Evaluation of the relationship between hematological parameters and placental adhesion anomaly in patients with placenta previa

Aim: The aim of this study is to investigate the relationship of haematological parameters of the patients who presented to our hospital between 2013 and 2017 and diagnosed with plasenta previa with plasental attachment anomalies. Material and Method: This is a retrospective study that aimed to investigate the cases who presented to the Clinic of the Gynaecology and Obstetrics Department of Dicle University's Faculty of Medicine between January 2013 and December 2017 and were diagnosed with plasenta previa, delivering their children in our clinic. The patients were grouped in three groups: While Group 1 consisted of 257 patients (33%) diagnosed with plasenta previa and who previously had no uterine surgery, Group 2 comprised 396 patients (51%) with a history of uterine surgery. Group 3, on the other hand, consisted of 120 patients (16%) who presented to our clinic with complaints of pain or water discharge. The data of the patients subjected to evaluation were demographic data, their gynaecologic and obstetrics stories, weeks of pregnancy at the time of delivery, delivery mode (Caesarean/vaginal delivery), admittance of the case (as emergency/selective case), types and quantities of blood transfusion in the intra-operative or post-operative period, type of anaesthesia (general/spinal), additional surgical interventions undertaken during or after the surgery, sex and weight of the newborns, Apgar scores recorded at 1 and 5 minutes after the delivery, birth year, values of haemoglobin, haematocrit, thrombocyte, leucocyte, mpv and rates of neutrophile/lymphocyte and thrombocyte/lymphocyte recorded before the delivery. The data were obtained from the electronic archive data base, information in patients' files and file notes taken during the surgery available in the hospital. Findings: The mean ages of the patients were 30.96±6.25 in Group 1, 32.34±5 3 in Group 2 and 28.58± 6.7 in Group 3. The study found that plasenta previa incidence in our clinic increased between 2013 and 2017. The study found no statistically significant difference between the groups' haemoglobin (HGB) level, haematocrit level (HCT), number of lymphocytes (LYM), erythrocyte distribution width (RDW) and platelet distribution width (PDW) (p>0.05). A statistically significant difference was found between the groups' platelet lymphocyte rates (PLR) (< 0.05). Comparing the groups with respect to mean platelet volumes (MPV) and neutrophil lymphocyte rates (NLR), the study found no statistically significant difference (p>0.05 ). In Group 1, 74 % (190) of the patients were operated as emergency case and 26% (67 patients) on selective basis. In Group 2, 74 % (292) of the patients had to be urgently operated, and 26% (104 patients) were operated on selective basis. While in Group 1 32,7% of the patients were operated under general anaesthesia and 67.3% under spinal anaesthesia, the same rates were 39.9% and 60.1% respectively in Group 2. While the study found no statistically significant difference between the birth weights of the newborns in three groups delivered by the prospective mothers comprising the sample of our study, significantly low Apgar scores at 1 and 5 minutes after delivery were found in Group 1 and 2 (p<0.05). While in Group 1 42% of the newborns were female and 58% male, it was 49% and 51% respectively in Group 2. In Group 3, on the other hand, 45% of the newborns were female and 55% male. With respect to transfusion needs, the study found a significant difference between the working groups. While 96.2% of the patients with plasenta previa had no complications, complications were recorded in 3.8% of the patients. The patients, in whom a complication developed, 25 in number, were all in Group 2. Of these 25 patients, 88% (22 patients) suffered an injury at bladder, 8% (2 patients) injury at bladder + ureter and 4% (1 patient) injury at the left hypogastric artery. While fertility sparing surgery was applied in 95.1% (621) of the patients diagnosed with plasenta previa in our clinic, 4.9% (32 patients) underwent hysterectomy. Only one of the patients who underwent hysterectomy was in Group 1, whereas all others were in Group 2. Of the patients diagnosed with plasenta previa, 1.26% (5 patients) only in Group 2 had relaparotomy. Conclusion: The study found that the incidence of plasenta previa, which is an important disorder with respect to morbidity and mortality, has increased. It was also found that plasenta previa is correlated with old age and higher number of deliveries and Caesarean interventions. The average birth week in patients with plasenta previa was 35,2± 2.7. The rate of male newborns was found to be higher. Examining the relationship between plasenta previa and blood parameters, no statistically significant difference was found between the three groups with respect to mean MPV levels. While the study found a significantly different PLR in patients in Group 2, no difference was found between groups in respect of NLR levels. The rate of the cases who delivered under urgent Caesarean section was significantly higher than those who delivered under selective Caesarean delivery. On the other hand, the rate of spinal anaesthesia application was higher than the rate of general anaesthesia. Of the patients diagnosed with plasenta previa, 4.9% had to undergo hysterectomy and 95% fertility sparing surgery. The study provided evidence that surgical interventions performed on patients with plasenta previa give rise to very few complications, the most frequent of which is the bladder injury. Key words: Plasenta previa, MPV, PRL, NRL