SEZARYENLERDE PLASENTANIN MYOMETRİUM İLE İLİŞKİSİNİN DEĞERLENDİRİLMESİ

Öz

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. 

Anahtar Kelimeler

• , 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

Kaynakça

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