Plasenta previa totalis olgularının 5 yıllık analizi
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Tarih
2015
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Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Plasenta previa totalis; plasentanın alt uterin segmente yerleşip internal servikal osu tamamen kapatması durumudur. Çalışmamızda plasenta previa totalis olgularında gelişebilecek komplikasyonların önceden tahmini ve en önemlisi maternal morbidite ve mortalitenin azaltılmasını amaçladık. Çalışmamıza Ocak 2009-Aralık 2013 tarihleri arasında, kliniğimizde plasenta previa totalis ön tanısı ile doğumu gerçekleştirilen 224 hasta dahil edildi. Plasenta previa parsiyalis, plasenta previa marjinalis, aşağı yerleşimli plasenta ön tanılı hastalar çalışmamıza dahil edilmedi. Histopatolojik tanıları olmadığından dolayı bütün invazyon anomalileri plasenta akreata olarak tanımlandı. Hastaların demografik verileri, jinekolojik ve obstetrik öyküleri, operasyondaki kesi şekilleri, plasental yapışma anomalileri, labaratuar parametreleri, yapılan kan transfüzyonları incelendi. Anestezi şekli, vakanın alınma şekli, ek cerrahi müdaheleler, yeni doğan 1. ve 5. dakika apgar skorları, ağırlık, cinsiyetleri, gelişen komplikasyonlar ve yoğun bakım gereksinimleri değerlendirildi. Veriler hastane elektronik arşiv veri tabanı kullanılarak temin edildi. Çalışma süresince hastanemizde toplam 10580 doğumun gerçekleştiği saptandı. Yıllara göre sezaryen oranlarının artışına paralel olarak plasenta previa totalis ve plasenta akreata olgularının görülme sıklığında artış olduğu saptandı. Çalışmamızda 5 yıllık plasenta akreata sıklığı 100 doğumda 1 olarak tespit edildi. Çalışmamızda geçirilmiş sezaryen sayısı ile invazyon oluşumu açısından istatiksel olarak anlamlı artış olduğu saptandı (p<0,005). Gelişen tüm intraoperatif ve postoperatif komplikasyonların invazyonu olan hastalarda olduğu saptandı. Özellikle invazyon düşünülen plasenta previa totalis olgularında erken tanı, yeterli preoperatif hazırlık çok önemlidir. Hastalar multidisipliner yaklaşımın sunulabileceği, kan bankası ünitesi, erişkin yoğun bakım ve yeni doğan yoğun bakım ünitesi iyi olan tersiyer merkezlere sevk edilmelidir. Olguların elektif olarak operasyona alınmasının maternal morbidite ve mortalitenin azaltılmasında veya önlenmesinde önemli etkenler olduğu kanaatindeyiz. Anahtar kelimeler: Plasenta previa, plasenta akreata, obstetrik kanamalar, sezaryen, histerektomi
Placenta previa totalis is a placenta presentation abnormality in which placenta completely closes cervical os. In our study, we aim to predict the possible complications in patients with placenta previa totalis and most importantly reduce maternal morbidity and mortality. In our study, 224 patients who delievered with a preliminary diagnosis of placenta previa totalis in our clinic between the time period January 2009 and December 2013 were included. The patients who diagnosed as placenta previa partialis, placenta previa marginalis and down implanted placenta were excluded at the study. The all invasion anomalies were defined as placenta accreta because of absence of the histopathologic diagnosis. Patient’s demographic datas, gynecological and obstetric history, the type of surgical incision, placental adhesion abnormalities, laboratory parameters and blood transfusions were examined. The type of anesthesia, additional surgical interventions, newborn neonatal apgar scores at 1 and 5 minutes, weight, gender, complications and intensive care requirements were evaluated. The data was obtained using the hospital's database electronic archive. During the study, a total of 10,580 births occured in our hospital. The cases of placenta previa totalis and accreata are seemed to be increased proportionally with the number of ceaserean section. In our study, the incidence of placenta accreta in 5 years was identified as 1 in 100 births. In our study, the formation of invasion was found to be statistically significantly increased with the number of cesarean delivery (p <0.005). All intraoperative and postoperative complications were observed in patients who had the invasion. Especially in cases of placenta previa totalis that invasion is considered, early diagnosis and preoperative preparation is so essential. Patients should be referred to tertiary centers in where there is a blood bank unit, an adult intensive care and a good neonatal intensive care unit and multidisciplinary approach can be offered. We believe that the most important factors to reduce or prevent maternal morbidity and mortality of patients are determining elective operations. Key words: Placenta previa, placenta accreta, obstetric hemorrhage, cesarean section, hysterectomy
Placenta previa totalis is a placenta presentation abnormality in which placenta completely closes cervical os. In our study, we aim to predict the possible complications in patients with placenta previa totalis and most importantly reduce maternal morbidity and mortality. In our study, 224 patients who delievered with a preliminary diagnosis of placenta previa totalis in our clinic between the time period January 2009 and December 2013 were included. The patients who diagnosed as placenta previa partialis, placenta previa marginalis and down implanted placenta were excluded at the study. The all invasion anomalies were defined as placenta accreta because of absence of the histopathologic diagnosis. Patient’s demographic datas, gynecological and obstetric history, the type of surgical incision, placental adhesion abnormalities, laboratory parameters and blood transfusions were examined. The type of anesthesia, additional surgical interventions, newborn neonatal apgar scores at 1 and 5 minutes, weight, gender, complications and intensive care requirements were evaluated. The data was obtained using the hospital's database electronic archive. During the study, a total of 10,580 births occured in our hospital. The cases of placenta previa totalis and accreata are seemed to be increased proportionally with the number of ceaserean section. In our study, the incidence of placenta accreta in 5 years was identified as 1 in 100 births. In our study, the formation of invasion was found to be statistically significantly increased with the number of cesarean delivery (p <0.005). All intraoperative and postoperative complications were observed in patients who had the invasion. Especially in cases of placenta previa totalis that invasion is considered, early diagnosis and preoperative preparation is so essential. Patients should be referred to tertiary centers in where there is a blood bank unit, an adult intensive care and a good neonatal intensive care unit and multidisciplinary approach can be offered. We believe that the most important factors to reduce or prevent maternal morbidity and mortality of patients are determining elective operations. Key words: Placenta previa, placenta accreta, obstetric hemorrhage, cesarean section, hysterectomy
Açıklama
Anahtar Kelimeler
Cerrahi-kadın doğum, Surgery-obs.-gyn, Kadın hastalıkları, Plasenta previa, Placenta previa, Plasenta akreata, Placenta accreta, Obstetrik kanamalar, Obstetric hemorrhage, Sezaryen, Cesarean section, Histerektomi, Hysterectomy
