Plasenta previa olgularında plasenta patolojilerinin değerlendirilmesi

Year 2023, Volume: 20 Issue: 1, 1612 - 1616, 30.03.2023

Duygu Tuğrul Ersak , Hakkı Şerbetçi , Uğurcan Zorlu , Bergen Laleli Koç , Özgür Kara , Dilek Sahin

https://doi.org/10.38136/jgon.1166796

Abstract

Amaç: Çalışmamızın birincil amacı, plasenta previanın (PP) altında yatan plasental patolojileri değerlendirmektir.
Gereçler ve Yöntem: Üçüncü basamak bir merkezde PP tanısı alan hastaların iki yılı aşkın verileri retrospektif olarak edinildi. Rutin olarak, PP tanısı konulan hastaların plasentaları patolojik incelemeye gönderilir. Hastaların klinikodemografik verileri kaydedildi. Plasental patolojik bulgular maternal vasküler lezyonlar, fetal vasküler lezyonlar, inflamatuar durumlar, umbilikal kord bulguları ve normal olmak üzere 5 ana grupta sınıflandırılıp değerlendirildi. Ayrıca hastaların hastaneye yatış anındaki tam kan sayımı sonuçları ve yenidoğan sonuçları kaydedildi.
Bulgular: Çalışmaya PP tanısı alan 32 hasta dahil edildi. Medyan yaş 34 (22-42), medyan gravida 3 (1-6) idi. PP hastalarının yaklaşık yarısında patolojik bulgu olarak maternal vasküler lezyonlar izlendi (43.75 %). Sırasıyla 10 hastada (32.25 %) enflamasyon, 8 hastada (25 %) umbilikal kord bulguları ve 2 hastada (6.25 %) fetal vasküler lezyon gözlendi. 3 hastada normal plasenta olduğu bildirildi. Ayrıca hastaların medyan nötrofil, nötrofil lenfosit oranı ve beyaz küre sayımı hastaneye yatış anında yüksek bulundu.
Sonuç: Maternal vasküler lezyonlar ve inflamasyon, PP hastalarında en sık saptanan plasental patolojik raporlardı. Ancak komplike olmayan gebeliklerin plasentalarını da içeren çalışmalar patolojik durumu fizyolojik durumdan ayırt etmek için literatüre ışık tutacaktır.

Keywords

Plasenta previa, patoloji, maternal vasküler lezyonlar, inflamasyon

Evaluation of placental pathologies in cases of placenta previa

Abstract

Objective: The primary aim of our study was to evaluate the underlying placental pathologies of placenta previa (PP).
Materials and Methods: Over two years data of patients diagnosed to be PP in a tertiary center were obtained retrospectively. Routinely, the placentas of patients diagnosed to be PP were sent for pathological examination. Clinicodemographic data of the patients were recorded. The placental pathological findings were classified and evaluated in 5 main groups: maternal vascular lesions, fetal vascular lesions, inflammatory situations, umbilical cord findings, and normal. Additionally, complete blood count results at admission time for hospitalization and the outcomes of the neonates were recorded.
Results: Thirty-two patients diagnosed to be PP were included in the study. The median age was 34 (22-42), and the median gravidity number was 3 (1-6). Maternal vascular lesions were observed in nearly half of the PP patients as a pathological finding (43.75 %). Inflammation was observed in 10 patients (31.25 %), umbilical cord findings in 8 patients (25.0 %), and fetal vascular lesions in 2 patients (6.25 %), respectively. 3 patients were reported to have normal placentas. In addition, the median neutrophile, neutrophile lymphocyte ratio, and white blood count were found to be high at admission time for hospitalization
Conclusion: Maternal vascular lesions and inflammation were the most common detected placental pathological reports in PP patients. However, studies including the placentas of uncomplicated pregnancies will shed light on the literature to distinguish the pathological condition from the physiological condition.

Keywords

Placenta previa, pathology, maternal vascular lesions, inflammation

References

• 1. Reddy UM, Abuhamad AZ, Levine D, Saade GR, Participants FIWI. Fetal imaging: Executive summary of a joint Eunice Kennedy Shriver National Institute of child health and human development, Society for Maternal-Fetal medicine, American Institute of ultrasound in medicine, American College of obstetricians and Gynecologists, American College of radiology, Society for pediatric radiology, and society of radiologists in ultrasound fetal imaging workshop. American journal of obstetrics and gynecology. 2014;210(5):387-97.
• 2. Cresswell JA, Ronsmans C, Calvert C, Filippi V. Prevalence of placenta praevia by world region: a systematic review and meta‐analysis. Tropical medicine & international health. 2013;18(6):712-24.
• 3. Ananth CV, Demissie K, Smulian JC, Vintzileos AM. Relationship among placenta previa, fetal growth restriction, and preterm delivery: a population-based study. Obstetrics & Gynecology. 2001;98(2):299-306.
• 4. Roberts CL, Algert CS, Warrendorf J, Olive EC, Morris JM, Ford JB. Trends and recurrence of placenta praevia: a population‐based study. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2012;52(5):483-6.
• 5. Dutta S, Dey B, Chanu S, Marbaniang E, Sharma N, Khonglah Y, et al. A retrospective study of placenta accreta, percreta, and increta in peripartum hysterectomies in a tertiary care institute in northeast India. Cureus. 2020;12(11).
• 6. Cornish EF, McDonnell T, Williams DJ. Chronic Inflammatory Placental Disorders Associated With Recurrent Adverse Pregnancy Outcome. Frontiers in Immunology. 2022:1837.
• 7. Weiner E, Miremberg H, Grinstein E, Mizrachi Y, Schreiber L, Bar J, et al. The effect of placenta previa on fetal growth and pregnancy outcome, in correlation with placental pathology. Journal of Perinatology. 2016;36(12):1073-8.
• 8. Faiz A, Ananth C. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. The journal of maternal-fetal & neonatal medicine. 2003;13(3):175-90.
• 9. Redline RW, Heller D, Keating S, Kingdom J. Placental diagnostic criteria and clinical correlation–a workshop report. Placenta. 2005;26:S114-S7.
• 10. Api O, Breyman C, Çetiner M, Demir C, Ecder T. Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report. Turkish journal of obstetrics and gynecology. 2015;12(3):173.
• 11. Katzman PJ, Genest DR. Maternal floor infarction and massive perivillous fibrin deposition: histological definitions, association with intrauterine fetal growth restriction, and risk of recurrence. Pediatric and developmental pathology. 2002;5(2):159-64.
• 12. Redline RW. Extending the spectrum of massive perivillous fibrin deposition (maternal floor infarction). Pediatric and Developmental Pathology. 2021;24(1):10-1.
• 13. Sebire N, Backos M, Goldin R, Regan L. Placental massive perivillous fibrin deposition associated with antiphospholipid antibody syndrome. BJOG: an international journal of obstetrics and gynaecology. 2002;109(5):570-3.
• 14. Man J, Hutchinson J, Heazell A, Ashworth M, Jeffrey I, Sebire N. Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death. Ultrasound in Obstetrics & Gynecology. 2016;48(5):579-84.
• 15. Nowak C, Joubert M, Jossic F, Masseau A, Hamidou M, Philippe H-J, et al. Perinatal prognosis of pregnancies complicated by placental chronic villitis or intervillositis of unknown etiology and combined lesions: about a series of 178 cases. Placenta. 2016;44:104-8.
• 16. Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK. Physiological changes in hematological parameters during pregnancy. Indian journal of hematology and blood transfusion. 2012;28(3):144-6.
• 17. Molberg P, Johnson C, Brown T. Leukocytosis in labor: what are its implications? Family Practice Research Journal. 1994;14(3):229-36.
• 18. Acker DB, Johnson MP, Sachs BP, Friedman EA. The leukocyte count in labor. American journal of obstetrics and gynecology. 1985;153(7):737-9.
• 19. Farkas J. PulmCrit: Neutrophil–Lymphocyte Ratio (NLR): Free Upgrade to Your WBC. May; 2019.
• 20. Gyamfi-Bannerman C, Medicine SfM-F. Society for Maternal-Fetal Medicine (SMFM) Consult Series# 44: Management of bleeding in the late preterm period. American Journal of Obstetrics and Gynecology. 2018;218(1):B2-B8.