Pervin DEMİR, Derya CIRIK AKDAĞ, Tuğba ZENGİN, Runa ÖZELÇİ, Berna DİLBAZ

Plasenta Previanın Obstetrik Sonuçlar Üzerine Etkisi

Amaç: Plasenta previa olgularının insidansını, klinik ve operatif özelliklerini incelemek ve gebelik sonuçları üzerine etkisini değerlendirmek.Gereç ve yöntem: Kliniğimizde 2011 Aralık ve 2013 Haziran tarihleri arasında doğumu gerçekleşmiş 32945 gebelikten 88 plasenta previa PP olgusu retrospektif olarak incelendi. Olguların demografik özellikleri,plasenta yerleşim tipleri,fetal doğum ağırlığı ve cinsiyeti, 5. dakika apgar skoru ve daha önce geçirmiş olduğu sezaryen sayısı kaydedildi. Bulgular: Çalışmamızda PP insidansı %0.26, bu olgularda ortalama yaş 31.08 ±5.12 23-42 , gebelik haftası 35.45±3.19 25-40 , gravida 3.19± 1.84 1-11 , parite 1.51± 1.49 0-10 olarak bulundu.Plasenta previa olgularının%68.2’si komplet,%23.9’u inkomplet, %3.4’ü marjinal,%4.5’i alt segmentyerleşimliydi. Plasenta previa olgularının %12.5’ine kanama kontolünü sağlamak için histerektomi yapıldı. Histerektomi yapılan vakaların %90,9’unda plasenta komplet yerleşimliydi ve hepsinin geçirilmiş sezaryen öyküsü vardı. Ortalama yenidoğan ağırlığı 2680± 913g 650-4250 ,ortalama 5. dakika apgar skoru 8.16 ±1.72 0-9 olarak bulundu ve fetusların %51,1’i erkek %48,9’u kız idi. Sonuç: Plasenta previa olgularında daha önce geçirilmiş sezaryen sayısında artış olması, gerek anne gerekse yenidoğanaçısından aşırı kanama ve prematüritede artış şeklinde olumsuz sonuçları beraberinde getirmektedir.Plasenta previa olgularında özellikle komplet yerleşimli ve daha önce sezaryen öyküsü olan hastalara acil peripartumhisterektomi yapılma ihtimali daha yüksektir.Sezaryen histerektomimorbiditesi yüksek bir operasyondur, bu nedenle plasenta previadan şüphelenildiğinde veya antenatal olarak tanı konulduğunda tersiyer merkezlerde ve tecrübeli bir ekip tarafından ve iyi planlanmış bir şekilde gerçekleştirilmelidir.

Anahtar Kelimeler:

Plasenta previa, komplet plasenta previa, histerektomi, postpartumhemoraji

Impact of Placenta Previa on Obstetric Outcome

Aim: To determine the incidence and clinical and operative characteristics of placenta previa PP and impact of placenta previa on obstetric outcome. Material and Methods: Eightyeight patients with placenta previa were evaluated from 32945 of pregnancies at the Obstetrics Department of a Tertiary Research and Education Hospital between December 2010 and June 2013. Demographic characteristics, types of placenta previa locations, neonatal weight,fetal sex,Apgar scores of 5th minutes and numbers of previous cesarean sections were recorded. Results: The incidence of PP in the present study was 0.26 %. The mean age of patients with placenta previa was 31.08 years old range 23-42 years , gestational week 35.45±3.19 25-40 , gravidity 3.19± 1.84 1-11 and parity was 1.51± 1.49 0-10 . There were 60 68.2% women with complete placenta previa, 21 23.9% with incomplete placenta previa,3 3.4% with marginal placenta previa,4 4.5% with a low lying placenta. Overall, 11 12.5% patients underwent obstetric hysterectomy. The majority of women 10 of 11 women 90.9%with an obstetric hysterectomy had complete PP. The mean neonatal weight was 2680 g range 650-4220g ,the fifth minutes Apgar scores were found as 8.16 ±1.72 0-9 . Among the 88 delivered neonates, 45 51.1% were male and 43 48.9% were female. Conclusion: The risk of adverse maternal and neonatal outcome in PP pregnancies increases with an increasing number of previous cesarean deliveries. It should be kept in mind that cases of PP especially with previous cesarean sections have high probability of emergency peripartum hysterectomy. When placenta previa suspected or diagnosed during antenatal follow up,the patient must be referred to a tertiary center and the delivery should be performed in suitable clinical settings with experienced surgeons.

Keywords:

Placenta previa, complete placenta previa, hysterectomy, postpartum hemorrhage,

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