Melih VELİPAŞAOĞLU, H. Mete TANIR, Metin ŞENTÜRK

Acil Peripartum Histerektomi: Bir Üniversite Hastanesinin 20 Yıllık Deneyimi

Amaç: Peripartum histerektomi sıklığı tüm dünyada giderek artmakta olan, obstetrik kanamaların tedavisinde son basamak olarak uygulanan hayat kurtarıcı bir cerrahi müdahaledir. Özellikle artan sezaryen hızları ile birlikte gelişen plasental anomaliler plasenta previa ve invazyon anomalileri peripartum histerektominin önemini artırmaktadır.Çalışmanın amacı, peripartum histerektominin bir üniversite kliniğindeki risk faktörlerini, insidansını endikasyonlarını, yönetim stratejilerini ve komplikasyonlarını incelemektir.Gereç ve Yöntemler: Bu retrospektif çalışmaya Mart 1997 ile Mart 2017 tarihleri arasında kliniğimizde doğum sonrası ilk 24 saat içinde peripartum histerektomi yapılan olguları dahil edilmiştir. Olguların demografik verileri, plasental anomali varlığı, histerektomi endikasyonları, yapıldı ise histerektomiye ek cerrahi müdahaleler, intraoperatif komplikasyonlar, transfüzyon ihtiyacı, verilen kan ürünü tipleri ve miktarları ile maternal ve perinatal mortaliteleri incelenmiştir.Bulgular: Kliniğimizde 20 yıl içinde 23 peripartum histerektomi yapılmış olup bu müdahale ‰ 1,7 sıklıkla uygulanmıştır. Peripartum histerektomi endikasyonları arasında en sık olarak plasenta invazyon anomalileri n=8; %34,8 , ikinci en sık olarak ise uterin atoni n=7; %30,4 olarak yer almaktaydı. Plasental anomalilerin plasenta previa ve invazyon anomalileri toplam oranı %52,17 olarak tespit edilmişti. Hastaların tamamına eritrosit süspansiyonu verilmiş olup verilen ortalama eritrosit süspansiyonu miktarı 11,52 ± 9,27 ünitedir. Perinatal mortalite hızı ‰ 120 iken maternal mortalite hızı ‰ 4,3 n=1 olarak tespit edilmiştir.Sonuç: Çalışma plasental anomalilere plasenta previa ve invazyon anomalileri bağlı peripartum histerektomi sıklığının giderek artığını göstermektedir. Bu nedenle bu problemlerin antenatal dönemde tanısının konması ve bu hastaların doğum yönetiminin tecrübeli bir ekip tarafından multidisipliner yaklaşımla yapılması gerekmektedir

Anahtar Kelimeler:

Peripartum histerektomi, Obstetrik kanama, Plasenta akreata, Uterin atoni, Plasenta previa

Emergency Peripartum Hysterectomy: 20-Year Experience of a University Hospital

Objective: Peripartum hysterectomy is a lifesaving procedure that is performed as the last step in the management of massive obstetric hemorrhage. Its incidence is increasing worldwide. Placental abnormalities that are associated with high cesarean rates are of utmost importance in the concept of peripartum hysterectomy.The purpose of this study was to elucidate the risk factors, incidence indications, management strategies and complications of peripartum hysterectomy in a university setting.Material and Methods: This retrospective study included the patients who gave birth and underwent hysterectomy in the 24h after delivery at our clinic between March 1997 and March 2017. Demographic characteristics, the presence of placental abnormalities, indications of hysterectomy, surgical interventions other than hysterectomy, intraoperative complications, need of transfusion, types and amount of transfused blood products, and perinatal and maternal mortality were examined.Results: There were 23 hysterectomy cases in 20 years with an incidence of 1.7‰. The most common indications were placental Results: There were 23 hysterectomy cases in 20 years with an incidence of 1.7‰. The most common indications were placental invasion anomalies n=8; 34.8% and uterine atony n=7; 30.4% . Total rate of placental abnormalities was 52.17%. All patients were given erythrocyte suspension with a mean amount of 11.52 ± 9.27 units per patient. Perinatal mortality rate was 120‰ and maternal mortality rate was 4.3‰ n = 1 . Conclusion: This study shows that the frequency of peripartum hysterectomy due to placental anomalies is increasing steadily. The diagnosis of these problems should therefore be made in the antenatal period and the management of these patients should be conducted with the multidisciplinary approach of an experienced team

Keywords:

Peripartum hysterectomy, Obstetric hemorrhage, Placenta acreta, Uterine atony, Placenta previa,

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