Plasental İnvazyon Anomalileri: Klinik Özellikler, Tanı ve Olası Sonuçlar
Özet
Plasenta akreata spektrumu (PAS), plasentanın myometriyuma anormal invazyonunu tanımlayan ve doğumda yaşamı tehdit eden masif kanamalara yol açabilen klinik bir durumdur. PAS; plasenta akreata, inkreata ve perkreata olmak üzere üç alt türe ayrılır ve en önemli risk faktörü önceki sezaryen doğum öyküsü ile birlikte görülen plasenta previadır. Son yıllarda artan sezaryen oranlarına bağlı olarak prevalansı yükselen bu anomalinin kesin patogenezi bilinmemekle birlikte desidua veya uterustaki defektlerden kaynaklandığı düşünülmektedir. Klinik olarak genellikle obstetrik ultrason taramalarında asemptomatik iken fark edilir; plasental lakünler ve mesane hattının bozulması en güvenilir sonografik bulgulardır. Doppler ultrasonografi ve gerekli durumlarda MRI, tanıyı doğrulamada ve invazyon derinliğini belirlemede kullanılan ek tekniklerdir. Doğum öncesi tanı, masif kan transfüzyonu ihtiyacını ve cerrahi komplikasyonları önemli ölçüde azaltarak peripartum histerektomi gibi maternal morbidite risklerini yönetmede kritik rol oynar. Maternal ve neonatal sonuçları optimize etmek amacıyla, risk grubundaki hastaların 18-24. gebelik haftalarında transabdominal ve transvajinal sonografi ile taranması ve doğumun uzman merkezlerde planlanması önerilmektedir.
Placenta accreta spectrum (PAS) is a clinical condition defining the abnormal invasion of the placenta into the myometrium, which can lead to life-threatening massive hemorrhage during delivery. Divided into three subtypes as placenta accreta, increata, and percreata, the most significant risk factor for PAS is placenta previa accompanied by a history of previous cesarean delivery. The prevalence of this anomaly has risen in recent years due to increasing cesarean rates, and although its exact pathogenesis remains unknown, it is thought to originate from defects in the decidua and/or uterus. Clinically, it is ideally suspected during routine obstetric ultrasound examinations while the patient is asymptomatic, with placental lacunae and the disruption of the bladder line serving as the most reliable sonographic findings. Doppler ultrasonography and, when necessary, MRI are supplementary techniques utilized to confirm the diagnosis and evaluate the depth of invasion. Antenatal diagnosis plays a critical role in managing maternal morbidity risks, such as peripartum hysterectomy, by significantly reducing the need for massive blood transfusions and surgical complications. To optimize maternal and neonatal outcomes, it is recommended to screen high-risk patients between 18 and 24 weeks of gestation using transabdominal and transvajinal sonography and to plan the delivery in specialized centers.
Referanslar
Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2019; 146:20.
Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and metaanalysis. Am J Obstet Gynecol 2019; 221:208.
Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previaplacenta accreta. Am J Obstet Gynecol 1997; 177:210.
Read JA, Cotton DB, Miller FC. Placenta accreta: changing clinical aspects and outcome. Obstet Gynecol 1980; 56:31.
Jauniaux E, Chantraine F, Silver RM, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynaecol Obstet 2018; 140:265.
Einerson BD, Comstock J, Silver RM, et al. Placenta Accreta Spectrum Disorder: Uterine Dehiscence, Not Placental Invasion. Obstet Gynecol 2020; 135:1104.
Tantbirojn P, Crum CP, Parast MM. Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta 2008; 29:639.
Khong TY. The pathology of placenta accreta, a worldwide epidemic. J Clin Pathol 2008; 61:1243.
Jauniaux E, Hussein AM, Elbarmelgy RM, et al. Failure of placental detachment in accreta placentation is associated with excessive fibrinoid deposition at the utero-placental interface. Am J Obstet Gynecol 2022;226:243.e1.
Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol 2018; 218:75.
Ben-Nagi J, Walker A, Jurkovic D, et al. Effect of cesarean delivery on the endometrium. Int J Gynaecol Obstet 2009; 106:30.
Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107:1226.
Nageotte MP. Always be vigilant for placenta accreta. Am J Obstet Gynecol 2014; 211:87.
Timor-Tritsch IE, Monteagudo A, Cali G, et al. Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol 2014; 44:346.
Silver RM, Fox KA, Barton JR, et al. Center of excellence for placenta accreta. Am J Obstet Gynecol 2015; 212:561.
Kaser DJ, Melamed A, Bormann CL, et al. Cryopreserved embryo transfer is an independent risk factor for placenta accreta. Fertil Steril 2015; 103:1176.
Fitzpatrick KE, Sellers S, Spark P, et al. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One 2012; 7:e52893.
Hayashi M, Nakai A, Satoh S, Matsuda Y. Adverse obstetric and perinatal outcomes of singleton pregnancies may be related to maternal factors associated with infertility rather than the type of assisted reproductive technology procedure used. Fertil Steril 2012; 98:922.
Esh-Broder E, Ariel I, Abas-Bashir N, et al. Placenta accreta is associated with IVF pregnancies: a retrospective chart review. BJOG 2011; 118:1084.
Baldwin HJ, Patterson JA, Nippita TA, et al. Antecedents of Abnormally Invasive Placenta in Primiparous Women: Risk Associated With Gynecologic Procedures. Obstet Gynecol 2018; 131:227.
Salmanian B, Fox KA, Arian SE, et al. In vitro fertilization as an independent risk factor for placenta accreta spectrum. Am J Obstet Gynecol 2020; 223:568.e1.
Miller HE, Leonard SA, Fox KA, et al. Placenta Accreta Spectrum Among Women With Twin Gestations. Obstet Gynecol 2021; 137:132.
Linn RL, Miller ES, Lim G, Ernst LM. Adherent basal plate myometrial fibers in the delivered placenta as a risk factor for development of subsequent placenta accreta. Placenta 2015; 36:1419.
Heller DS, Wyand R, Cramer S. Recurrence of Basal Plate Myofibers, with Further Consideration of Pathogenesis. Fetal Pediatr Pathol 2019; 38:30.
Pekar-Zlotin M, Melcer Y, Levinsohn-Tavor O, et al. Cesarean Scar Pregnancy and Morbidly Adherent Placenta: Different or Similar? Isr Med Assoc J 2017; 19:168.
Timor-Tritsch IE, Monteagudo A, Cali G, et al. Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obstet Gynecol 2014; 43:383.
Kayem G, Seco A, Beucher G, et al. Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study. BJOG 2021; 128:1646.
Hung TH, Shau WY, Hsieh CC, et al. Risk factors for placenta accreta. Obstet Gynecol 1999; 93:545.
Khong TY, Healy DL, McCloud PI. Pregnancies complicated by abnormally adherent placenta and sex ratio at birth. BMJ 1991; 302:625.
James WH. Sex ratios of offspring and the causes of placental pathology. Hum Reprod 1995; 10:1403.
Carusi DA, Fox KA, Lyell DJ, et al. Placenta Accreta Spectrum Without Placenta Previa. Obstet Gynecol 2020; 136:458.
Kupferminc MJ, Tamura RK, Wigton TR, et al. Placenta accreta is associated with elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1993; 82:266.
Zelop C, Nadel A, Frigoletto FD Jr, et al. Placenta accreta/percreta/increta: a cause of elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1992; 80:693.
Shainker SA, Silver RM, Modest AM, et al. Placenta accreta spectrum: biomarker discovery using plasma proteomics. Am J Obstet Gynecol 2020; 223:433.e1.
Washecka R, Behling A. Urologic complications of placenta percreta invading the urinary bladder: a case report and review of the literature. Hawaii Med J 2002; 61:66.
Mehrabadi A, Hutcheon JA, Liu S, et al. Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage. Obstet Gynecol 2015; 125:814.
Zelop CM, Harlow BL, Frigoletto FD Jr, et al. Emergency peripartum hysterectomy. Am J Obstet Gynecol 1993; 168:1443.
Glaze S, Ekwalanga P, Roberts G, et al. Peripartum hysterectomy: 1999 to 2006. Obstet Gynecol 2008; 111:732.
Morlando M, Schwickert A, Stefanovic V, et al. Maternal and neonatal outcomes in planned versus emergency cesarean delivery for placenta accreta spectrum: A multinational database study. Acta Obstet Gynecol Scand 2021; 100 Suppl 1:41.
Marcellin L, Delorme P, Bonnet MP, et al. Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta. Am J Obstet Gynecol 2018; 219:193.e1.
Gielchinsky Y, Mankuta D, Rojansky N, et al. Perinatal outcome of pregnancies complicated by placenta accreta. Obstet Gynecol 2004; 104:527.
Seet EL, Kay HH, Wu S, Terplan M. Placenta accreta: depth of invasion and neonatal outcomes. J Matern Fetal Neonatal Med 2012; 25:2042.
Warshak CR, Ramos GA, Eskander R, et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 2010; 115:65.
Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015; 212:218.e1.
Grosvenor A, Silver R, Porter TF, Zempolich K. Optimal management of placenta accreta. Am J Obstet Gynecol 2007; 195:S82.
van Beekhuizen HJ, Stefanovic V, Schwickert A, et al. A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum. Acta Obstet Gynecol Scand 2021; 100 Suppl 1:12.
Dannheim K, Shainker SA, Hecht JL. Hysterectomy for placenta accreta; methods for gross and microscopic pathology examination. Arch Gynecol Obstet 2016; 293:951.
Buca D, Liberati M, Calì G, et al. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 52:304.
Fitzpatrick KE, Sellers S, Spark P, et al. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG 2014; 121:62.
Bailit JL, Grobman WA, Rice MM, et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015; 125:683.
Thurn L, Lindqvist PG, Jakobsson M, et al. Abnormally invasive placentaprevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2016; 123:1348.
Melcer Y, Jauniaux E, Maymon S, et al. Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa. Am J Obstet Gynecol 2018; 218:443.e1.
Levine D, Hulka CA, Ludmir J, et al. Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging. Radiology 1997; 205:773.
Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol 2005; 26:89.
Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med 1992; 11:333.
Guy GP, Peisner DB, Timor-Tritsch IE. Ultrasonographic evaluation of uteroplacental blood flow patterns of abnormally located and adherent placentas. Am J Obstet Gynecol 1990; 163:723.
Pagani G, Cali G, Acharya G, et al. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 97:25.
Bowman ZS, Eller AG, Kennedy AM, et al. Accuracy of ultrasound for the prediction of placenta accreta. Am J Obstet Gynecol 2014; 211:177.e1.
Jauniaux E, Collins SL, Jurkovic D, Burton GJ. Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. Am J Obstet Gynecol 2016; 215:712.
Bhide A, Sebire N, Abuhamad A, et al. Morbidly adherent placenta: the need for standardization. Ultrasound Obstet Gynecol 2017; 49:559.
Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 2016; 47:271.
Braun T, van Beekhuizen HJ, Morlando M, et al. Developing a database for multicenter evaluation of placenta accreta spectrum. Acta Obstet Gynecol Scand 2021; 100 Suppl 1:7.
Chou MM, Ho ES, Lee YH. Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Ultrasound Obstet Gynecol 2000; 15:28.
Twickler DM, Lucas MJ, Balis AB, et al. Color flow mapping for myometrial invasion in women with a prior cesarean delivery. J Matern Fetal Med 2000; 9:330.
Shih JC, Palacios Jaraquemada JM, Su YN, et al. Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques. Ultrasound Obstet Gynecol 2009; 33:193.
Berkley EM, Abuhamad AZ. Prenatal diagnosis of placenta accreta: is sonography all we need? J Ultrasound Med 2013; 32:1345.
Comstock CH, Bronsteen RA. The antenatal diagnosis of placenta accreta. BJOG 2014; 121:171.
Maldjian C, Adam R, Pelosi M, et al. MRI appearance of placenta percreta and placenta accreta. Magn Reson Imaging 1999; 17:965.
Kirkinen P, Helin-Martikainen HL, Vanninen R, Partanen K. Placenta accreta: imaging by gray-scale and contrast-enhanced color Doppler sonography and magnetic resonance imaging. J Clin Ultrasound 1998; 26:90.
Einerson BD, Rodriguez CE, Kennedy AM, et al. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am J Obstet Gynecol 2018; 218:618.e1.
Kilcoyne A, Shenoy-Bhangle AS, Roberts DJ, et al. MRI of Placenta Accreta, Placenta Increta, and Placenta Percreta: Pearls and Pitfalls. AJR Am J Roentgenol 2017; 208:214.
Millischer AE, Salomon LJ, Porcher R, et al. Magnetic resonance imaging for abnormally invasive placenta: the added value of intravenous gadolinium injection. BJOG 2017; 124:88.
Ray JG, Vermeulen MJ, Bharatha A, et al. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. JAMA 2016; 316:952.
McDonald RJ, Levine D, Weinreb J, et al. Gadolinium Retention: A Research Roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates. Radiology 2018; 289:517.
Jha P, Pōder L, Bourgioti C, et al. Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders. Eur Radiol 2020; 30:2604.
Bourgioti C, Zafeiropoulou K, Fotopoulos S, et al. MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders. J Magn Reson Imaging 2019; 50:602.
Familiari A, Liberati M, Lim P, et al. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 97:507.
Calì G, Giambanco L, Puccio G, Forlani F. Morbidly adherent placenta: evaluation of ultrasound diagnostic criteria and differentiation of placenta accreta from percreta. Ultrasound Obstet Gynecol 2013; 41:406.
Doulaveris G, Ryken K, Papathomas D, et al. Early prediction of placenta accreta spectrum in women with prior cesarean delivery using transvaginal ultrasound at 11 to 14 weeks. Am J Obstet Gynecol MFM 2020; 2:100183.
