Plasenta Yapışma Anomalilerinde Sonografik Görünüm Ve Obstetrik Yönetim

Abstract

Günümüzde görülme sıklığı sabit bir şekilde artmış olan plasental yapışma anomalileri hayatı tehdit eden kanamalar ve hatta maternal ölüm gibi ciddi komplikasyonlara yol açmaktadır. Doğum öncesi bu bozukluğun tanısının konması anestezi uzmanı ve jinekolojik cerrahın hazır bulunduğu daha güvenli ve planlanmış cerrahi girişimin sağlanmasını da mümkün kılabilir. Yakın bir geçmişe kadar plasentanın değerlendirilmesi yalnızca ultrasonografi ile sağlanırken teknolojik gelişmeler ile doppler ultrasonografi ve manyetik rezonans görüntülemede plasental yapışma anomalilerinin tanısında kullanılmaya başlanmıştır. Görüntüleme tetkikleri olmadan önce plasental invazyon derinliği klinik olarak net belirlenemiyordu ve plasenta akreta terimi tüm anormal plasental yapışmalara verilen isimdi. Plasenta akreta; plasentanın uterus duvarına desidua bazalisin yokluğu nedeni ile anormal bir şekilde ve koryo-nik villusların direkt olarak myometriuma yapışması ile karakterize bir durum olarak tanımlanır. Plasenta akretanın en önemli risk faktörü önceki geçirilmiş uterus cerrahisidir. Her ne kadar alt uterin segment cerrahi sonrası iyileşse de birçok sezar-yan vakasında skar alanında cerrahi prosedürden yıllar sonra bile hem miyometriyum hem de endometriyumda önemli kayıplar olabilir. Özet olarak, yapılan cerrahi ve plasental yapışma anomalileri birbiriyle ilişkilidir. Erken tanı ve planlanmış uygun koşullarda ve multidispliner yaklaşımla yapılan cerrahi girişimler bu durumla ilgili mortalite ve morbiditelerin azaltılmasına yardım edecektir. En kesin tedavi total abdominal histerektomi olmakla beraber günümüzde plasentayı in situ bırakan konservatif yaklaşımlar düşük mortalite ve morbidite hızları nedeniyle bilhassa perkreta olgularında gittikçe daha çok kullanılabilir hale gelmektedir plasenta akretanın sonografik görünümü ve obstetrik yönetim stratejileri bu derlemede geniş olarak ele alınmıştır.

Keywords

• Plasenta Akreta
• tanı
• hastalık yönetimi
• tedavi

Sonographic Appearance And Obstetric Management Of Placenta Adhesion Abnormalities

Abstract

The incidence of placental adhesive disorders has grown steadily, they may lead to serious complications such as catastrophic blood loss and even maternal death. Antenatal diagnosis of this condition may yield to a safer planned surgery with availability of the presence of an anesthesiologist and a gynecology surgeon. Until recently, the evaluation of the placenta was made by using only ultrasound screening, in technological advances, doppler US and magnetic resonance imaging become increasingly available in diagnosing placental adhesive disorders. Before advanced imaging techniques, all placental adhesive disorders were named as placenta acc-reta and the depth of invasion was not recognized clinically. Placenta accreta is defined as abnormal adherence of the placenta to the uterine wall, whereby the chorionic villi directly attach to the myometrium due to the absence of the normal decidua basalis between the villi and myometrium. The most important risk factor for placenta accreta is previous uterine surgery. Although complete healing takes place after lower uterine segment surgeries, in number of cesarean cases, serious myo-metrial and endometrial tissue loss occurs even years after the surgery. In summary, uterine surgical procedures and placental adhesive disorders are closely related to each other and early diagnosis and planned surgical intervention in appropriate conditions with a multidisciplinary approach will help reduce the mortality and morbidity related to this condition. Although the most definitive treatment is an abdominal hysterectomy, conservative management including not removing the placenta from the uterus was found to be related to lower mortality and morbidity rates and it becomes gradually popular way of treatment especially for placenta percreta cases. In this review, the obstetrical management of placenta accreta and its so-nografic appearence were evaluated extensively.

Keywords

• Placenta accreta
• diagnosis
• disease management
• therapy

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