Plasenta Previa Olgularının Retrospektif Değerlendirilmesi

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

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