Latar Belakang: Perdarahan masif merupakan komplikasi paling banyak pada kasus spektrum plasenta akreta. Penyebab perdarahan terutama tergantung dari derajat keparahan spektrum plasenta akreta yang dapat diprediksi dari USG dan secara klinis dibuktikan pada saat operasi. Meskipun banyak faktor yang memengaruhi jumlah perdarahan saat operasi, namun memprediksi jumlah perdarahan melalui jumlah aliran darah yang masuk ke uterus adalah suatu patut diperhatikan. Oleh karena itu, penelitian ini bertujuan untuk memahami hubungan volume flow arteri uterina dan iliaka interna terhadap perdarahan, temuan intraoperasi dan histopatologi pada kasus SPA.
Tujuan: Mengetahui hubungan volume flow dan diameter arteri uterina dan iliaka interna dengan perdarahan dan temuan intraoperasi serta histopatologi pada pasien spektrum plasenta akreta.
Metode: Sebuah studi cross-sectional dilakukan pada 31 wanita, yang secara klinis didiagnosis dengan SPA. Pengukuran volume flow dan diameter arteri uterina dan iliaka interna dilakukan dengan USG Doppler sebelum operasi dilakukan. Temuan intraoperasi dan hasil histopatologi dikategorikan sesuai kriteria klinis dan histopatologi FIGO. Jumlah perdarahan intraoperasi diukur dan dicatat. Data kemudian dianalisis menggunakan Statistical Package for Social Sciences (SPSS) versi 25.
Hasil: Dari 31 subjek penelitian didapatkan jumlah perdarahan intraoperasi sebanyak 1500 (1000-3000) mL. Sebagian besar tindakan yang dilakukan bersifat elektif (n=18; 58,1%) dengan seksio sesarea diikuti oleh histerektomi sebanyak 19 kasus (61,3%). Temuan klinis intraoperasi yang paling sering ditemukan adalah kriteria klinis FIGO 1 sebanyak 15 kasus (48,4%). Hasil histopatologi terbanyak adalah kriteria histopatologi FIGO 2 sebanyak 19 kasus (61,3%).
Rerata volume flow Arteri Iliaka Interna (p=0,002) berkorelasi dengan jumlah perdarahan intraoperasi dengan koefisien korelasi sebesar 0,525, sedangkan rerata volume flow Arteri Uterina tidak berkorelasi dengan jumlah perdarahan intraoperasi. Rerata diameter arteri uterina (p=0,034) berkorelasi positif dengan jumlah perdarahan intraoperasi dengan koefisien korelasi sebesar 0,383. Hal ini menunjukkan semakin besar volume flow arteri Iliaka Interna, semakin besar jumlah perdarahan intraoperasi. Ditemukan bahwa rerata diameter arteri iliaka interna memiliki perbedaan secara statistik dengan temuan klinis intraoperatif (p=0,044). Tidak ditemukan hubungan antara rerata volume flow dan diameter arteri uterina dan arteri iliaka interna dengan hasil histopatologi.
Kesimpulan. Pengukuran volume flow arteri iliaka interna dan diameter arteri uterina dapat memberikan gambaran perkiraan jumlah perdarahan saat operasi kasus spektrum plasenta akreta. ......Background: Massive bleeding is the most common complication in cases of the placenta accreta spectrum (PAS). The cause of bleeding largely depends on the severity of the PAS, which can be predicted through ultrasound (USG) and clinically confirmed during surgery. Although many factors influence the amount of bleeding during surgery, predicting the amount of bleeding through the measurement of blood flow into the uterus is noteworthy. Therefore, this study aims to understand the relationship between the volume flow of the uterine and internal iliac arteries and bleeding, intraoperative findings, and histopathology in PAS cases.
Objective: To determine the Relationship between Volume Flow and Diameter of Uterine and Internal Iliac Arteries with Intraoperative Bleeding and Findings, as well as Histopathology in Patients with Placenta Accreta Spectrum.
Methods: A cross-sectional study was conducted on 31 women clinically diagnosed with PAS. Measurement of volume flow and diameter of the uterine and internal iliac arteries was performed using Doppler ultrasound before surgery. Intraoperative findings and histopathological results were categorized according to clinical and FIGO histopathological criteria. The amount of intraoperative bleeding was measured and recorded. The data were then analyzed using Statistical Package for Social Sciences (SPSS) version 25.
Results: From 31 study subjects, the amount of intraoperative bleeding was found to be 1500 (1000-3000) mL. Most procedures were elective (n=18; 58.1%), with cesarean section followed by hysterectomy in 19 cases (61.3%). The most common intraoperative clinical finding was FIGO clinical criteria 1 in 15 cases (48.4%). The majority of histopathological results were FIGO histopathological criteria 2 in 19 cases (61.3%). The mean volume flow of the Internal Iliac Artery (p=0.002) correlated with the amount of intraoperative bleeding with a correlation coefficient of 0.525, while the mean volume flow of the Uterine Artery did not correlate with the amount of intraoperative bleeding. The mean diameter of the uterine artery (p=0.034) positively correlated with the amount of intraoperative bleeding with a correlation coefficient of 0.383. This indicates that the larger the volume flow of the Internal Iliac Artery, the greater the amount of intraoperative bleeding. It was found that the mean diameter of the internal iliac artery differed statistically with intraoperative clinical findings (p=0.044). No relationship was found between the mean volume flow and diameter of the uterine and internal iliac arteries with histopathological results.
Conclusion: Measurement of the volume flow of the internal iliac artery and the diameter of the uterine artery can provide an estimate of the amount of bleeding during surgery in cases of the placenta accreta spectrum.
Latar Belakang: Klasifikasi Lodwick sudah sering digunakan untuk memprediksi derajat keganasan pada suatu tumor tulang. Terdapat klasifikasi terbaru yakni modified Lodwick-Madewell, yang yang diharapkan meningkatkan tingkat akurasi, namun belum terdapat laporan mengenai tingkat akurasi dan kesesuaian klasifikasi yang terbaru. Tujuan: Menilai kesesuaian kemampuan klasifikasi modified Lodwick-Madewell dengan klasifikasi Lodwick dalam membedakan klasifikasi keganasan tumor tulang berdasarkan hasil pemeriksaan patologi anatomi. Metode: Sebanyak 102 pasien memenuhi kriteria penelitian yang telah dilakukan pemeriksaan radiografi dan patologi anatomi. Analisis hubungan untuk membandingkan temuan klasifikasi modified Lodwick-Madewell maupun klasifikasi Lodwick dengan temuan pemeriksaan patologi anatomi dilakukan menggunakan uji modified Mc Nemar-Bowker dengan analisis kesesuaian dinilai dengan uji Kappa Cohen. Hasil: Nilai diagnostik antara klasifikasi Lodwick dan modified Lodwick-Madewell dengan nilai p masing-masing 0,265 dan 0,064 secara berurutan. Nilai Kappa Cohen untuk penggunaan klasifikasi Lodwick dan modified Lodwick-Madewell dengan nilai R sebesar 0,596 dan 0,557 secara berurutan. Hasil rasio konkordans pada klasifikasi Lodwick juga menunjukkan hasil yang sedikit lebih tinggi dibandingkan dengan klasifikasi modified Lodwick-Madewell, dengan rasio konkordans masing-masing secara berurutan 73,5% dan 70,6 %. Kesimpulan: Tingkat kesesuaian klasifikasi modified Lodwick-Madewell sama dengan klasifikasi Lodwick dalam menentukan klasifikasi keganasan tumor tulang berdasarkan hasil pemeriksaan patologi anatomi. Meskipun demikian, tingkat konkordansi modified Lodwick-Madewell lebih rendah dibandingkan dengan klasifikasi Lodwick dalam menentukan klasifikasi keganasan tumor tulang berdasarkan hasil pemeriksaan patologi anatomi. ......Background: The Lodwick classification has often been used to predict the degree of malignancy of a bone tumor. There is a new classification, namely modified Lodwick-Madewell, which is expected to increase the level of accuracy, however there has been no report regarding the level of accuracy and suitability of the latest classification. Objective: Assessing the suitability of the modified Lodwick-Madewell classification with the Lodwick classification in differentiating the classification of malignant bone tumors based on the results of anatomical pathology examination. Method: A total of 102 patients met the research criteria who had radiographic and anatomical pathology examinations. Correlation analysis to compare the findings of the modified Lodwick-Madewell classification and the Lodwick classification with the findings of anatomical pathology examination was carried out using the modified Mc Nemar-Bowker test with suitability analysis assessed using the Cohen's Kappa test. Results: The diagnostic value between the Lodwick and modified Lodwick-Madewell classifications with p values of 0.265 and 0.064 respectively. Cohen's Kappa value for using the Lodwick and modified Lodwick-Madewell classifications with an R value of 0.596 and 0.557 respectively. The concordance ratio results in the Lodwick classification also show slightly higher results compared to the modified Lodwick-Madewell classification, with concordance ratios of 73.5% and 70.6% respectively. Conclusion: The level of suitability of the modified Lodwick-Madewell classification is the same as the Lodwick classification in determining the malignancy classification of bone tumors based on the results of anatomical pathology examination. However, the modified Lodwick-Madewell concordance level is lower than the Lodwick classification in determining the malignancy classification of bone tumors based on the results of anatomical pathology examination.