Muradiye YILDIRIM, Deniz OLUKLU, Ezgi TURGUT, Dilek SAHİN

İlk Trimester Serum Belirteçlerinin Plasenta Akreta Spektrumu Öngörüsündeki Önemi: Vaka Kontrol Çalışması

Amaç: Plasenta previa (PP) tanılı olgularda plasenta akreta indeks (PAI) skoru ile ilk trimester serum belirteçlerinin (PAPP-A, serbest β HCG) Plasenta Akreta Spektrumu (PAS) öngörüsündeki yerini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamıza 30 PAS, 30 adezyon anomalisi saptanmayan plasenta previa olgusu ile 60 sağlıklı gebe dahil edildi. Çalışmaya dahil edilen olguların, üçüncü trimesterda PAI skoru belirlendi, ardından ilk trimester serum belirteçleri ve operasyon sonuçları (sezaryen, histerektomi) kaydedildi. Bulgular: Çalışmamızda da PP ve kontrol grubundaki olgular karşılaştırıldığında PAPP-A(mIU/ml), PAPP-A MoM ve serbest β HCG MoM değerleri PP grubunda istatistiksel olarak anlamlı derecede daha yüksekti (p<0.001). PP olguları ile PAS olguları karşılaştırıldığında ilk trimester serum belirteçlerinin PAS grubunda ve peripartum histerektomiye giden grupta istatistiksel olarak anlamlı derecede yüksek olduğunu bulduk (p<0.001). İlk trimester serum belirteçlerinin PAS öngörüsünde PAI skorlaması kadar başarılı olduğu sonucuna ulaştık. En güçlü parametrenin ise PAI skorlaması olduğunu bulduk. Sonuç: PAI skorlamasının gerek sonografik ve teknik açıdan belli bir tecrübe gerektirmesi, gerek transvajinal yolla uygulanabilirliği açısından hasta konforunu etkilemesi göz önüne alındığında PAS öngörüsünde benzer değere sahip olması nedeniyle ilk trimester serum belirteçleri de kullanılabilir. Bu verileri kullanarak hastaların üçüncü basamak merkeze sevk edilip multidisipliner preoperatif hazırlık yapılmasının perinatal morbidite ve mortaliteyi azaltacağını düşünmekteyiz.

Anahtar Kelimeler:

Plasenta Previa, Plasenta Akreta Spektrumu, Plasenta Akreta İndeks, PAPP-A, serbest β HCG

Importance of First Trimester Serum Markers in Predicting Placenta Accreta Spectrum: A Case-Control Study

Aim: We aimed to investigate the placenta accreta index (PAI) score and first-trimester serum markers (PAPP-A, free β HCG) in the prediction of Placenta Accreta Spectrum (PAS) in cases diagnosed with placenta previa (PP). Material and Methods: 30 PAS cases, 30 placenta previa cases without adhesion anomaly, and 60 healthy pregnants were included in our study. The PAI score was determined in the third trimester of the cases included in the study, then first-trimester serum markers and surgical outcomes (cesarean section, hysterectomy) were recorded. Results: In our study, when the cases in the PP and control groups were compared, PAPP-A(mIU/ml), PAPP-A MoM, and free β HCG MoM values were statistically significantly higher in the PP group (p<0.001). When PP and PAS cases were compared, we found that first-trimester serum markers were statistically significantly higher in the PAS group and the group undergoing peripartum hysterectomy (p<0.001). We found that the strongest parameter was the PAI score in predicting PAS, and first-trimester serum markers are as successful as PAI scoring. Conclusion: Considering that PAI scoring requires a certain experience in sonographic and technical terms and affects patient comfort in the transvaginal application, first-trimester serum markers can also be used because they have a similar value in predicting PAS. Using these data, we think referring patients to tertiary centers and multidisciplinary preoperative preparation that requires an experienced surgical team will help reduce perinatal morbidity and mortality.

Keywords:

Placenta Previa, Placenta Accreta Spectrum, Placenta Accreta Index, PAPP-A, free β HCG,

PDF

___

Jauniaux E, Bunce C, Gronbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. American journal of obstetrics and gynecology. 2019;221(3):208-18.
Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J, Diagnosis FPA, Management Expert Consensus P. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2018;140(3):265-73.
Belfort MA, Shamshirsaz AA, Fox KA. The diagnosis and management of morbidly adherent placenta. Seminars in perinatology. 2018;42(1):49-58.
Flood KM, Said S, Geary M, Robson M, Fitzpatrick C, Malone FD. Changing trends in peripartum hysterectomy over the last 4 decades. American journal of obstetrics and gynecology. 2009;200(6):632 e1-6.
Rac MW, Dashe JS, Wells CE, Moschos E, McIntire DD, Twickler DM. Ultrasound predictors of placental invasion: the Placenta Accreta Index. American journal of obstetrics and gynecology. 2015;212(3):343 e1-7.
Silver RM. Abnormal Placentation: Placenta Previa, Vasa Previa, and Placenta Accreta. Obstetrics and gynecology. 2015;126(3):654-68.
Fialova L, Malbohan IM. Pregnancy-associated plasma protein A (PAPP-A): theoretical and clinical aspects. Bratislavske lekarske listy. 2002;103(6):194-205.
Morris RK, Bilagi A, Devani P, Kilby MD. Association of serum PAPP-A levels in first trimester with small for gestational age and adverse pregnancy outcomes: systematic review and meta-analysis. Prenat Diagn. 2017;37(3):253-65.
Pilalis A, Souka AP, Antsaklis P, Daskalakis G, Papantoniou N, Mesogitis S, et al. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler and PAPP-A at 11-14 weeks' gestation. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2007;29(2):135-40.
Khong TY. The pathology of placenta accreta, a worldwide epidemic. Journal of clinical pathology. 2008;61(12):1243-6.
Sirikunalai P, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, et al. Associations between maternal serum free beta human chorionic gonadotropin (beta-hCG) levels and adverse pregnancy outcomes. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2016;36(2):178-82.
Tulek F, Kahraman A, Taskin S, Ozkavukcu E, Soylemez F. Changes in first trimester screening test parameters in pregnancies complicated by placenta previa and association with hyperemesis gravidarum. Journal of the Turkish German Gynecological Association. 2014;15(4):212-6.
Wang F, Zhang L, Zhang F, Wang J, Wang Y, Man D. First trimester serum PIGF is associated with placenta accreta. Placenta. 2020;101:39-44.
Dashe JS, McIntire DD, Ramus RM, Santos-Ramos R, Twickler DM. Persistence of placenta previa according to gestational age at ultrasound detection. Obstetrics and gynecology. 2002;99(5 Pt 1):692-7.
Desai N, Krantz D, Roman A, Fleischer A, Boulis S, Rochelson B. Elevated first trimester PAPP--a is associated with increased risk of placenta accreta. Prenat Diagn. 2014;34(2):159-62.
D'Antonio F, Rijo C, Thilaganathan B, Akolekar R, Khalil A, Papageourgiou A, et al. Association between first-trimester maternal serum pregnancy-associated plasma protein-A and obstetric complications. Prenat Diagn. 2013;33(9):839-47.
Happe SK, Yule CS, Spong CY, Wells CE, Dashe JS, Moschos E, et al. Predicting Placenta Accreta Spectrum: Validation of the Placenta Accreta Index. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2021;40(8):1523-32.
Agarwal S, Agarwal A, Chandak S. Role of placenta accreta index in prediction of morbidly adherent placenta: A reliability study. Ultrasound. 2021;29(2):92-9.
Abu Hashim H, Shalaby EM, Hussien MH, El Rakhawy M. Diagnostic accuracy of the placenta accreta index for placenta accreta spectrum: A prospective study. International Journal of Gynecology & Obstetrics. 2022;156(1):71-6.