PLANLANMIŞ SEZARYEN VEYA ACİL SEZARYEN UYGULANMIŞ OLGULARIN SONUÇLARININ KARŞILAŞTIRILMASI

Objective: The aim of this study was to compare perinatal and operative outcomes of patients with placenta previa managed with planned cesarean section versus emergency cesarean section between the years 2000 and 2004 in the Istanbul Faculty of Medicine. Materials and methods: The data of 60 patients with placenta previa managed between January 2000 and December 2004 were retrospectively reviewed. We divided the patients into two groups according to their emergency state at the time of delivery. Group I (n=25): patients with placenta previa who were delivered by emergency cesarean section due to life-threatening vaginal bleeding and group II (n=35): patients with placenta previa who were delivered by a planned cesarean section with obstetric indications after initial admission to our clinic. We compared maternal morbidity in terms of operative and postoperative complications and perinatal outcomes of the two groups. The amounts of blood transfusion were also evaluated. Results: The mean ages of the first and the second groups were 31.6 and 31.7 years, respectively (p=0.927). The duration of surgical procedures was not significantly different between the two groups (100.6 minutes in group I and 90.6 minutes in group II, p=0.792). The total blood transfusion between only cesarean groups was not different significantly (the mean blood transfusion amount in group I was 449 ml and in group II was 448 ml, p=0.693). Atotal of 12 obstetric hysterectomies were performed in the two groups. Among the patients who underwent hysterectomy, the mean amount of blood transfusion in the emergency cesarean hysterectomy group was significantly higher than that in the elective cesarean hysterectomy group (2750 ml versus 1078 ml, p<0.001). The operative time of the obstetric hysterectomy procedure was higher in the emergency group than that in the elective group (231 minutes versus 171 minutes, p<0.001). No maternal deaths were observed in any group. One bladder injury occurred in a patient with placenta percreta. Conclusion: Emergency cesarean versus planned cesarean section approach in patients with placenta previa did not show any significant difference regarding the duration of cesarean section, the amount of blood transfusion, or maternal morbidity and mortality. However, the patients who required hysterectomy due to intraoperative massive bleeding (mostly associated with abnormal placentation) in the emergency cesarean section group had significantly more blood transfusion and longer duration of operative time than those in the elective ceserean section group. Therefore, it is the emergent hysterectomy procedure which influences perioperative outcomes in patients with placenta previa and not the ceserean section.