Plasenta Previa Olgularının Retrospektif Değerlendirilmesi

Year 2020, , 18 - 22, 31.03.2020

Çiğdem Kunt İşgüder , Selim Gülücü , Yunus Emre Bulut , İlhan Bahri Delibaş Tuğba Yurt , Asker Zeki Özsoy

https://doi.org/10.16899/jcm.591664

Abstract

ÖZET

Amaç: Bu çalışmada, plasenta previa (PP) olgularında maternal sosyo-demografik özelliklerin, obstetrik risk faktörlerin ve perinatal sonuçların değerlendirilmesini amaçladık.

Gereç ve Yöntem: Çalışmada Ocak 2013- Kasım 2017 tarihleri arasında kliniğimizde takip edilen 71 PP olgusu retrospektif olarak incelendi. Olguların obstetrik öyküleri, prepartum ve postpartum hemoglobin değerleri, kan transfüzyon ihtiyacı, 1. ve 5.  dakika apgar skorları, kanama kontrolünü sağlamak amacıyla yapılan cerrahi manevralar, plasental invazyon bulgusu, intrauterin ölü fetus ve neonatal ölüm gibi komplikasyonlar incelendi.

Bulgular: Değerlendirilen 71 PP olgusunun %19,7 (n=14)’sini nullipar kadınlar oluştururken, %22,5 (n=16)’ini daha önce 1 kez, %42,3 (n=30)’ünü 2 kez, %15,5 (n=11)’ini üç veya daha fazla sayıda doğum yapmış kadınlar oluşturuyordu. Olguların %53,5 (n=38)’inin önceden sezaryen öyküsü yoktu, %45 (n=32)’inin geçirilmiş 1 ve 2 sezaryen öyküsü, %1,5 (n=1)’ünün üç sezaryen öyküsü vardı. Ortalama bebek doğum ağırlığı 2749.79 ± 777.38 gr (980 gr -4680 gr), 1. ve 5. dakika apgar skorları sırası ile 7.31 ± 1.39 ve 8.24 ± 1.33 olarak tespit edildi.  İnvazyon bulguları nedeniyle 9 olguya peripartum histerektomi uygulandı. On üç olguya perioperatif, sekiz olguya postoperatif kan transfüzyonu yapıldı.

Sonuç: PP, hem erken doğum ve buna bağlı yenidoğan sorunları hem de plasental invazyon anomalileri ve maternal kanama nedeni ile günümüzde neonatal ve maternal morbidite ve mortalitenin önemli nedenleri arasındadır. Optimal sonuç elde edebilmek için PP’den şüphelenildiğinde ve antenatal dönemde tanı konulduğunda peripartum histerektomi ve uterin devaskülarizasyon manevraları konusunda tecrübeli ve oluşabilecek komplikasyonlara müdahale edebilecek deneyimli cerrahların bulunduğu ve kan ürünlerinin temin edilebileceği üçüncü basamak merkezlerde operasyonların yapılmasında fayda vardır.

Keywords

Plasenta previa, kan transfüzyonu, obstetrik risk faktörleri

Retrospective Evaluation of Patients with Placenta Previa

Abstract

ABSTRACT

Objective: In
this study, we aimed to to evaluate the maternal sosyo-demographic features,
perinatal outcomes and obstetric risk factors in patients with placenta previa.

Material and Method: The
data of 71 patients with placenta previa followed up in our clinic between
January 2013 and November 2017 were evaluated retrospectively in this study.
The cases were evaluated according to obstetrical stories, prepartum and
postpartum hemoglobin values, need of transfusion, APGAR scores,  and surgical maneuvers to provide bleeding
control, placental invasion findings, in utero mort fetalis and neonatal
mortality were all investigated.

Results: Of
the 71 PP cases; 14 (19.7%) were nulliparas, 16 (22.5%) give birth to a child
only once, 30(42.3%) two times and 11 (15.5%) three or more times. 38 (53.5%)
women had no cesarean delivery previously whereas 32 (45%) had one or two, and
one woman had three previous cesarean delivery. Mean birth weight was 2749.79±777.38
gr (980gr-4680 gr). Mean first and fifth minute APGAR scores were 7.31±1.39 and
8.24±1.33 respectively. 9 peripartum hysterectomy operation were performed due
to placental invasion abnormalities. Additionally thirteen intraoperative and
eight postoperative blood transfusion were done. 


Conclusion: PP is currently one of the important causes of
neonatal and maternal  morbidity and
mortality not only for preterm birth and accordingly newborn problems but also
placental invasion abnormalities and maternal bleeding. In order to achive the
optimal result, when there is a suspicion or antenatal diagnosis of placenta
previa, delivery should be planned in tertiary centers where surgeons are
experienced in the field of peripartum hysterectomy and uterine
devascularization and blood products are provided easily.

Keywords

Placenta previa, blood transfusion, obstetric risk factors

References

• 1. Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E. Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet 2011; 284(1): 47-51.
• 2. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003; 13(3): 175-190.
• 3. Francois K, Johnson JM, Harris C. Is placenta previa more common in multiple gestations? Am J Obstet Gynecol 2003; 188(5): 1226-1227.
• 4. Rasmussen S, Albrechtsen S, Dalaker K. Obstetric history and the risk of placenta previa. Acta Obstet Gynecol Scand 2000; 79(6): 502-507.
• 5. Jauniaux E, Jurkovic D. Placenta accreta: Pathogenesis of a 20th century iatrogenic uterine disease. Placenta 2012; 33(4): 244-251.
• 6. Kollmann M, Gaulhofer J, Lang U, Klaritsch P. Placenta praevia: incidence, risk factors and outcome. J Matern Fetal Neonatal Med 2016; 29(9): 1395-1398.
• 7. Tuzovic L, Djelmis J, Ilijic M. Obstetric risk factors associated with placenta previa development: Case-control study. CMJ 2003; 44(6): 728-733.
• 8. Cunningham, FG. (2010). Obstetric Hemorrhage. In: Williams Obstetrics, 24th edition, Cunningham F, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY (eds). NY: McGraw-Hill, p 802.
• 9. Oppenheimer L, Armson A, Farine D, Keenan-Lindsay L, Morin V, Pressey T, et al. Maternal Fetal Medicine Committee. Diagnosis and management of placenta previa. J Obstet Gynaecol Can 2007; 29(3): 261-266.
• 10. Rani PR, Haritha PH, Gowri R. Comparative study of transperineal and transabdominal sonography in the diagnosis of placenta previa. J Obstet Gynaecol Res 2007; 33(2): 134-137.
• 11. Bhatt AD, Meena A, Desai MR. Maternal and perinatal outcome in cases of placenta previa. IJSR 2014; 3: 299-301.
• 12. Nørgaard LN, Pinborg A, Lidegaard Ø, Bergholt T. A Danish national cohort study on neonatal outcome in singleton pregnancies with placenta previa. Acta Obstet Gynecol Scand 2012; 91(5): 546-551.
• 13. Iyasu S, Saftlas AK, Rowley DL, Koonin LM, Lawson HW, Atrash HK. The epidemiology of placenta previa in the United States, 1979 through 1987. Am J Obstet Gynecol 1993; 168(5): 1424-1429.
• 14. Artunç Ülkümen B, Pala HG, Aktenk F, Bülbül Baytur Y. Plasenta previa olgularında gebelik sonuçları Ege Tıp Degisi 2014; 53(2): 88-91.
• 15. Gurol-Urganci I, Cromwell DA, Edozien LC, Smith GC, Onwere C, Mahmood TA, et al. Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis. BMC Pregnancy Childbirth. 2011; 11: 95.
• 16. Mgaya AH, Massawe SN, Kidanto HL, Mgaya HN. Grand multiparity: is it still a risk in pregnancy? BMC Pregnancy and Childbirth 2013; 13: 241.
• 17. Hershkowitz R, Fraser D, Mazor M, Leiberman JR. One or multiple previous cesarean sections are associated with similar increased frequency of placenta previa. Eur J Obstet Gynecol Reprod Biol 1995; 62(2): 185-188.
• 18. Abu-Heija A, El-Jallad F, Ziadeh S. Placenta previa: effect of age, gravidity, parity and previous cesarean section. Gynecol Obstet Invest 1999; 47(1): 6-8.
• 19. Demissie K, Breckenridge MB, Joseph L, Rhoads GG. Placenta previa: preponderance of male sex at birth. Am J Epidemiol 1999; 149(9): 824-830.
• 20. Dola CP, Garite TJ, Dowling DD, Friend D, Ahdoot D, Asrat T. Placenta previa: does its type affect pregnancy outcome? Am J Perinatol 2003; 20(7): 353-360.
• 21. Crane JM, Van den Hof MC, Dodds L, Armson BA, Liston R. Maternal complications with placenta previa. Am J Perinatol 2000; 17(2): 101-105.
• 22. Küçükbaş M, Cevrioğlu AS. İntrauterin balon tamponad uygulamaları ile postpartum kanamaların konservatif tedavisi. TJOD Dergisi 2010; 7(4): 305-308.
• 23. Daskalakis G, Simou M, Zacharakis D, Detorakis S, Akrivos N, Papantoniou N, et al. Impact of placenta previa on obstetric outcome. Int J Gynecol Obstet 2011; 114(3): 238-241.
• 24. Grobman WA, Gersnoviez R, Landon MB, Spong CY, Leveno KJ, Rouse DJ, et al. Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstet Gynecol 2007; 110(6): 1249-1255.
• 25. Tapisiz OL, Altinbas SK, Yirci B, Cenksoy P, Kaya AE, Dede S, et al. Emergency peripartum hysterectomy in a tertiary hospital in Ankara, Turkey: a 5-year review Arch Gynecol Obstet 2012; 286(5): 1131-1134.
• 26. Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am 2015; 42(2): 381-402.
• 27. D'Antonio F, Bhide A. Ultrasound in placental disorders. Best Pract Res Clin Obstet Gynaecol 2014; 28(3): 429-442.
• 28. Kocher MR, Sheafor DH, Bruner E, Newman C, Mateus Nino JF. Diagnosis of abnormally invasive posterior placentation: the role of MR imaging Radiol Case Rep. 2017; 12(2): 295-299.