Ünal İSAOĞLU, Mehmet YILMAZ, Sedat KADANALI

The evaluation of uterine rupture in 61 turkish pregnant women

Amaç: Çalışmamızın amacı, hamilelik sırasında komplet veya inkomplet uterin rüptür gelişen hastalardaki risk faktörleri, mater- nal ve perinatal sonuçları ve komplikasyonları retrospektif olarak incelemek. Metod: 1999-2009 tarihleri arasında kliniğimizde tespit edilen, gebelikte görülen 61 uterus rüptürü olgusu retrospektif olarak incelendi. Bulgular: Kliniğimizde uterin rüptürün insidansı 10 yıllık peryotta %0.12 olarak hesaplandı. 54 (%88.5) hasta düşük sosyoekonomik durumdaydı. 51 (%83.6) hasta hiç antenatal bakım almamıştı. 48 (%78.6) hasta daha önceden sezaryen, myomektomi veya metro- plasti operasyonu olmuştu. 26 (%42.6) hasta grandmultipardı. Hastaların 58 (%95.1)'ine primer tamir yapıldı. Üç (%4.9) hastaya subtotal histerektomi yapıldı. 15 fetal ölüm olurken hiç maternal ölüm olmadı. Sonuç: Gebe uterusunun rüptürü sıklıkla uyarı vermeden ortaya çıkan büyük bir obstetrik komplikasyondur. Uterin rüptür skarlı uterusa sahip hastalarda olduğu gibi skarsız uterusa sahip hastalarda da görülebilen bir komplikasyondur. Grandmultiparite özel- likle skarsız uterusa sahip hastalarda çok önemli bir risk faktörüdür. Düşük oranlarına rağmen uterin rüptür, anne ve fetüs için çok önemli bir komplikasyondur. Uterin rüptürün tedavisinde erken teşhis, hemen preoperatif resusitasyon, kaybolan kanın hızlı replasmanı ve acil cerrahi tedavi çok önemlidir. Histerektomi, uterin rüptür vakalarının yönetiminde ilk seçenek değildir.

61 Gebe hastada uterus rüptürünün değerlendirilmesi

Aim: The aim of our study, to evaluate the patients with complete or incomplete uterine rupture which occurred during pregnancy ret- rospectively and to analyze and present of the risk factors, maternal and perinatal outcomes, and complications. Method: Sixty one patients diagnosed as uterine rupture were investi- gated retrospectively in our clinic between 1999 and 2009. Result: The incidence of uterine rupture for our department in a ten year period was calculated as 0.12 %. Fifty four patients (88.5%) were in low socioeconomic status. Fifty one (83.6%) patients did not receive any antenatal care. Forty eight (78.6%) of the cases had previous ute rine surgery due to cesarean, myomectomy or metroplasty. Twenty six cases (42.6%) were grand multiparous. Primer repair of uterus was performed in 58 (95.1%) of the patients. Subtotal abdominal hyste rectomy was performed in three patients (4.9%). There were 15 fetal deaths while no maternal death was occurred. Conclusion: Rupture of the pregnant uterus is a major obstetric comp lication that occurs often with no warning signs. Uterine rupture is a potential complication for patients with non-scarred uterus as well as scarred uterus. Grand multiparty is a very important risk factor, espe- cially in patients without uterine scar. Despite to its low rate, uterine rupture is a very important complication for mother and fetus. Early diagnosis, immediate preoperative resuscitation, rapid replacement of blood loss, and urge surgical therapy are very important in treat- ment of uterine rupture. Hysterectomy is not the first choice in case of uterine rupture management.

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