Plasenta yapışma anomalileri: Klinik yaklaşım ve yönetim

Serkan Kahyaoğlu; Şevki Çelen; İnci Kahyaoğlu; Leyla Mollamahmutoğlu; Nuri Danışman

EN TR

Plasenta yapışma anomalileri: Klinik yaklaşım ve yönetim

Abstract

Obstetric risks have increased among pregnancies following previous cesarean section deliveries. Placenta accreta and cesarean scar pregnancies, as abnormal placentation entities, represent two important clinical manifestations. Placenta accreta is characterised with a placenta that is abnormally adherent to uterine cavity because of the absence of decidua basalis and presence of incompletely developed fibrinoid layer. Placenta accreta occurs in 5-10% of pregnancies complicated with placenta previa. Placenta increta and percreta are the other serious abnormalities of placental implantation that demonstrates invasion of chorionic villi into the myometrium and uterine serosa respectively. Placenta accreta has been seen rarely as 1 in 30.000 births in 1950’s but the incidence of placenta accreta has increased recently to 1 in 553 and 2510 deliveries in parallel with increased cesarean sectio deliveries. Previous uterine surgery is the most important risk factor for placenta accreta. Thin, defectively formed or absent decidua basalis layer can not show resistance to deep penetration of trophoblasts and placenta invades this pathological region of uterus that has previously been traumatised by uterine surgery. Abnormal placental implantation impedes placental removal spontaneously following delivery. The first clinical sign of placenta accreta is profuse and life threatening bleeding that occurs during manuel removal of placenta. Placenta accreta is diagnosed with characteristic signs during prenatal ultrasound examination including color doppler modalities. Magnetic resonance imaging is also helpful for equivocal cases. Massive bleeding and resultant disseminated intravascular coagulation, adult respiratuar distress syndrome, renal insufficiency, unplanned surgery and death are serious complications of placenta accreta. Preoperative and intraoperative management strategies of placenta accreta have been detailed in this review.

Keywords

Placenta accreta, management, clinical approach, treatment strategies

Plasenta yapışma anomalileri: Klinik yaklaşım ve yönetim

Öz

Önceki sezaryan doğumları takibeden gebeliklerde obstetrik riskler artmıştır. Anormal plasentasyon oluşumları olarak plasenta akreta ve sezaryan skar gebelikleri iki önemli klinik durumdur. Plasenta akreta; plasentanın uterin kaviteye desidua bazalisin yokluğu nedeni ile anormal bir şekilde yapışması ve fibrinoid tabakanın inkomplet gelişimi ile karakterize bir tanıdır. Plasenta previa ile komplike olan gebeliklerin %5-10’unda plasenta akreta olur. Plasental implantasyonun daha ciddi anormallikleri, koryonik villusların myometriyum içine kadar invaze olduğu plasenta inkreta ve koryonik villusların uterus serozasını penetre ettiği plasenta perkretadır. 1950’li yıllarda yaklaşık 30.000 doğumda bir görülen plasenta akretanın insidansı son yıllarda artan sezaryan ile doğumların prevelansındaki artışa paralel olarak 553 ile 2510 doğumda bir görülmeye başlamıştır. Plasenta akretanın en önemli risk faktörü önceki geçirilmiş uterus cerrahisidir. Alt uterin segmentin skarlı alanındaki ince, kötü oluşan veya olmayan desidua bazalis tabakasının trofoblastların derin penetrasyonuna direnç gösterememez ve plasenta önceki uterin cerrahiye bağlı olarak travmatize olan uterusun patolojik bir bölgesini invaze eder. Anormal plasental implantasyon doğumu takiben plasentanın normal ayrılmasına engel olur. Plasenta akretanın ilk klinik bulgusu manuel plasenta ayrılması girişimi sırasında meydana gelen aşırı ve hayatı tehdit eden kanamadır. Plasenta akretaya renkli dopler modalitelerini de içeren prenatal ultrason muayenesindeki karakteristik bulguların varlığı ile tanı konur. Şüpheli vakalarda manyetik rezonans görüntüleme yararlı olur. Masif kanama ve bunun sonucunda gelişebilen dissemine intravasküler koagülasyon, erişkin respiratuar distres sendromu, böbrek yetmezliği, planlanmamış cerrahi ve ölüm plasenta akretanın en ciddi komplikasyonlarıdır. Plasenta akretanın preoperatif ve intraoperatif yönetim stratejileri bu derlemede detaylı olarak ele alınmıştır.

Anahtar Kelimeler

Plasenta akreta, yönetim, klinik yaklaşım, tedavi stratejileri

Kaynakça

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Ayrıntılar

Birincil Dil

İngilizce

Konular

-

Bölüm

-

Yazarlar

Serkan Kahyaoğlu

Şevki Çelen

İnci Kahyaoğlu

Leyla Mollamahmutoğlu

Nuri Danışman

Yayımlanma Tarihi

30 Aralık 2013

Gönderilme Tarihi

15 Ocak 2012

Kabul Tarihi

-

Yayımlandığı Sayı

Yıl 2013 Cilt: 35 Sayı: 4

IZ

https://izlik.org/JA79JR85ZE

Kaynak Göster

RIS / Bibtex

AMA

1.Kahyaoğlu S, Çelen Ş, Kahyaoğlu İ, Mollamahmutoğlu L, Danışman N. Plasenta yapışma anomalileri: Klinik yaklaşım ve yönetim. CMJ. 2013;35(4):618-628. https://izlik.org/JA79JR85ZE