Perinatal outcome of patients with placenta percreata

Öz

Aim: Placental invasion anomalies are rare, but it causes serious fetomaternal morbidity and mortality. In our study, we aimed to evaluate the fetomaternal results of cases with Abnormal Invasive Placenta ( Placenta Percreata). Methods: Patients who underwent a peripartum hysterectomy or whose placenta was left in uterin cavity due to placenta percreata in our hospital were retrospectively analyzed. Data of 20 patients were noted. Results: The mean age of the patients was ± SD (min-max) 33 ± 5,704 (25-46) and 60% (n = 12) of the patients had additional diseases. Fifty five percent of patients (n=11) were operated in emergency conditions and 45% (n = 9) in elective conditions. Surgical complications were 65% (n = 13) bladder injuries, 30% (n = 6) disseminated intravascular coagulation (DIC), 20% (n = 4) infection, 15% (n = 3) relapartomy and 5% (n = 1) was pulmonary embolism. Mortality increased three times (OR; 3.003 (95% CI, 0.372-24.390) in patients with a comorbidity, while 4.7 times (OR; 4.784) in emergency operations. Operations under elective conditions and previously ultrasonographic diagnosis (Odd ratio values ; 0,219 (95% CI, 0,021-2,447) and 0,615 (95% CI, 0,043-8,695), recpectively) decreased maternal mortality. Conclusion: Prenatal diagnosis and performing elective surgeries in percreata cases are important to reduce maternal mortality. Although there are various surgical complications, we think that DIC development is important in mortality and massive transfusion does not decrease the mortality.

Anahtar Kelimeler

• recurrent caesarean
• hysterectomy
• placenta percreata

Plasenta perkreatalı hastaların perinatal sonuçları

Öz

Amaç: Plasenta invazyon anomalileri nadir görülmesine rağmen ciddi fetometarnal morbidite ve mortaliteye sebep olmaktadır. Çalışmamızda plasenta invazyon anomalisi olan olguların perinatal sonuçlarını değerlendirmeyi amaçladık. Yöntemler: Hastanemizde 2012-2014 tarihleri arasında peripartum histerektomi yapılan ve intraoperatif plasentası uterin kavitede bırakılan hastalar retrospektif olarak incelendi. 20 hastanın verileri not edildi. Bulgular: Hastaların yaş ortalamaları ± SD (min-max) 33 ± 5,704. (25-46) saptandı. Hastaların % 60’ında (n=12) ek hastalıklar da vardı. Hastaların % 55’i (n=11) acil şartlarda ve % 45’i (n=9) elektif şartlarda opere edildi. Perkreta operasyonlarında oluşan cerrahi komplikasyonlar sıklığına göre sırasıyla % 65(n=13) mesane yaralanması, % 30 (n=6) dissemine intravaskülar kuagulasion (DIC), % 20 (n=4) enfeksiyöz komplikasyonlar ve % 5 (n=1) pulmoner emboli şeklindeydi. Maternal mortalite riskinin ek hastalığı olan hastalarda 3 kat (OR; 3,003 (95%CI, 0,372-24,390) ve acil şartlarda ameliyat olan hastalarda 4,7 kat (OR;4,784 (95%CI, 0,408-47,619) artığı saptandı. Hastaların elektif şartlarda ameliyat olması ve önceden ultrasonografik olarak tanı almış olmalarının da (OR; 0,219 (95%CI, 0,021-2,447), OR; 0,615 (95%CI, 0,043-8,695) maternal mortalite riskini azalttığı saptandı. Korelasyon analizinde maternal mortalite ile maternal yaş (0,473, p=0,035) ve masive kan transfüzyonunun (0,562, p=0,010) pozitif korelasyon, postoperatif hemoglobin değeri ile de negatif kolerasyon gösterdiği saptanmıştır (-0,723, p= 0,010). Sonuç: Plasenta perkreatalı hastalarda, prenatal tanı konulmuş olması ve hastaların elektif şartlarda opere edilmesi maternal mortalite riskinin azaltılması açısından önem arz etmektedir. Çeşitli cerrahi komplikasyonlar olmasına rağmen DIC tablosu mortalite açısından önemlidir ve bu tabloda masif transfüzyon da mortaliteyi azaltmamaktadır.

Anahtar Kelimeler

• Tekrarlayan sezaryen
• histerektomi
• plasenta perkreata

Kaynakça

1. Chan B, Lam H, Yuen J, et al. Conservative management of placenta praevia with accreta. Hong Kong Med J. 2008;14(6):479-84.
2. Gielchinsky Y, Rojansky N, Fasouliotis S, et al. Placenta accreta—summary of 10 years: a survey of 310 cases. Placenta. 2002;23(2-3):210-214.
3. Jauniaux E, Bunce C, Grønbeck L, et al. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019.
4. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa–placenta accreta. Am J Obstet Gynecol. 1997;177(1):210-214.
5. Ye J, Zhang J, Mikolajczyk R, et al. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data. BJOG. 2016;123(5):745-753.
6. Clausen C, Lönn L, Langhoff‐Roos J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand. 2014;93(2):138-143.
7. Cim N, Elci E, Sayan S, et al. Trends and causes of maternal mortality in Eastern province of Turkey. Eastern Journal Of Medicine. 2017;22(4):191.
8. Chantraine F, Braun T, Gonser M, et al. Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity. Acta Obstet Gynecol Scand. 2013;92(4):439-444.

9. Wh TE. Ultrasonographical features of morbidly-adherent placentas. Singapore Med J. 2007;48(9):799-803.
10. Wortman AC, Alexander JM. Placenta accreta, increta, and percreta. Obstetrics and Gynecology Clinics. 2013;40(1):137-154.
11. Matsuzaki S, Yoshino K, Endo M, et al. Conservative management of placenta percreta. International Journal of Gynecology & Obstetrics. 2018;140(3):299-306.
12. Yu P-C, Ou H-Y, Tsang LL-C, et al. Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation. Fertil Steril. 2009;91(5):1951-1955.
13. Kilicci C, Ozkaya E, Eser A, et al. Planned cesarean hysterectomy versus modified form of segmental resection in patients with placenta percreta. The Journal of Maternal-Fetal & Neonatal Medicine. 2018;31(22):2935-2940.
14. Iwata A, Murayama Y, Itakura A, et al. Limitations of internal iliac artery ligation for the reduction of intraoperative hemorrhage during cesarean hysterectomy in cases of placenta previa accreta. J Obstet Gynaecol Res. 2010;36(2):254-259.
15. Eller A, Porter T, Soisson P, et al. Optimal management strategies for placenta accreta. BJOG. 2009;116(5):648-654.
16. O'Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol. 1996;175(6):1632-1638.
17. Shrivastava V, Nageotte M, Major C, et al. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am J Obstet Gynecol. 2007;197(4):402. e1-402. e5.
18. Camuzcuoglu A, Vural M, Hilali NG, et al. Surgical management of 58 patients with placenta praevia percreta. Wien Klin Wochenschr. 2016;128(9-10):360-366.
19. Sak S, Barut M, Incebiyik A, et al. Management of peripartum hysterectomies performed on patients with placenta percreta in a tertiary central hospital. J Matern Fetal Neonatal Med. 2019 Mar;32(6):883-888.
20. D'antonio F, Palacios‐Jaraquemada J, Lim P, et al. Counseling in fetal medicine: evidence‐based answers to clinical questions on morbidly adherent placenta. Ultrasound Obstet Gynecol. 2016;47(3):290-301.
21. Obstetricians ACo, Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol. 2013;121(4):908.
22. Lal AK, Hibbard JU. Placenta previa: an outcome-based cohort study in a contemporary obstetric population. Arch Gynecol Obstet. 2015;292(2):299-305.
23. Riteau A-S, Tassin M, Chambon G, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. PLoS One. 2014;9(4).
24. Lopes ES, de Lucena Feitosa FE, Brazil AV, et al. Assessment of sensitivity and specificity of ultrasound and magnetic resonance imaging in the diagnosis of placenta accreta. Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics. 2019;41(01):017-023.
25. Chantraine F, Braun T, Gonser M, et al. Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity. Acta Obstet Gynecol Scand. 2013 Apr;92(4):439-44.
26. Allam IS, Gomaa IA, Fathi HM, et al. Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study. Arch Gynecol Obstet. 2014 Nov;290(5):891-6.