Radiological evaluation of placental invasion anomalies: single center data
Keywords:Placenta previa; placenta accreta; obstetric hemorrhages; cesarean section; hysterectomy
Placenta previa totalis refers to the placenta lying over the lower uterine segment and completely covering the internal cervical os. The aim of this study was to predict the complications that may develop in cases with placenta previa totalis and most importantly, to decrease maternal morbidity and mortality rates.
A total of 185 patients, who were diagnosed with placenta previa totalis in our clinic between January 2011 and December 2015 and underwent cesarean section, were included in the present study. Patients with placenta previa partialis, placenta previa marginalis, lower placenta pre-diagnosis, and placenta previa less than 24 weeks of gestation were excluded. Demographic data, gynecological and obstetric histories, type of surgical incision, placental adhesion anomalies, laboratory parameters, and blood transfusions of the patients were examined. Patients' type of application to our clinic, gestational week, birth weight, sex of the newborn, Apgar score of the first and fifth minutes, additional surgical interventions and complications developed were evaluated. The data were obtained using PROBEL Hospital Information Management System, which is the hospital electronic archive database.
It was observed that a total of 60039 babies were delivered (29894 vaginal deliveries, 30145 cesarean sections) in our hospital during the study period. The frequency of the five-year placental invasion anomaly was found to be six in 10000 births. There was a statistically significant increase in the number of previous cesarean sections and invasion formation (p<0.05).
Early diagnosis and adequate preoperative preparation are of great importance particularly in cases with placenta previa totalis who are thought to have an invasion. Patients should be referred to tertiary centers with high-quality blood bank unit, adult intensive care unit and neonatal intensive care unit, where a multidisciplinary approach can be offered. We believe that the elective operation of the cases is an important factor in reducing or preventing maternal morbidity and mortality.
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