Case of placenta previ̇a totali̇s 5-year analysis

Placenta previa totalis is a placenta presentation abnormality in which placenta completely closes cervical os. In our study, we aim to predict the possible complications in patients with placenta previa totalis and most importantly reduce maternal morbidity and mortality. In our study, 224 patients who delievered with a preliminary diagnosis of placenta previa totalis in our clinic between the time period January 2009 and December 2013 were included. The patients who diagnosed as placenta previa partialis, placenta previa marginalis and down implanted placenta were excluded at the study. The all invasion anomalies were defined as placenta accreta because of absence of the histopathologic diagnosis. Patient's demographic datas, gynecological and obstetric history, the type of surgical incision, placental adhesion abnormalities, laboratory parameters and blood transfusions were examined. The type of anesthesia, additional surgical interventions, newborn neonatal apgar scores at 1 and 5 minutes, weight, gender, complications and intensive care requirements were evaluated. The data was obtained using the hospital's database electronic archive. During the study, a total of 10,580 births occured in our hospital. The cases of placenta previa totalis and accreata are seemed to be increased proportionally with the number of ceaserean section. In our study, the incidence of placenta accreta in 5 years was identified as 1 in 100 births. In our study, the formation of invasion was found to be statistically significantly increased with the number of cesarean delivery (p <0.005). All intraoperative and postoperative complications were observed in patients who had the invasion. Especially in cases of placenta previa totalis that invasion is considered, early diagnosis and preoperative preparation is so essential. Patients should be referred to tertiary centers in where there is a blood bank unit, an adult intensive care and a good neonatal intensive care unit and multidisciplinary approach can be offered. We believe that the most important factors to reduce or prevent maternal morbidity and mortality of patients are determining elective operations. Key words: Placenta previa, placenta accreta, obstetric hemorrhage, cesarean section, hysterectomy