THE MANAGEMENT STRATEGIES IN THE PLACENTA ACCRETA SPECTRUM IN TERTIARY CENTERS IN TÜRKİYE TÜRKİYE'DEKİ ÜÇÜNCÜL MERKEZLERDE PLASENTA AKRETA SPEKTRUMUNUN YÖNETİM STRATEJİLERİ


BÜYÜKKURT S., MELEKOĞLU R., Hati̇Poğlu İ.

Istanbul Tip Fakultesi Dergisi, vol.87, no.1, pp.43-53, 2024 (ESCI) identifier

  • Publication Type: Article / Article
  • Volume: 87 Issue: 1
  • Publication Date: 2024
  • Doi Number: 10.26650/iuitfd.1351897
  • Journal Name: Istanbul Tip Fakultesi Dergisi
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.43-53
  • Keywords: Perinatology, placenta accreta, postpartum hemorrhage, questionnaires, surveys
  • Çukurova University Affiliated: Yes

Abstract

Objective: To determine the differences and consensus points in managing patients with placenta accreta spectrum (PAS) disorder in a nationwide survey. Material and Method: Forty-seven items were asked via an online survey. Seventy-seven percent responded to the survey (37/48). Consensus/strong consensus was predefined as 75%-89% (28-33/37)/>90% (≥34/37) of panelists agreeing on an answer. Result: In a few areas, consensus or strong consensus was achieved. These are the absence of interventional radiology (89.2%) and cell-saver in the institution (94.6%), a rare selection of magnetic resonance (83.8%), and frequent use of transvaginal so-nography (94.6%) as an adjuvant diagnostic tool. Penetrative sexual intercourse is prohibited (78.4%); perineal shaving (81.1%) and rectal enema (94.6%) are not used; general anesthesia (75.7%) is the preferred technique; hypothermia control (97.3%) is not omitted; and administration of oxytocin (75.7%) is similar to routine cesarean section; vascular injuries are managed by vascular surgeons (78.4%); gynecologic oncologists are not a regular part of the surgical team (86.5%); routine insertion of a central venous cannula (78.4%) is not considered and placement of an abdominal drain (89.2%) is usually performed. Surgery is often performed through a median abdominal incision (83.8%), and a total hysterectomy (81.1%) is chosen. Routine hypogastric artery ligation (91.9%) is not performed. In the postoperative period, the patients are allowed to have early mobilization (91.9%) and oral intake (83.8%). They are habitually discharged on the 3rd-4th postoperative day (75.7%). Psychiatric needs are often neglected (94.6%). Conclusion: These consensus points could help obstetricians manage this complicated condition. These results also demonstrate the need for evidence-based data for implementing proper treatment strategies for PAS disorder. Future research is sought for these points.