Plasenta Accreta Spectrum: Klinik Yönetimi
Özet
Plasenta Accreta Spektrum (PAS), plasentanın anormal trofoblastik invazyonu nedeniyle uterus duvarına patolojik olarak yapışması durumudur ve doğum sonrası hayatı tehdit eden kanamalara yol açar. Küresel düzeyde artan sezaryen oranları, PAS prevalansının artmasındaki en önemli etken olarak kabul edilmektedir. En büyük risk faktörü mükerrer sezaryen sonrası gelişen plasenta previa olup, ileri anne yaşı ve geçirilmiş uterin cerrahiler de riski artırır. Klinik olarak ilk belirti genellikle plasentanın ayrılmaması ve aşırı kanamadır. Erken tanı için ultrasonografi (USG) ve Manyetik Rezonans Görüntüleme (MRI) yöntemleri birlikte kullanılmalıdır; çoklu plasental lakunalar ve mesane hattının bozulması en önemli USG bulgularındandır. PAS yönetimi, multidisipliner bir yaklaşımla üçüncü basamak sağlık merkezlerinde planlanmalı ve stabil hastalar için 34-36. gebelik haftaları arasında doğum gerçekleştirilmelidir. Cerrahi müdahalede en sık uygulanan prosedür sezaryen histerektomi olmakla birlikte, fertilite istemi olan uygun olgularda uterus koruyucu konservatif cerrahi teknikler de başarıyla uygulanabilmektedir. Sonuç olarak, iatrojenik bir antite olan PAS'ın perinatal ve maternal sonuçlarını iyileştirmek için sezaryen oranlarının düşürülmesi ve erken tanı büyük önem taşımaktadır.
Placenta Accreta Spectrum (PAS) is a pathological adhesion condition resulting from abnormal trophoblastic invasion of the placenta into the uterus, leading to life-threatening postpartum hemorrhage. The rising global rates of cesarean deliveries are considered the most significant factor driving the increase in PAS prevalence. The foremost risk factor is placenta previa developing after recurrent cesarean sections, while advanced maternal age and previous uterine surgeries also increase the risk. Clinically, the primary sign is excessive bleeding and the failure of the placenta to separate during delivery. For early diagnosis, ultrasonography (USG) and Magnetic Resonance Imaging (MRI) should be utilized together; multiple placental lacunae and the disruption of the bladder line are among the most critical USG findings. The management of PAS requires a multidisciplinary approach at tertiary care centers, with scheduled delivery recommended between the 34th and 36th gestational weeks for stable patients. Although cesarean hysterectomy is the most frequently performed surgical procedure, uterine-preserving conservative surgical techniques can also be successfully applied in eligible cases where fertility is desired. In conclusion, to improve perinatal and maternal outcomes in PAS, which is an iatrogenic clinical entity, reducing cesarean rates and ensuring early diagnosis remain vital.
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