Ali YANIK, Ahmet Emin MUTLU, Yasin BIYIK, Hidayet YENİOCAK, Abdullah BOZTOSUN

Doğum sonrası kanaması olan olgularda intraabdominal cerrahi yaklaşımların değerlendirilmesi

Amaç. Kliniğimizde doğum sonrası kanama nedeni ile cerrahi müdahale yapılan olgularımızınincelenmesi amaçlandı. Yöntem. Ocak 2009 ile Aralık 2011 tarihleri arasında kliniğimizdeintraabdominal cerrahi yaklaşımla müdahale edilen doğum sonrası kanamalı olgular geriye dönükolarak değerlendirildi. Bulgular. Doğum sonrası kanamalı 44 olgudan 10unda (%22.8) vajinaldoğum sonrasında, 34ünde (%77,2) sezaryen esnasında veya sonrasında intraabdominal cerrahimüdahale uygulandı. Doğum sonrası kanamaya bağlı maternal mortalite oranımız %0,017 olarakbulundu. Histerektomi ve bilateral hipogastrik arter ligasyonu %31,8 oranları ile ilk tercih edilenyaklaşımlar olurken, atoni (% 47.7) ve plasenta previa (% 25) en sık kanama sebepleri olarakbulundu. Tüm olgular için histerektomi oranımız %47,7 olarak bulundu. Histerektomioperasyonunun atoni haricindeki diğer kanama sebeplerinde %62,5 oranında tercih edildiği, atoniliolgularda ise %30 oranında tercih edildiği ve bu oranların anlamlı olduğu görüldü (p=0,032).Plasental yapışma anomalisi ve plasenta previa bulunan olgularda sezaryen sayısı diğer olgularagöre anlamlı yüksekti (1,23±1,14e karşı 0,55±0,75; p=0.043). 043). Sonuç: Doğum sonrasıkanamalı olgularımızda histerektomi oranımız yüksek bulundu. Bu yüksek oran, sezaryensayısının artması ile ilişkili plasental yapışma anormallikleri ile izah edilebilir. Bu nedenle doğumsonrası kanamanın primer önlenmesi için sezaryen oranlarının azaltılması belki de en etkili yololacaktır. Bununla birlikte histerektomi konservatif tedavilerin başarısızlığında başvurulacak sonyöntem olmalıdır.

Evaluation of intra-abdominal surgical approaches in cases with postpartum haemorrhage

Aim. We aimed to review patients who underwent intra-abdominal surgical intervention due topostpartum hemorrhage in our clinic. Method. Cases with postpartum hemorrhage, who weretreated with intraabdominal surgical approach between January 2009 and December 2011 wereretrospectively evaluated. Results. Of the 44 patients with postpartum hemorrhage, intra- abdominal surgical intervention was performed after vaginal delivery in 10 patients (22.8%),whereas 34 (77.2%) patients underwent intraabdominal surgical intervention during or aftercesarean. Maternal mortality rate due to postpartum hemorrhage was found to be 0.017%.Hysterectomy and bilateral hypogastric artery ligation were firstly preferred approaches with ratesof 31.8%, while atonia (47.7%) and placenta previa (25.0%) were found as the most commoncauses of hemorrhage. Postpartum hysterectomy rate was found as 47.7% for all cases. Our resultsshowed that hysterectomy was preferred at a rate of 62.5% for hemorrhage causes other thanatonia, while it was preferred at a rate of 30% in atonia, which were found to be significant(p=0,032). Numbers of cesarean were significantly higher in patients with placental adhesionanomaly or placenta previa than other patients (1.23±1.14 vs. 0.55±0.75; p=0.043). Conclusion:The hysterectomy rate in cases with postpartum hemorrhage was high in our trial. This high ratiocan be explained by placental adhesion abnormalities associated with increased number ofcesarean sections. For this reason, perhaps reducing the rates of cesarean section would be themost effective way in the primary prevention of postpartum hemorrhage. However; hysterectomyshould be the last method to be applied in case of failure after conservative methods.

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