TÜRKİYE'DEKİ ÜÇÜNCÜL MERKEZLERDE PLASENTA AKRETA SPEKTRUMUNUN YÖNETİM STRATEJİLERİ

Öz

Amaç: Plasenta akreta spektrumunun (PAS) yönetimindeki ortak ve farklı yaklaşımların ulusal çapta bir anket çalışmasıyla belirlenmesi. Gereç ve Yöntem: Çevrim içi bir anket ile 47 soru yöneltildi. Katılımcıların %77’si ankete cevap verdi (37/48). Katılımcıların cevaplarında uyum için %75-89 (28–33/37), kuvvetli uyum için ≥ %90 (≥34/37) fikir birliği arandı. Bulgular: Az sayıda konuda uyum ve kuvvetli uyum sağlanabildi. Bunlar girişimsel radyoloji imkânı olmaması (%89,2), hücre kurtarıcı olmaması (%94,6), manyetik rezonansın nadiren kullanılması (%83,8), yardımcı görüntüleme yöntemi olarak sıklıkla transvajinal sonografi (%94,6) kullanılmasıdır. Penetran cinsel ilişkinin yasaklanması (%78,4), perine traşı (%81,1) ve lavman kullanılmaması (%94,6), genel anestezi kullanılması (%75,7), hipotermi kontrolünün ihmal edilmemesi (%97,3), oksitosinin sezaryende kullanılan dozda uygulanması (%75,7), damar yaralanmalarında damar cerrahisinden yardım alınması (%78,4), jinekolojik onkoloji uzmanlarının ameliyatlara rutin olarak çağrılmaması (%86,5), santral venöz kateterin rutin olarak rutin olarak takılmaması (%78,4) ve ameliyat bitiminde genellikle dren konulması (%89,2) ise diğer noktalardır. Katılımcılar arasında insizyon tercihi genellikle orta hat kesidir (%83,8) ve ameliyat şekli total histerektomidir (%81,1). Ameliyat sonrası dönemde hastaların hareket etmesi (%91,9) ve beslenmesi (%83,8) kısıtlanmamaktadır. Genellikle ameliyat sonrası 3.-4. günlerde taburcu edilmelerine (%75,7) karar verilmektedir. Psikiyatrik ihtiyaçları genellikle ihmal edilmektedir (%94,6). Sonuç: Görüş birliği elde edilen noktalar bu karmaşık sorunun yönetiminde doğum hekimlerine yardımcı olabilir. Bu sonuçlar aynı zamanda PAS’ın doğru yönetimi için kanıta dayalı bilgi açığını ortaya koymaktadır. Bu konular için gelecekte yapılacak çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Perinatoloji
• plasenta akreta
• postpartum kanama
• anket

THE MANAGEMENT STRATEGIES IN THE PLACENTA ACCRETA SPECTRUM IN TERTIARY CENTERS IN TÜRKİYE

Öz

Objective: To determine the differences and consensus points in managing patients with placenta accreta spectrum (PAS) disorder in a nationwide survey. Material and Method: Forty-seven items were asked via an online survey. Seventy-seven percent responded to the survey (37/48). Consensus/strong consensus was predefined as 75%– 89% (28–33/37)/>90% (≥34/37) of panelists agreeing on an answer. Result: In a few areas, consensus or strong consensus was achieved. These are the absence of interventional radiology (89.2%) and cell-saver in the institution (94.6%), a rare selection of magnetic resonance (83.8%), and frequent use of transvaginal sonography (94.6%) as an adjuvant diagnostic tool. Penetrative sexual intercourse is prohibited (78.4%); perineal shaving (81.1%) and rectal enema (94.6%) are not used; general anesthesia (75.7%) is the preferred technique; hypothermia control (97.3%) is not omitted; and administration of oxytocin (75.7%) is similar to routine cesarean section; vascular injuries are managed by vascular surgeons (78.4%); gynecologic oncologists are not a regular part of the surgical team (86.5%); routine insertion of a central venous cannula (78.4%) is not considered and placement of an abdominal drain (89.2%) is usually performed. Surgery is often performed through a median abdominal incision (83.8%), and a total hysterectomy (81.1%) is chosen. Routine hypogastric artery ligation (91.9%) is not performed. In the postoperative period, the patients are allowed to have early mobilization (91.9%) and oral intake (83.8%). They are habitually discharged on the 3rd-4th postoperative day (75.7%). Psychiatric needs are often neglected (94.6%). Conclusion: These consensus points could help obstetricians manage this complicated condition. These results also demonstrate the need for evidence-based data for implementing proper treatment strategies for PAS disorder. Future research is sought for these points.

Anahtar Kelimeler

• Perinatology
• placenta accreta
• postpartum hemorrhage
• surveys and questionnaires

Kaynakça

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