of blood product transfusion, and the duration of hospitalization were evaluated. The patients who had placental abruption and elective Cesarean sections were compared for the week of the Cesarean section, fetal weight, Apgar scores, and duration of hospitalization. With regards to the patients who had placental abruption and elective cesarean sections, the mean age was 26.9±6.2 and 28.1±5.2 years, gravida was 2.1±1.2 and 2.5±1.6, and parity was 0.8±1.0 and 1.0±1.1, respectively. There was a statistically significant difference in delivery week, gravida, fetal weight, Apgar scores by minutes 1 and 5, and the duration of hospitalization between the two groups p < 0.05 . In 31 patients 34.8% in the abruption group, the first symptom was vaginal bleeding. At least one risk factor was established in 32 patients 35.9% , whereas there were no risk factors in 57 patients 64.1% . Preeclampsia was the most common finding among the risk factors. The perinatal mortality was 12.4%. The rate of delivery prior to week 37 was 53.9%. There was a negative correlation between the size of abruption and the Apgar scores by minutes 1 and 5 p=0.000, r=0.487; p=0.000, r=0.397, respectively . Placenta abruptio occurs largely in patients with no risk factors. The most common risk factor is hypertansive disease and the most common symptom is vaginal bleeding. Although ultrasonography has an indispensable place in diagnosis, in our study ultrasonographic findings could be determined in only 1/4 of patients

Keywords

• Placental abruptio,risk factors,perinatal outcome

References

1. ) Hladky K, Yankowitz J, Hansen WF. Placental abruption. Obstet Gynecol Surv. 2002; 57(5): 299-305.
2. ) Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006; 108(4):1005-16.
3. ) Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O. Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand. ;85(6):700-5. ) Salihu HM, Bekan B, Aliyu MH, Rouse DJ, Kirby RS, Alexander GR. Perinatal mortality associated with abruptio placenta in singletons and multiples. Am J Obstet Gynecol ; 193(1): 198–203. ) Sheiner E, Shoham-Vardi I, Hallak M, Hadar A, Gortzak- Uzan L, Katz M, et al. Placental abruption in term pregnancies: clinical significance and obstetric risk factors. J Matern Fetal Neonatal Med 2003; 13(1): 45–9.
4. ) Mankita R, Friger M, Pariente G, Sheiner E. Seasonal variation in placental abruption. J Matern Fetal Neonatal Med. 2012; 25(11): 2252-5.
5. ) Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med 2002; 21(8): 837–40.
6. ) Aliyu MH, Salihu HM, Lynch O, Alio AP, Marty PJ. Placental abruption, offspring sex, and birth outcomes in a large cohort of mothers. J Matern Fetal Neonatal Med. ; 25(3): 248-52. ) Ananth CV, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol 2001; 153: – 7.
7. ) Hossain N, Khan N, Sultana SS, Khan N. Abruptio placenta and adverse pregnancy outcome. J Pak Med Assoc. 2010; 60(6): 443-6.
8. ) Nath CA, Ananth CV, DeMarco C, Vintzileos AM, New Jersey-Placental Abruption Study Investigators. Low birthweight in relation to placental abruption and maternal thrombophilia status. Am J Obstet Gynecol 2008; 198: e1-5.

9. ) Ananth CV, Savitz DA, Bowes WA Jr, Luther ER. Influence of hypertensive disorders and cigarette smoking on placental abruption and uterine bleeding during pregnancy. Br J Obstet Gynaecol 1997; 104(5): 572–8.
10. ) Kramer MS, Usher RH, Pollack R, Boyd M, Usher S. Etiologic determinants of abruptio placentae. Obstet Gynecol 1997; 89(2): 221–6.
11. ) Misra D, Ananth CV. Risk factor profiles of placental abruption in first and second pregnancies: Heterogeneous etiologies. J Clin Epidemiol 1999; 52(5): 453–61.
12. ) Domissee J, Tiltman AJ. Placental bed biopsies in placental abruption. Br J Obstet Gynaecol 1992; 99(8): –4.