Plasental Anomaliler ve Plasenta Akreta Spektrumu Yönetimi

Yazarlar

Özet

Plasenta Akreta Spektrumu (PAS), plasentanın uterus duvarına anormal yapışması veya invazyonu ile karakterize, maternal morbidite ve mortalite riski yüksek bir obstetrik komplikasyondur. En önemli risk faktörü geçirilmiş sezaryen öyküsü ve plasenta previa varlığıdır. Prenatal tanı, multidisipliner bir ekip tarafından planlı bir doğum yapılabilmesi ve komplikasyon riskinin azaltılabilmesi için hayati öneme sahiptir. Tanıda birincil yöntem, karakteristik bulguları (plasental lakünler, retroplasental clear zone kaybı, mesane duvarında kesinti ve benzeri) gösteren ultrasonografidir. Manyetik rezonans görüntüleme (MRG), özellikle ultrasonun yetersiz kaldığı posterior yerleşimli plasenta olgularında veya invazyon derinliğinin değerlendirilmesi gereken olgularda tamamlayıcı olarak kullanılır. Yönetim, deneyimli bir merkezde perinatolog, jineko-onkolog, anestezist ve kan bankası ekibini içeren multidisipliner bir yaklaşım gerektirir. Standart tedavi, plasentanın yerinde bırakılarak yapıldığı sezaryen histerektomidir ve masif kanama riskini en aza indirmeyi hedefler. Seçilmiş, uygun vakalarda uterus koruyucu (konservatif) yaklaşımlar (plasentanın bırakılması veya fokal rezeksiyonu) da bir alternatif olabilir, ancak bu yöntemlerin risk-fayda dengesi iyi değerlendirilmelidir. Planlı bir doğum, acil durumlara kıyasla maternal sonuçları belirgin şekilde iyileştirir.

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