RESUMO
This study aimed to compare fertility-sparing interventions and hysterectomy among women with placenta accreta spectrum disorder (PAS) who underwent caesarean deliveries. We retrospectively reviewed the data, and classified 148 patients as follows: group B: Bakri balloon without resection (n = 83); group R: segmental uterine resection (n = 23); and group H: hysterectomy (n = 42). The groups differed significantly with respect to operative time, transfused blood products, and post-operative intensive care unit and hospital stays. Morbidity was the highest in group H. The aforementioned parameters did not differ between Groups B and R. Groups R and H differed regarding the operative time, post-operative hospital stay, and transfused blood products. Although the treatment modality and PAS severity differed between the groups of patients with preserved fertility, the surgical outcome parameters did not differ. Hence, the effectiveness of these approaches may be similar without foregoing patient safety.IMPACT STATEMENTWhat is already known on this subject? As caesarean delivery rates have increased worldwide, the incidence of placenta accreta spectrum disorder (PAS), which has high morbidity and mortality rates, has also risen. Planned caesarean hysterectomy is recommended to reduce mortality and morbidity, but fertility is lost.What do the results of this study add? The severity of PAS can range from mild to severe. A patient-tailored approach, which was based on the intra-operative findings and used either a Bakri balloon tamponade or segmental uterine resection, reduced morbidity and preserved fertility.What are the implications of these findings for clinical practice and/or further research? Instead of adhering to the conventional approach that involves an elective caesarean hysterectomy based on antenatal imaging, more suitable approaches should be considered from the spectrum of haemostatic and fertility-preserving options available, while considering a surgeon's experience, the intra-operative findings, and patients' needs.
Assuntos
Preservação da Fertilidade/métodos , Histerectomia/métodos , Placenta Acreta/terapia , Índice de Gravidade de Doença , Adulto , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Duração da Cirurgia , Placenta Acreta/patologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Tamponamento com Balão Uterino/métodosRESUMO
PURPOSE: Placenta previa is abnormal localization of the placenta, associated with high rates of maternal-fetal morbidity and mortality. This abnormal implantation may also be in the form of invasion to surroundings defined as placenta accreta spectrum (PAS). The increasing rates of cesarean section raise the frequency of placenta previa and PAS in recent years. Although there are some recommendations, the optimal timing of caesarean delivery concerning fetal and maternal benefits is still unclear. The aim of this study is to compare maternal, surgical and perinatal outcomes of placenta previa cases who underwent emergency or planned surgery. METHODS: The women who underwent cesarean section for placenta previa between October 2013 and February 2019 at a tertiary care center were retrospectively analyzed. They were divided into two main groups as planned and urgent, and into two subgroups as complicated (PAS) and uncomplicated (non-PAS). RESULTS: Of the 313 women who met the inclusion criteria, 176 were planned and 137 were urgent cesarean sections. In the urgent group, gestational age, duration of surgery, maternal preoperative and pre-discharge hemoglobin levels, requirement of blood and blood product, additional surgical interventions, length of maternal postoperative intensive care unit and hospital stay, neonatal birthweight, Apgar scores, length of the follow-up in neonatal intensive care unit, invasive and non-invasive mechanical ventilation were significantly different. CONCLUSIONS: Maternal complication rates are increased in women who are operated on emergency conditions due to placenta previa. Perinatal outcomes are better in women who underwent planned surgery and in those with gestational age greater than 37 weeks.
Assuntos
Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Adulto , Índice de Apgar , Peso ao Nascer , Cesárea/efeitos adversos , Cesárea/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Turquia/epidemiologiaRESUMO
BACKGROUND: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Genital TB (GTB) is a form of extrapulmonary TB that occurs more frequently in women, in whom it classically presents in association with menstrual irregularity, pregnancy loss and short and long-term sequelae especially infertility in infected women. Patients with GTB are usually young women diagnosed during workup for infertility. GTB is rare in postmenopausal women and responsible for only approximately 1% of postmenopausal bleeding. In this study, we aimed to evaluate the laboratory, clinical and demographic characteristics of female GTB cases. CASE: We presented four female GTB cases with distinct clinical symptoms. All patients have no history of TB, and no acid-fast bacilli were seen in smears prepared from the clinical materials of the patients. Histopathological examinations revealed granulomatous inflammation in all patients. CONCLUSION: In the light of the clinical features of these cases we aimed to emphasize that, female GTB must be taken into account in the patients with different clinical symptoms like postmenopausal bleeding, menometrorrhagia, infertility, and menstrual irregularities. We believe that these symptoms will be helpful for the diagnosis and treatment of female GTB.