Aktuelle Trends in der gynäkologischen Onkologie

Abstrakt

Factors affecting the management, clinical course and treatment outcome of placenta invasion anomaly - Hasan Cilgin Kafkas University

Hasan Cilgin

Hasan Cilgin

Kafkas University, Turkey

 

Abstract: This examination intended to decide the clinical qualities, treatment choices and components influencing the result of our patients who were experienced the cesarean segment because of placenta intrusion peculiarity Materials and techniques: In this investigation, a sum of 106 placenta attack inconsistencies cases that were analyzed and rewarded somewhere in the range of 2012 and 2018 were reflectively assessed. All the related data including the subtleties of segment qualities, clinical indications and discoveries, analytic instruments utilized, treatment choices, chance elements for placenta intrusion abnormality, result of treatment just as related dreariness and mortality were gotten from medical clinic tolerant database and spared in organized information passage structures intended for this reason. Results: During the investigation time frame, 72 of the 106 patients (67.9 %) determined to have placenta attack irregularity had at any rate one past cesarean segment. In 22 cases history of past uterine instrumentation were watched, especially when the executives of unsuccessful labor/premature birth was being thought of and in remaining twelve cases no etiology was found. The majority of the activities 62(58.5%) were led under elective conditions. Twelve of 26 central placenta accreta cases were treated with two-sided hypogastric conduit ligation because of expanded seeping during the activity, 4 with Bakri swell tamponade in the blend with B-Lynch pressure stitch, 6 with placental bed immersion and 4 with wedge-molded incomplete resection. Seven (6.6%) patients experienced urology and two experienced cardiovascular specialist counsels during the activity. Six (5.6%) cases experienced total bladder cut fix. Forty-six (43.4%) of the cases experienced transfusion during the activity and blood items were given to 15 (14%) tolerant postoperatively. Seven (6.6%) patients created dilutional thrombocytopenia because of enormous transfusion. Histopathologically, in 62 cases (58.5%) placenta accreata, in 28 cases (26.4%) placenta increata and in 16 cases (15.1%) placenta percreata was analyzed. No intraoperative or postoperative mortality was seen in all the tasks. End: Just due to past cesarean segment and history of past uterine instrumentation the recurrence of placenta intrusion peculiarities is expanding so ladies ought to be educated about the potential dangers when advised preceding careful clearing and clinical administration or cervical aging ought to be thought of. Cesarean segment hysterectomy as an old style treatment of placenta attack irregularity ought to be performed by a group of experienced and all around arranged tertiary communities where a multidisciplinary approach can be advertised.

 

Introduction: Placenta accreta is characterized as irregular trophoblast attack of part or the whole placenta into the myometrium of the uterine divider. Placenta accreta range, some time ago known as drearily disciple placenta, alludes to the scope of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. Maternal dismalness and mortality can happen in view of serious and once in a while dangerous discharge, which frequently requires blood transfusion. Paces of maternal demise are expanded for ladies with placenta accreta range. Furthermore, patients with placenta accreta range are bound to require hysterectomy at the hour of conveyance or during the baby blues period and have longer medical clinic remains 2. In 2015, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal–Fetal Medicine built up a normalized hazard proper maternal glorified consideration framework for offices, in view of area and ability of the clinical staff, to lessen in general maternal horribleness and mortality in the United States. This assignment is alluded to as "levels of maternal consideration," and exists for conditions, for example, placenta accreta range. Placenta accreta range is viewed as a high-chance condition with genuine related morbidities; consequently, ACOG and the Society for Maternal–Fetal Medicine suggest these patients get level III (subspecialty) or higher consideration. This level incorporates ceaselessly accessible clinical staff with fitting preparing and involvement with overseeing complex maternal and obstetric entanglements, including placenta accreta range, just as predictable access to interdisciplinary staff with skill in basic consideration (ie,critical care subspecialists, hematologists, cardiologists, and neonatologists). The general assets should have been ready to accomplish improved wellbeing results in the setting of a known or suspected placenta accreta incorporate making arrangements for conveyance with proper subspecialists and approaching a blood donation center with conventions set up for enormous transfusion.

 

Materials and methods: This was a review cum planned observational investigation led in the Department of Obstetrics and Gynecology in a tertiary consideration referral medical clinic in Mumbai between January 2012 and November 2014. The examination incorporated every single pregnant lady, independent of equality status, with gestational age over 26 weeks who had any kind of drearily follower placenta analyzed on USG shading Doppler/attractive reverberation imaging (MRI) or had been determined intra-operatively to have dismally disciple placenta. All patients included had conveyed in this establishment. For forthcoming cases, total history and physical assessment of the patient alongside pertinent examinations (ultrasound with shading doppler and MRI) for finding of drearily disciple placenta were archived. Clinic records were read for the review cases. The boundaries contemplated were the method of introduction of the patient and life span of the incubation, history of past lower fragment/old style Cesarean area or and other intrauterine usable methodology (dilatation and curettage, manual expulsion of placenta, myomectomy, and so forth.), method of conveyance of the current pregnancy, interventional end point (pressing/prophylactic inflatable position in inner iliac corridor/inward iliac supply route ligation/uterine vein embolization/hysterectomy-old style/lower section/peri-partum), neonatal result and length of emergency clinic remain. Every patient was followed as long as 2 months baby blues with sequential observing of serum beta HCG levels and doppler ultrasound for placental volume.

 

Results: During the study period, 72 of the 106 patients (67.9 %) diagnosed with placenta invasion anomaly had at least one previous caesarean section. In 22 cases history of previous uterine instrumentation were observed, particularly when management of miscarriage/abortion was being considered and in remainning twelve cases no etiology was found. Most of the operations 62(58.5%) were conducted under elective conditions. Twelve of 26 focal placenta accreta cases were treated with bilateral hypogastric artery ligation due to increased bleeding during the operation, 4 with Bakri balloon tamponade in the combination with B-Lynch compression suture, 6 with placental bed saturation and 4 with wedge-shaped partial resection. Seven (6.6%) patients underwent urology and two underwent cardiovascular surgeon consultations during the operation. Six (5.6%) cases underwent complete bladder laceration repair. Forty-six (43.4%) of the cases underwent transfusion during the operation and blood products were given to 15 (14%) patient postoperatively. Seven (6.6%) patients developed dilutional thrombocytopenia due to massive transfusion. Histopathologically, in 62 cases (58.5%) placenta accreata, in 28 cases (26.4%) placenta increata and in 16 cases (15.1%) placenta percreata was diagnosed. No intraoperative or postoperative mortality was observed in all the operations.

Conclusion: Just because of previous caesarean section and history of previous uterine instrumentation the frequency of placenta invasion anomalies is increasing so women should be informed about the potential risks when counseled prior to surgical evacuation and medical management or cervical ripening should be considered. Cesarean section hysterectomy as a classical treatment of placenta invasion anomaly should be performed by a team of experienced and well-planned tertiary centers where a multidisciplinary approach can be offered.