The effects of the association of placenta previa and placenta accreta on the short-term maternal morbidity

Plasenta previa ve plasenta akreta birlikteli¤inin k›sa dönem maternal morbiditeye etkileri

Abstract

Objective: We aimed to compare the effects of placenta previa (PP) and placenta accreta (PA) on the short-term maternal morbidity alone and together. Methods: The data of the patients who were diagnosed with PP, PA or placenta previa accreta (PPA) which includes both of them between January 2010 and December 2018 in a tertiary reference center were analyzed retrospectively. The records of the patients were compared between 3 groups for age, gravida, parity, week of gestation, previous cesarean section, history of curettage and myomectomy, gestational complications, placental location, hospitalization at hospital and intensive care unit, decreased level of hemoglobin, blood product transfusions, procedures to control bleeding and complications. Results: Six out of 192 patients were excluded from the study as they delivered in other hospitals, and the data of 186 patients were analyzed. There were 141 (75.8%) patients with PP only, 9 (4.8%) patients with PA only, and 36 (19.4%) patients with PPA. The erythrocyte transfusion was significantly higher in PPA patients than PP patients (p<0.001). The possibility for the transfusion of any blood product was lower in PP group than other groups. While the rate of hospitalization at intensive care unit was higher in PPA group, the number of hospitalization day at hospital was significantly lower in PP group than PA (p=0.042) and PPA (p<0.001) groups. Urinary complication was observed less in PP patients. The hysterectomy rate was higher in PPA patients with than PP and PA patients (p=0.004). Conclusion: The rates of maternal morbidity and hysterectomy increase when PP and PA are together compared to the cases where they are alone.

Özet

(PA) tek bafl›na ve birlikteliklerinde k›sa dönem maternal morbiditeye etkilerini karfl›laflt›rmay› hedefledik. Yöntem: Üçüncü basamak referans merkezinde Ocak 2010 – Aral›k 2018 tarihleri aras›nda tan›s› konan PP, PA veya her ikisini birlikte içeren plasenta previa akreta (PPA) hastalar›n›n verileri retrospektif olarak analiz edildi. Hasta kay›tlar› yafl, gravida, parite, gestasyon haftas›, geçirilmifl sezaryen, küretaj ve miyomektomi öyküsü, gebelik komplikasyonlar›, plasenta lokasyonu, hastane ve yo¤un bak›m yat›- fl›, hemoglobin düflüflü, kan ürünü transfüzyonlar›, kanama kontrolü için yap›lan giriflimler, komplikasyonlar için 3 grup aras›nda karfl›laflt› r›ld›. Bulgular: Toplam 192 hasta içerisinden alt› hasta, do¤umlar› baflka hastanelerde gerçekleflti¤i için çal›flma d›fl› b›rak›ld› ve 186 hastan› n verileri analiz edildi. Sadece PP olan 141 (%75.8) hasta, sadece PA olan 9 (%4.8) hasta ve PPA olan 36 (%19.4) hasta mevcuttu. Eritrosit transfüzyonu PPA hastalar›nda, PP hastalar›ndan anlaml› olarak daha yüksekti (p<0.001). Herhangi bir kan ürünü transfüzyonu olas›l›¤› PP’de di¤er gruplara göre daha azd›. Yo¤un bak›m yat›fl oran› PPA grubunda daha fazla iken, hastanede yat›fl günü say›s› PP grubunda, PA (p=0.042) ve PPA gruplar›ndan (p<0.001) anlaml› olarak daha düflüktü. Üriner komplikasyona PP hastalar›nda daha az rastland›. PPA hastalar›nda histerektomi oran›, PP ve PA hastalar›na göre daha fazla bulundu (p=0.004). Sonuç: PP ve PA’n›n tek bafl›na bulunmas›na göre birlikteliklerinde k›sa dönem maternal morbidite ve histerektomi oranlar› artmaktad› r.