İlk Trimester Serum Belirteçlerinin Plasenta Akreta Spektrumu Öngörüsündeki Önemi: Vaka Kontrol Çalışması

Abstract

Amaç: Plasenta previa (PP) tanılı olgularda plasenta akreta indeks (PAI) skoru ile ilk trimester serum belirteçlerinin (PAPP-A, serbest β HCG) Plasenta Akreta Spektrumu (PAS) öngörüsündeki yerini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamıza 30 PAS, 30 adezyon anomalisi saptanmayan plasenta previa olgusu ile 60 sağlıklı gebe dahil edildi. Çalışmaya dahil edilen olguların, üçüncü trimesterda PAI skoru belirlendi, ardından ilk trimester serum belirteçleri ve operasyon sonuçları (sezaryen, histerektomi) kaydedildi. Bulgular: Çalışmamızda da PP ve kontrol grubundaki olgular karşılaştırıldığında PAPP-A(mIU/ml), PAPP-A MoM ve serbest β HCG MoM değerleri PP grubunda istatistiksel olarak anlamlı derecede daha yüksekti (p<0.001). PP olguları ile PAS olguları karşılaştırıldığında ilk trimester serum belirteçlerinin PAS grubunda ve peripartum histerektomiye giden grupta istatistiksel olarak anlamlı derecede yüksek olduğunu bulduk (p<0.001). İlk trimester serum belirteçlerinin PAS öngörüsünde PAI skorlaması kadar başarılı olduğu sonucuna ulaştık. En güçlü parametrenin ise PAI skorlaması olduğunu bulduk. Sonuç: PAI skorlamasının gerek sonografik ve teknik açıdan belli bir tecrübe gerektirmesi, gerek transvajinal yolla uygulanabilirliği açısından hasta konforunu etkilemesi göz önüne alındığında PAS öngörüsünde benzer değere sahip olması nedeniyle ilk trimester serum belirteçleri de kullanılabilir. Bu verileri kullanarak hastaların üçüncü basamak merkeze sevk edilip multidisipliner preoperatif hazırlık yapılmasının perinatal morbidite ve mortaliteyi azaltacağını düşünmekteyiz.

Keywords

• Plasenta Previa
• Plasenta Akreta Spektrumu
• Plasenta Akreta İndeks
• PAPP-A
• serbest β HCG

Importance of First Trimester Serum Markers in Predicting Placenta Accreta Spectrum: A Case-Control Study

Abstract

Aim: We aimed to investigate the placenta accreta index (PAI) score and first-trimester serum markers (PAPP-A, free β HCG) in the prediction of Placenta Accreta Spectrum (PAS) in cases diagnosed with placenta previa (PP). Material and Methods: 30 PAS cases, 30 placenta previa cases without adhesion anomaly, and 60 healthy pregnants were included in our study. The PAI score was determined in the third trimester of the cases included in the study, then first-trimester serum markers and surgical outcomes (cesarean section, hysterectomy) were recorded. Results: In our study, when the cases in the PP and control groups were compared, PAPP-A(mIU/ml), PAPP-A MoM, and free β HCG MoM values were statistically significantly higher in the PP group (p<0.001). When PP and PAS cases were compared, we found that first-trimester serum markers were statistically significantly higher in the PAS group and the group undergoing peripartum hysterectomy (p<0.001). We found that the strongest parameter was the PAI score in predicting PAS, and first-trimester serum markers are as successful as PAI scoring. Conclusion: Considering that PAI scoring requires a certain experience in sonographic and technical terms and affects patient comfort in the transvaginal application, first-trimester serum markers can also be used because they have a similar value in predicting PAS. Using these data, we think referring patients to tertiary centers and multidisciplinary preoperative preparation that requires an experienced surgical team will help reduce perinatal morbidity and mortality.

Keywords

• Placenta Previa
• Placenta Accreta Spectrum
• Placenta Accreta Index
• PAPP-A
• free β HCG

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