SEZARYENLERDE PLASENTANIN MYOMETRİUM İLE İLİŞKİSİNİN DEĞERLENDİRİLMESİ

Year 2017, , 157 - 161, 13.12.2017

Busra Demir Cendek Filiz Ayse Avsar , Ozlem Sarici H. Levent Keskin , Aylin Kılıç Yazgan Ali İpek Evrim Bostancı

https://doi.org/10.16948/zktipb.257642

Abstract

Amaç:
Günümüzde görülme sıklığı rölatif olarak artmış olan plasental yapışma
anomalileri (PYA) tiplerine göre ciddi komplikasyonlara yol açmakta, doğum
öncesi invazyon varlığının belirlenmesi ve tipinin açıklanması doğumu
gerçekleştirecek hekim açısından büyük önem taşımaktadır. Bu prospektif,
kesitsel ve tanımlayıcı çalışmanın amacı, en az bir kez sezaryen (C/S) olmuş ve
tekrar C/S planlanan hastalarda preoperatif gri skala ve doppler USG ile PYA açısından
değerlendirip histopatolojik tanı ile karşılaştırmaktır.

Metod:
Bu amaçla Ocak 2013-Temmuz 2013 tarihleri arasında, Yıldırım Beyazıt
Üniversitesi Tıp Fakültesi Ankara Atatürk Eğitim Araştırma Hastanesi Kadın
Hastalıkları ve Doğum bölümüne başvuran, daha öncesinde en az bir kez C/S olan
ve bu gebeliğinde de C/S planlanan toplam 104 olgu çalışma kapsamına alınmıştır.
Bu gebelere preoperatif PYA’nın belirlenmesi amacıyla gri skala ve doppler USG
yapılıp, intraoperatif plasental yatak biyopsisi alınarak histopatolojik
inceleme ile karşılaştırılmıştır. 

Sonuç:
C/S
endikasyonlarının %74’ü bir kez C/S, %25,5’i iki kez C/S ve %1’i ikiden fazla
C/S’dir. Hastaların hiçbirinde intraoperatif PYA şüphesi, postoperatif
komplikasyon ve patoloji sonucunda da PYA rastlanmamıştır. %77,9 hastada doppler
USG normal çıkmıştır. %20,2’sinde yalnızca subplasental alanda vaskülarite
artışı, %1,0’inde subplasental alanda vaskülarite artışı ve laküner akım
varlığı, %1,0’inde yalnızca laküner akım varlığı görülmüştür. Gri skala USG’de
%90,4 hastada herhangi bir bulguya rastlanmamıştır. %2,0’sinde plasental lakün
ve retroplasental berrak alan obliterasyonu, %7,6’sında plasental alandaki en
ince miyometriyal kalınlığın <1 mm olduğu görülmüştür.

           Tartışma:
Bizim çalışmamızda PYA görülmemesinin nedeni yapılan cerrahi tekniğe, bireysel
yara iyileşmesi gibi faktörlere bağlanabilir. Anormal plasentasyona neden olan mekanizmalar
hâlâ net değildir. 

Keywords

, Sezaryen, Plasental Yapışma Anomalileri

Determination of Placenta- Myometrium Relationship in Caesarian Sections

Abstract

Objective: The relative prevalence of placental
attachment abnormalities (PAA) has been increased lately. They may cause severe
complications in respect to their types, and determining presence and the type
of the invasion before delivery is important for the obstetrician. The
objective of this prospective, cross –
sectional and descriptive study was to investigate PAA preoperatively
using gray scale and Doppler ultrasonography (USG) in patients who had a
Caesarian section (C/S) at least once before and scheduled for C/S again,  and to compare the results with
histopathological diagnosis.

Material and Methods: A total of 104
pregnant women who admitted to Yıldırım Beyazıt University Medical
Faculty, Atatürk Education and
Research Hospital Obstetrics and Gynecology Department between January and July
2013, and scheduled for C/S were included in the study. All of the included
patients had had C/S before, at least once. Gray scale and Doppler USG was
performed in all patients to determine PAA, and the findings were compared with
the histopathologic results of placental bed biopsy obtained during C/S.

Results: The indications for C/S were previous
C/S once in 74%, previous C/S twice in 25.5%, and previous C/S more than twice
in 1% of the patients. None of the patients had any suspicion for PAA
intraoperatively, postoperative complications, or PAA in the histopathological
diagnosis. There were no findings on Doppler USG in  77.9% of the patients, 20.2% of them had
increased vascularity alone, 1.0% had increased vascularity and lacunar
flow,  and 1.0% had lacunar flow alone in
the subplasental region. There were no findings on gray scale USG in 90.4% of
the patients. There were placental lacunae and obliteration of the
retroplacental clear zone in 2.0% of the patients, and the thinnest myometrial
wall was < 1 mm
in the placental region in 7.6% of them.

Conclusion: Absence of PAA in
our series may be due to factors such as our surgical technique, and individual
wound healing processes. The mechanisms causing abnormal placentation are not
still clear 

Keywords

Pregnancy, Ceaserian

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