Plasenta dekolmanı olan hastaların bir sonraki gebeliklerinde prognoz değerlendirilmesi
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Tarih
2024
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Plasenta dekolmanı maternal ve fetal mortaliteyi arttıran aynı zamanda öngörülemeyen bir gebelik komplikasyonu olarak kabul ediliyor. Araştırmamızda, kliniğimize plasenta dekolmanı nedeni ile acil sezeryan yapılan gebelerde,bir sonraki gebeliklerinde maternal ve fetal prognoz değerlendirilmesini amaçlamaktadır. Gereç ve Yöntem: Bu çalışmaya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde 2013-2023 yılları arasında plasenta dekolmanı ön tanısı ile sezaryen doğuma alınan ve dekolman plasenta tanısı operasyonda doğrulanan 54 gebelik dahil edilmiştir. Klinik ve sonografik olarak dekolman plasenta şüphesi ile doğuma alınan 186 gebenin 9 tanesi makroskopik ve histolojik olarak tanı almadığı için, 5 tanesi de vajinal doğum sonrası dekolman olarak tanı aldığı, 7 tanesinin dekolman yüzdesi %30 ın altına olması, 3 tanesi dış merkezden sezeryan sonrası sevk ile tarafımıza başvurduğu, 60 tanesi son gebelik olması, 11 tanesi bilateral tubal ligasyon olması, 32 tanesine ulaşılamadığı için çalışmaya dahil edilmemiştir. Araştırmaya dekolma plasenta tanısı alan, 20.gestasyon haftadan daha büyük gebe hastalar dahil edilmiştir. Dekolman plasenta tanısı, spesifik klinik ultrasonografi görüntüsü ile birlikte plasentanın makroskopik olarak incelemesi sonucu dekolman plasenta gözlenmesi ile konulmuştur. Araştırma verileri retrospektif olarak hastaların arşiv dosyaları ve elektronik bilgi sistemi üzerinden elde edilmiştir. Aynı zamanda tüm hastalar, hastane sistemi üzerinden telefon bilgilerine ulaşılarak arandı .Hastaların hastane sistemi üzerinden, ameliyat notu, epikrizleri ve poliklinik kayıtları incelendi.
Bulgular: Bu çalışma, 54 dekolman plasenta öyküsüne sahip kadınları ve dekolman öyküsü bulunmayan ancak sezaryen ile doğum yapmış olan 100 gebe kadını içermektedir. Toplamda 154 gebe kadın ile bu araştırma tamamlanmıştır. dekolman ve kontrol grubunun sosyodemografik ve klinik özelliklerinin ve tekrar dekolman olma riskini etkileyebilecek parametrelerin karşılaştırılması hedeflenmiştir. Önceki gebelikteki yaşı için her bir yaş artışı için dekolman riski yaklaşık olarak %6 artmaktadır; ancak bu artış istatistiksel olarak anlamlı değildir (p=0.090). Sonraki gebelikteki yaşı için yaşta her bir yıl azalması ile dekolman riskinde %2 azalma gözlenmiş, ancak bu azalma da istatistiksel olarak anlamlı değildir (p=0.52).BMI'da her bir birim azalması ile dekolman riskinde %3 azalma gözlenmiştir, bu da istatistiksel olarak anlamlı değildir (p=0.32). Gebelik sayısındaki her bir artış dekolman riskini %1 oranında arttırmaktadır, bu değişiklik istatistiksel olarak anlamlı değildir (p=0.91).Doğum sayısındaki her bir artış dekolman riskini %33 oranında arttırmaktadır, ancak bu istatistiksel olarak anlamlı değildir (p=0.16).GDM varlığı dekolman riskinde bir artışa yol açsa da, bu artış istatistiksel olarak anlamlı değildir (p=0.74). Gestasyonel hipertansiyon varlığı dekolman riskinde bir azalmaya yol açsa da, bu azalma istatistiksel olarak anlamlı değildir (p=0.49). Trombosit sayısındaki değişiklikler dekolman riskini etkilememektedir (p=0.79). Bu değişkenler, tekrar dekolman olma riskini etkilemediği görülmektedir. Diğer taraftan, tekrar dekolman olma riskini anlamlı şekilde etkileyen değişkenler şunlardır:
Tedavi ile desteklenen gebeliklerde dekolman riski 3.17 kat artmaktadır (p=0.045).Sezaryen sayısındaki her bir artış dekolman riskini %54 oranında arttırmaktadır (p=0.025).Önceki gebelikteki hafta için gebelik haftasındaki her bir haftalık azalma dekolman riskini %53 oranında azaltmaktadır (p=0.001). Sonraki gebelikteki hafta için gebelik haftasındaki her bir haftalık azalma dekolman riskini %41 oranında azaltmaktadır (p=0.001).Abortus sayısındaki her bir artış dekolman riskini %58 oranında azaltmaktadır (p=0.002).Küretaj sayısındaki her bir artış dekolman riskini %44 oranında azaltmaktadır (p=0.023).Erken membranrüptürü olması dekolman riskini 19.5 kat arttırmaktadır (p=0.001).Fetal gelişme geriliği olan gebeliklerde dekolman riski 3.45 kat artmaktadır (p=0.007).Preeklemsi varlığı dekolman riskini 8.1 kat arttırmaktadır (p=0.001).Proteinüri varlığı dekolman riskini 14.1 kat arttırmaktadır (p=0.001).HELLP sendromu varlığı dekolman riskini yaklaşık 18 kat arttırmaktadır, ancak bu artışın p-değeri sınırda anlamlıdır (p=0.055).Antihipertansif ilaç kullanımı dekolman riskini 3.17 kat arttırmaktadır (p=0.045).Hemoglobin değerindeki her bir g/dL azalma dekolman riskini %27 oranında azaltmaktadır (p=0.004).WBC sayısındaki her bir birimlik artış dekolman riskini %33 oranında arttırmaktadır (p=0.001).Kompresyon sütürüuygulanması dekolman riskini yaklaşık 10 kat arttırmaktadır (p=0.001).Plasental anomali varlığı dekolman riskini 7.2 kat arttırmaktadır (p=0.008).Sezaryenler arasındaki sürenin her bir ay kısalması dekolman riskini %28 oranında azaltmaktadır (p=0.001).DMAH kullanımı dekolman riskini 3.89 kat arttırmaktadır (p=0.001).Aspirin kullanımı dekolman riskini 14.1 kat arttırmaktadır (p=0.001).Bu değişkenler, tekrar dekolman olma riskini anlamlı şekilde etkilemektedir.
Sonuç: Dekolman plasenta maternal ve fetal mortaliteyi arttıran öngörülemeyen bir gebelik komplikasyonudur ve bunun tekrar edilmesi çok daha katastrofik durumlara sebep olabilir, o yüzden bir sonraki gebelikte tekrar etme riskini araştırdışımız bu çalışmada tedavi gebelik varlığı, sezaryen sayısında artma, erken membran rüptürü, fetal gelişme geriliği, preeklampsi, proteinüri, WBC artışı plasental anomali varlığı, DMAH ve aspirin kullanımı, gebelik haftasında azalma, preoperatif hemoglobin değerinde azalma, sezaryenler arasındaki sürede azalma deolman plasenta riskinin arttığını tespit ettik. Ancak bu konuda çok merkezli prospektif randomize kontrollu çalışmalara ihtiyaç vardır.
Objective: Placental abruption is considered an unpredictable pregnancy complication that increases maternal and fetal mortality. Our research aims to evaluate the maternal and fetal prognosis of pregnant women who underwent emergency cesarean section due to placental abruption in their next pregnancies. Materials and Methods: This study included 54 pregnancies that were delivered by cesarean section with the preliminary diagnosis of placenta abruption at the Gynecology and Obstetrics Clinic of Necmettin Erbakan University Meram Medical Faculty Hospital between 2013 and 2023, and the diagnosis of placental abruption was confirmed during the operation. Of the 186 pregnant women who were taken to labor with clinical and sonographic suspicion of placenta abruption, 9 of them were not diagnosed macroscopically and histologically, 5 of them were diagnosed as abruption after vaginal birth, 7 of them were diagnosed as abruption after vaginal birth, 7 of them were referred because the abruption percentage was below 30%, and 3 of them were referred from an external center after cesarean section. 60 of them were in the last pregnancy, 11 of them had bilateral tubal ligation, and 32 of them were not included in the study because they could not be reached. Pregnant patients older than the 20th week of gestation who were diagnosed with abruptio placentae were included in the study. The diagnosis of abruptio placenta was made by observing abruptio placenta as a result of macroscopic examination of the placenta along with specific clinical ultrasonography image. Research data were obtained retrospectively from patients' archive files and electronic information system. At the same time, all patients were called by accessing their telephone information through the hospital system. The patients' surgery notes, epicrisis and outpatient clinic records were examined through the hospital system. Results: This study included 54 women with a history of placental abruption and 100 pregnant women without a history of abruption but who had delivered by cesarean section. This research was completed with a total of 154 pregnant women. It was aimed to compare the sociodemographic and clinical characteristics of the detachment and control groups and the parameters that may affect the risk of re-detachment. For each additional year of age at the previous pregnancy, the risk of detachment increases by approximately 6%; however, this increase is not statistically significant (p=0.090). A 2% decrease in the risk of detachment was observed with each year of decrease in age at the next pregnancy, but this decrease was not statistically significant (p = 0.52). A 3% decrease in the risk of detachment was observed with each unit decrease in BMI, which is statistically significant. is not significant (p=0.32). Each increase in the number of pregnancies increases the risk of detachment by 1%, this change is not statistically significant (p = 0.91). Each increase in the number of births increases the risk of detachment by 33%, but this is not statistically significant (p = 0.16). Presence of GDM Although it causes an increase in the risk of detachment, this increase is not statistically significant (p = 0.74). Although the presence of gestational hypertension leads to a decrease in the risk of abruption, this decrease is not statistically significant (p = 0.49). Changes in platelet count do not affect the risk of detachment (p = 0.79). These variables do not appear to affect the risk of re-detachment. On the other hand, variables that significantly affect the risk of re-detachment are: The risk of detachment increases 3.17 times in pregnancies supported by treatment (p = 0.045). Each increase in the number of cesarean sections increases the risk of detachment by 54% (p = 0.025). Each week of decrease in the week of pregnancy for the week in the previous pregnancy reduces the risk of detachment by 53% (p). =0.001). Each week of reduction in the gestational age for the next week reduces the risk of detachment by 41% (p=0.001). Each increase in the number of abortions reduces the risk of detachment by 58% (p=0.002). Each increase in the number of curettages reduces the risk of detachment by 44%. (p=0.023). Premature rupture of membranes increases the risk of detachment by 19.5 times (p=0.001). The risk of detachment in pregnancies with fetal growth restriction increases by 3.45 times (p=0.007). The presence of preeclampsia increases the risk of detachment by 8.1 times (p=0.001). Proteinuria. Its presence increases the risk of detachment by 14.1 times (p = 0.001). The presence of HELLP syndrome increases the risk of detachment by approximately 18 times, but the p-value of this increase is borderline significant (p = 0.055). The use of antihypertensive drugs increases the risk of detachment by 3.17 times (p = 0.045). Each g/dL decrease in hemoglobin value reduces the risk of detachment by 27% (p = 0.004). Each unit increase in the WBC count increases the risk of detachment by 33% (p = 0.001). Application of compression suture increases the risk of detachment by approximately 10 times (p = 0.001). Presence of placental anomaly increases the risk of abruption by 7.2 times (p=0.008). Shortening the time between cesareans by each month reduces the risk of abruption by 28% (p=0.001). Use of LMWH increases the risk of abruption by 3.89 times (p=0.001). Aspirin use It increases the risk of detachment by 14.1 times (p = 0.001). These variables significantly affect the risk of re-detachment. Conclusion: Placental abruption is an unpredictable pregnancy complication that increases maternal and fetal mortality, and its recurrence may cause much more catastrophic situations, so in this study we investigated the risk of recurrence in the next pregnancy, presence of treatment pregnancy, increase in the number of cesarean sections, premature rupture of membranes, fetal growth restriction, preeclampsia. We found that the risk of placenta increases without the presence of proteinuria, increased WBC, presence of placental anomaly, use of LMWH and aspirin, decrease in gestational age, decrease in preoperative hemoglobin value, decrease in the time between cesareans. However, multicenter prospective randomized controlled studies are needed on this subject.
Objective: Placental abruption is considered an unpredictable pregnancy complication that increases maternal and fetal mortality. Our research aims to evaluate the maternal and fetal prognosis of pregnant women who underwent emergency cesarean section due to placental abruption in their next pregnancies. Materials and Methods: This study included 54 pregnancies that were delivered by cesarean section with the preliminary diagnosis of placenta abruption at the Gynecology and Obstetrics Clinic of Necmettin Erbakan University Meram Medical Faculty Hospital between 2013 and 2023, and the diagnosis of placental abruption was confirmed during the operation. Of the 186 pregnant women who were taken to labor with clinical and sonographic suspicion of placenta abruption, 9 of them were not diagnosed macroscopically and histologically, 5 of them were diagnosed as abruption after vaginal birth, 7 of them were diagnosed as abruption after vaginal birth, 7 of them were referred because the abruption percentage was below 30%, and 3 of them were referred from an external center after cesarean section. 60 of them were in the last pregnancy, 11 of them had bilateral tubal ligation, and 32 of them were not included in the study because they could not be reached. Pregnant patients older than the 20th week of gestation who were diagnosed with abruptio placentae were included in the study. The diagnosis of abruptio placenta was made by observing abruptio placenta as a result of macroscopic examination of the placenta along with specific clinical ultrasonography image. Research data were obtained retrospectively from patients' archive files and electronic information system. At the same time, all patients were called by accessing their telephone information through the hospital system. The patients' surgery notes, epicrisis and outpatient clinic records were examined through the hospital system. Results: This study included 54 women with a history of placental abruption and 100 pregnant women without a history of abruption but who had delivered by cesarean section. This research was completed with a total of 154 pregnant women. It was aimed to compare the sociodemographic and clinical characteristics of the detachment and control groups and the parameters that may affect the risk of re-detachment. For each additional year of age at the previous pregnancy, the risk of detachment increases by approximately 6%; however, this increase is not statistically significant (p=0.090). A 2% decrease in the risk of detachment was observed with each year of decrease in age at the next pregnancy, but this decrease was not statistically significant (p = 0.52). A 3% decrease in the risk of detachment was observed with each unit decrease in BMI, which is statistically significant. is not significant (p=0.32). Each increase in the number of pregnancies increases the risk of detachment by 1%, this change is not statistically significant (p = 0.91). Each increase in the number of births increases the risk of detachment by 33%, but this is not statistically significant (p = 0.16). Presence of GDM Although it causes an increase in the risk of detachment, this increase is not statistically significant (p = 0.74). Although the presence of gestational hypertension leads to a decrease in the risk of abruption, this decrease is not statistically significant (p = 0.49). Changes in platelet count do not affect the risk of detachment (p = 0.79). These variables do not appear to affect the risk of re-detachment. On the other hand, variables that significantly affect the risk of re-detachment are: The risk of detachment increases 3.17 times in pregnancies supported by treatment (p = 0.045). Each increase in the number of cesarean sections increases the risk of detachment by 54% (p = 0.025). Each week of decrease in the week of pregnancy for the week in the previous pregnancy reduces the risk of detachment by 53% (p). =0.001). Each week of reduction in the gestational age for the next week reduces the risk of detachment by 41% (p=0.001). Each increase in the number of abortions reduces the risk of detachment by 58% (p=0.002). Each increase in the number of curettages reduces the risk of detachment by 44%. (p=0.023). Premature rupture of membranes increases the risk of detachment by 19.5 times (p=0.001). The risk of detachment in pregnancies with fetal growth restriction increases by 3.45 times (p=0.007). The presence of preeclampsia increases the risk of detachment by 8.1 times (p=0.001). Proteinuria. Its presence increases the risk of detachment by 14.1 times (p = 0.001). The presence of HELLP syndrome increases the risk of detachment by approximately 18 times, but the p-value of this increase is borderline significant (p = 0.055). The use of antihypertensive drugs increases the risk of detachment by 3.17 times (p = 0.045). Each g/dL decrease in hemoglobin value reduces the risk of detachment by 27% (p = 0.004). Each unit increase in the WBC count increases the risk of detachment by 33% (p = 0.001). Application of compression suture increases the risk of detachment by approximately 10 times (p = 0.001). Presence of placental anomaly increases the risk of abruption by 7.2 times (p=0.008). Shortening the time between cesareans by each month reduces the risk of abruption by 28% (p=0.001). Use of LMWH increases the risk of abruption by 3.89 times (p=0.001). Aspirin use It increases the risk of detachment by 14.1 times (p = 0.001). These variables significantly affect the risk of re-detachment. Conclusion: Placental abruption is an unpredictable pregnancy complication that increases maternal and fetal mortality, and its recurrence may cause much more catastrophic situations, so in this study we investigated the risk of recurrence in the next pregnancy, presence of treatment pregnancy, increase in the number of cesarean sections, premature rupture of membranes, fetal growth restriction, preeclampsia. We found that the risk of placenta increases without the presence of proteinuria, increased WBC, presence of placental anomaly, use of LMWH and aspirin, decrease in gestational age, decrease in preoperative hemoglobin value, decrease in the time between cesareans. However, multicenter prospective randomized controlled studies are needed on this subject.
Açıklama
Anahtar Kelimeler
Dekolman plasenta, Abrupt placenta, tekrarlayan dekolman plasenta, recurrent placental abruption, preeklampsi, preeclampsia, hipertansiyon, hypertension, IUGR
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Khiavi, P. E. (2024). Plasenta dekolmanı olan hastaların bir sonraki gebeliklerinde prognoz değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Kadın Hastalıkları ve Doğum Anabilim Dalı, Konya.
