TERSİYER BİR MERKEZİN 5 YILLIK VERİLERİNİN RETROSPEKTİF ANALİZİ: PLASENTAL İNVAZYON DERECESİ OPERATİF TEKNİĞİ ETKİLİYOR MU?

Year 2023, , 51 - 54, 30.04.2023

Sabahattin Anıl Arı , Fırat Ökmen , Aslı Suner , Ali Akdemir , Çağdaş Şahin , Özgür Yeniel , Ahmet Ergenoğlu , Teksin Çırpan

https://doi.org/10.52831/kjhs.1228737

Abstract

Amaç: Çalışmanın amacı plasenta invazyon derecesi ile tedavide kullanılan cerrahi yöntemlerin ilişkisinin incelenmesiydi.
Yöntem: Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde 2017-2022 yılları arasında sezaryen yapılan ve histopatolojik inceleme sonrası plasenta akreata spekturumu (PAS) tanısı alan olgular çalışmaya dahil edildi. Olguların yaşı, gebelik sayısı, daha önce geçirdikleri sezaryen sayısı, uygulanan cerrahi yöntem, eritrosit transfüzyon ihtiyaçları ve histopatolojik inceleme sonuçları elektronik ve basılı hasta dosyalarından elde edilerek olgu formuna kaydedildi. Vakaların yönetiminde kullanılan operatif teknikler, sezaryen+bilateral uterin arter ligasyonu, sezaryen+segmental rezeksiyon, sezaryen+bilateral uterin arter ligasyonu+segmental rezeksiyon+bilateral internal iliak arter ön dal ligasyonu ve son olarak sezaryen+histerektomi şeklinde belirlendi.
Bulgular: Dahil edilme kriterlerini karşılayan 109 olgu retrospektif çalışmaya alındı. Olguların medyan yaşı 33 (IQR:7), geçirilmiş sezaryen sayısı ise 2 (IQR:1) olarak bulundu. Yapılan analizlerde sezaryen sayısı ile invazyon derecesi arasında pozitif korelasyon saptandı. (p<.001). 52 (%48.6) olguda organ koruyucu cerrahi, 55 (%51.4) olguda ise sezaryen histerektomi operasyonu uygulandı. Histopatolojik incelemeler sonucunda 45 (%42.2) olguda PAS grade 1, 40 (%37.3) olguda PAS grade 2 ve 22 (%20.5) olguda PAS grade 3 saptandı. Uygulanan operatif yöntemler ile histopatolojik sonuçlar arasında bir korelasyon gösterilemedi (p=.394). Yine aynı şekilde cerrahi yöntemler ile daha önceden geçirilmiş sezaryen sayısı arasında bir korelasyon saptanmadı (p=.652). Olgular için gerekli olan eritrosit transfüzyon sayıları ile plasental invazyon derecesi arasında bir korelasyon gösterilmedi (p=.151).
Sonuç: Plasental invazyon derecesi daha önce geçirilmiş sezaryen sayısı ile orantılı şekilde artmaktadır. Operasyon tipi ve eritrosit transfüzyon sayıları ile invazyon derecesi arasında ilişki yoktur.

Keywords

Sezaryen, Plasenta Akreta, Plasenta Previa

RETROSPECTIVE ANALYSIS OF 5-YEAR DATA FROM A TERTIARY CENTER: DOES DEGREE OF PLACENTAL INVASION AFFECT OPERATIVE TECHNIQUE?

Abstract

Objective: The aim of the study is to determine the relationship between the degree of placental invasion and the surgical methods used in the treatment.
Method: Cases who underwent cesarean section between 2017-2022 and were diagnosed with placenta accreta spectrum (PAS) after histopathological examination were included in the study. Age, number of pregnancies, number of previous cesarean sections, surgical method, need for erythrocyte transfusion and histopathological examination results were obtained from electronic and printed patient files. The operative techniques used in the management of the cases were determined as cesarean section+bilateral uterine artery ligation, cesarean section+segmental resection, cesarean section+bilateral uterine artery ligation+segmental resection+bilateral internal iliac artery anterior branch ligation and finally cesarean section+hysterectomy.
Results: A total of 109 cases that met the inclusion criteria were included in the retrospective study. The median age of the cases was found to be 33 (IQR:7), and the number of previous cesarean sections was 2 (IQR:1). Positive correlation was found between the number of cesarean sections and the degree of invasion in the analyses conducted (p<.001). Organ-preserving surgery was performed in 52 (48.6%) cases, and cesarean hysterectomy was performed in 55 (51.4%) cases. Histopathological examination revealed PAS grade 1 in 45 (42.2%) cases, PAS grade 2 in 40 (37.3%) cases, and PAS grade 3 in 22 (20.5%) cases. No correlation was found between the surgical methods and histopathological results (p=.394). Similarly, no correlation was found between the surgical methods and the number of previous cesarean sections (p=.652). There was no correlation between the number of erythrocyte transfusions required for the cases and the degree of placental invasion (p=.151).
Conclusion: The degree of placental invasion increases in proportion to the number of previous cesarean sections. There is no relationship between the type of operation and the number of erythrocyte transfusions and the degree of invasion.

Keywords

Cesarean Section, Placenta Accreta, Placenta Previa

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