The effect of dNK cells on abnormal excessive placental invasion in patients with placenta percreata: A comparison between patients undergoing partial resection and total hysterectomy

obstetric problems. There are limited studies on the role of decidual natural killer (dNK) cells in the pathogenesis of placenta adhesion abnormalities. This study aims to investigate the impact of dNK cells on abnormal excessive placental invasion and their predictive role in treatment selection in patients undergoing cesarean section due to placenta percreata. Materials and Methods: This single-center, hospital-based, cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Harran University Medical Faculty, between 2015 and 2024. It included 28 patients who underwent partial resection and 41 patients who underwent total hysterectomy due to placenta percreata diagnosed during cesarean sections. The partial resection group and the total hysterectomy group were compared in terms of sociodemographic characteristics, clinical features, and dNK cell density. Pathologically, dNK cell density was graded based on the number of positive cells. Additionally, patients were classified into four groups based on the number of positive cells: Group 1 (0-4 cells), Group 2 (5-9 cells), Group 3 (10-14 cells), and Group 4 (15 or more cells). Results:While the number of gravida and parity was higher in the total hysterectomy group, the number of C-sections was similar. ROC analysis showed that the number of positive cells had a statistically significant diagnostic performance for predicting partial resection (AUC: 0.751, p<0.001), with the best cut-off point being >4, a sensitivity of 67.9%, and a specificity of 75.6%. Multivariate analysis indicated that age (OR: 0.85, p=0.008) decreased the likelihood of partial resection, whereas having more than 4 positive cells (OR: 7.90, p=0.001) significantly increased the likelihood of partial resection. Additionally, analysis based on the grouping of positive cells (Group 1: 0-4 cells, Group 2: 5-9 cells, Group 3: 10-14 cells, Group 4: 15 or more cells) showed that as the number of positive cells increased, the frequency of partial resection significantly increased (p=0.002). The total hysterectomy group required more blood transfusions both intraoperatively and perioperatively. The presence of complications and hospital stays were similar in both groups. Conclusion: Our study has supported evidence regarding the role of dNK cells in reproductive health and diseases. Furthermore, it has provided new evidence to the literature suggesting that the density of dNK cells may be associated with the severity of placental invasion and that an increased number of these cells may enhance the chances of performing uterus-preserving surgery in patients with placenta percreata.