Hüseyin KIYAK, Tolga KARACAN, Sefi Eser ÖZYÜREK, Emre Volkan KASIMOĞULLARI, Hasan Fehmi YAZICIOGLU

MEDİKAL TEDAVİYE YANITSIZ OBSTETRİK KANAMALI OLGULARDA SIRALI UTERİN ARTER DEVASKÜLARİZASYON SONUÇLARI

Amaç: Sezaryen ameliyatlarinda karsilasilan ve kontrol edilemeyen kanamalari yonetmede proksimal ve distal uterin arter ligasyonun terapoti etkinligini tanimlamak Dizayn: Retrospectie study. Gereç ve Yöntem: Sezaryen ile dogum yapan ve peroperati kontrol altia alinamayan kanama ile karsilasilan 65 kadin incelendi.Bu hastalarin tedavisinde proksimal uterin arter ligasyonu ,distal uterin arter ligasyonu ya da hem proksimal hem de uterin arter ligasyonu altt yatan nedenlere gore uygulandi.Bunlara ragmen kanamanin persiste etti olgulara bilateral hipogastrik arter ligasyonu ve kanama halen devam ediyorsa histerektomi uygulandi. Sonuçlar: 61 hastanin kanamasi yalnizca uterin arter ligasyonu ile( proksimal uterin arter ligasyonu,distal uterin arter ligasyonu ya da distal/proksimal uterin arter ligasyonu) kontrol altia alindi.4 akreta tanili hastaya uterin arter ligasyonuna ek olarak hipogastrik arter ligasyonu ve histerektomi operasyonu uygulandi .Distal uterin arter ligasyonu cogunlukla uterin atoni nedenli kanamalarda etkin iken ,proksimal uterin arter ligasyonu ya da distal ve proksimal uterin arter ligasyonu plasenta previa ya da akreta nedenli kanamalarda tedavi saglamisti.32 akreta tanili hastanin 24 tanesine hem proksimal uterin arter ligasyonu hem distal uterin arter ligasyonu ,4 tanesine proximal uterin arter ligasyonu, 4 tanesine de histerektomi uygulanmisti. Tartıma: Sezaryen sirasinda karsilasilan kontrol altia alinamayan kanamalarda uterin arter ligasyon teknigi basarili,emniyetli ve hayat kurtarici bir islemdir.Ozellikle plasenta akreta ya da previa gibi uterusu korumanin cok guc oldugu vakalarda bulgularimiz proksimal arter ligasyonunun yararli oldugunu göstermisti.

Stepwise Uterine Artery Ligatin Results In Patints With Postpartum Bleeding Unresponsive To Medical Treatment

Objectie: To describe the therapeutial effiency of proximal and distal uterine artery ligatins performed totreat uncontrolled bleeding encountered during cesarean sectin operatins.Design: Retrospectie study.Materials and Method: 65 parturient women delivered by cesarean sectin. An uncontrolled peroperatiebleedings were encountered. Uterine artery ligatins were performed proximally , distally or both segmentsdepending on the etilogy. In cases where the bleeding could not be controlled, hypogastric artery ligatins ;and if persistent, a hysterectomy was performed.Results: 61 patints were treated with uterine artery ligatins (proximal uterine artery ligatin, distal uterineartery ligatin or distal/proximal uterine artery ligatin). An additinal hypogastric artery ligatin was requiredin 4 accreta cases where a hysterectomy was needed, as well. While distal uterine artery ligatins could treatmost atony cases, proximal uterine artery or distal/proximal uterine artery ligatin were effctie in treatigbleeding due to placenta accreta and/or previa. Of 32 accreta cases; 24 were treated with distal/proximaluterine artery ligatin; 4 with proximal uterine artery ligatin, only; and in 4, a hysterectomy was performed.Discussion: Uterine artery ligatin techniques are successful, safe and life saving interventins for treatiguncontrolled bleeding during cesarean sectin. Especially in conditins where uterus preservatin isconsidered to be diffilt due to placenta accreta and/or previa, our fidings show that proximal uterineartery ligatin can provide an added benefi for the patint.

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1. WHO. Maternal mortality in 2000. Estiates developed by WHO, UNICEF, and UNFPA. Geneva: Department of Reproductie Health and Research, World Health Organizatin; 2004..
2. Arbab F, Boulie D, Bied V. et al.Uterine rupture in fist and second trimestr of pregnancy aftr in vitro fertiizatin and embryo transfer.Hum Reprod 1996;11:1120-1122
3. Condous GS, Arulkumaran S. Medical and conservatie surgical management of postpartum hemorrhage. J Obstet Gynaecol Can 2003;25(11):931–6.
4. Waters EG. Surgical management of partum hemorrhage with partiular reference to ligatin of uterine arteries. Am j Obstet Gynecol 1952;64:1143-8.,
5. Nelson SH, Suresh NS. Lack of reactiity of uterine arteries from patints with obstetric hemorrhage. 1992;166:1436-43 Acta Obstet Gynecol Scand. 1998;77:186–90
6. Fawcus S, Moodley J. Postpartum haemorrhage associated with caesarean sectin and caesarean hysterectomy Best Practie &Res. Clin. Obst. and Gynecology 2012, 27: 233-249
7. Fawcus S, Mbombo N, Hofmeyr GJ Saving mothers, Chapter 4. The fit report of the natinal confientil enquiry into maternal deaths in South Africa 2008-201. A short report. Pretoria: Department of Health. 2012.
8. Fawcus S & Mbombo N. Deaths from haemorrhage associated with caesarean sectin in South Africa, 2009. Abstract FIGO Cape Town, South Africa.
9. Zwart JJ, Richters JM, Ory F et al. Severe maternal morbidity during pregnancy, delivery, and puerperium in the Netehrlands: a natinwide populatin-based study of 371000 pregnancies. BJOG 2008: 115:842-850.
11. B-Lynch, Coker A, Lawal AH et al. The B-Lynch surgical technique for the control of massive postpartum hemoorhage: an alternatie to hysterectomy? Five cases reported BJOG 1997; 104:372-375
12. Preventin and management of postpartum hemorrhage. RCOG Green-top guideline 2009;52. update April 2011.
13. Kaoiean S. Successful use of the B-Lynch uterine compression suture in treatig intractable postpartum hemorrhage aftr cesarean delivery in Rajavithi Hospital J Med Assoc Thai 2013; 96(11):1408-1415
14. O’Leary JL, O’Leary JA Uterine artery ligatin in the control of intractable postpartum hemorrhage Am. J. Obstet. Gynecol. 1966;94: 920-924
15. Tsirulnikov MS Ligatin of the uterine vessels during obstetrical hemorrhages. Immediate and long-term results J Gynecol Obstet Biol
16. Reprod (Paris). 1979;8(8):751-3.
17. AbdRabbo SA Stepwise uterine devascularizatin: a novel technique for management of uncontrolled postpartum hemorrhage with preservatin of the uterus. Am J Obstet Gynecol. 1994 Sep;171(3):694-700
18. Sentihes L, Gromez A, Marpeau L et al. Fertiity aftr pelvic arterial embolizatin, stepwise uterine devascularizatin, hypogastric artery ligatin, and B-Lynch suture to control postpartum hemorrhage. Int J Gynaecol Obstet. 2010 Mar;108(3):249. doi: 10.1016/j. ijgo.2009.10.003
19. Sziller I, Hupuczi P, Papp Z (2007) Hypogastric artery ligatin for severe hemorrhage in obstetric patints. J Perinat Med 35(3):187 192
20. Boynukalin FK1, Boyar H, Gormus H, Aral AI, Boyar N Bilateral hypogastric artery ligatin in emergency setti for intractable postpartum hemorrhage: a secondary care center experience. Clin Exp Obstet Gynecol. 2013;40(1):85-8
21. Roopnarinesingh R, Fay L & Mckenna P. A 27-year review of obstetric hysterectomy. J Obstet Gynaecol 2003; 23: 252–254
22.Knight M, & on behalf of UKOSS. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG 2007; 114: 1380–1387.
23. Morel O, Malarti C, Muhlstein J et al. Pelvic arterial ligatins for severe post-partum hemorrhage. Indicatins and techniques. J Visc.
24. Surg. 2011 Apr;148(2):e95-102. doi: 10.1016