Evaluation of cases with placental adhesion anomaly

Objective: We aimed to retrospectively evaluate the clinical and ultrasonographic findings of the patients who were diagnosed with placental adhesion anomaly between 2015-2021, followed up and operated in our clinic and to reveal the factors affecting the prognosis. Materials and Methods: Our study is a retrospective study examining the patients who were diagnosed with placental adhesion anomaly in Çukurova University Medical Faculty Balcalı Hospital between January 2015 and January 2021 and were followed up and operated in our hospital. 280 pregnant patients with placenta accreta spectrum (PAS), all of whom were diagnosed, followed up and treated in our clinic were included in the study. Demographic data, gynecological and obstetric histories, ultrasonography (USG) images and clinical features of these patients were obtained from patient files and the electronic registry system. Results: In our study, the mean age of the patients was 32.7±5.1, gravida 3.98±1.6, parity 2.41±1.2, mean number of previous cesarean section 2.09±0.9, mean number of curettage 0.56±0.9. There were 238 (85%) pregnant women with placenta previa in this pregnancy. While 278 (99.3%) patients were spontaneous pregnancies, 2 (0.7%) patients were in vitro fertilization (IVF) pregnancies. 34 (12.1%) pregnant women smoke. USG findings of patients diagnosed with PAS (number of lacunae >2, presence of myometrial effacement, placental thickness ≥55 mm, blood flow in lacunae, increased uteroplacental and/or uterovesical blood flow) were compared with the postoperative results of the patients and patients who underwent hysterectomy are compared with those who underwent uterine-sparing surgery. In these two compared cases, it was observed that the patients needed inotropes, the duration of surgery increased, the need for intensive care emerged, the length of hospital stay was prolonged, the APGAR scores and the surgical week of the infants were lower. We observed that the estimated amount of bleeding, the need for erythrocyte suspension, the need for thrombocyte suspension, and the need for fresh frozen plasma increased. It was observed that as the number of previous cesarean sections in patients with PAS increased, the duration of surgery was longer, the amount of bleeding and hospitalization time increased, and the APGAR scores of the babies were lower. In the comparison of patients who underwent hysterectomy and internal iliac artery ligation (IIAL) operation with hysterectomy, it was observed that the surgical time was longer in patients who underwent IIAL, the amount of transfusion needed was higher, and this method was used in patients with a higher estimated amount of bleeding. Conclusion: The factors affecting the perioperative and postoperative prognosis and the degree of morbidity can be estimated with using preoperative risk factors and ultrasonography findings in patients with PAS. In the analysis of the ultrasonography findings with postoperative results used in our study, it was found to be useful in estimating the severity of the disease. This allows us to predict the mode of the operation and the situations that we may encounter during and after the operation. It is possible to reduce maternal and fetal morbidity with preparations for these. Keywords: Spectrum of placenta accreta, placental lacuna, maternal morbidity, cesarean hysterectomy