Obstetrik hastalarda dissemine intravasküler koagulasyon: maternal ve fetal sonuçları

Amaç: Çalışmamızda obstetrik nedenlerle dissemine intravasküler koagulasyon (DİK) gelişen hastaların, antepartum değerlendirilmesi ile gelişebilecek komplikasyonların önceden önlenmesi ve maternal ve fetal morbidite ve mortalitenin azaltılması yönünde yol gösterici bilgilerin elde edilmesi amaçlanmıştır. Gereçler ve Yöntem: Obstetri ve perinatoloji kliniklerine yatan ve DİK gelişen obstetrik hastalar retrospektif olarak incelendi. Hastaların DİK skorlaması International Society on Thrombosis and Haemostasis (ISTH) kriterlerine göre yapıldı. Hastaların maternal ve fetal sonuçları dökümante edildi. Bulgular: Verilerin incelendiği 6 yıllık süre içerisinde 108281 doğumda 57 gebede DİK geliştiği tespit edildi ve DİK insidansı %0,052 olarak bulundu. DİK öncülü gebelik komplikasyonu kategorileri: plasenta invazyon ve implantasyon anomalileri, postpartum kanama (atoni), plasenta dekolmanı, gebeliğin hipertansif hastalığı ve diğer olarak bulundu. Maternal morbidte oranı %38.6, maternal mortalite oranı 1 hastayla %1.75 olarak bulundu. Hastaların %35’ine laparotomi/re-laparotomi ve bu hastalardan %21’ne histerektomi yapıldı. Yenidoğan doğum ağırlığı ortalaması 2341.3 gramdır. Yenidoğan yoğun bakım ihtiyacı %34.5, ölü doğum oranı %25,5’tir. Neonatal ölüm oranı %3,6 olarak tespit edilmiştir . Sonuç: Doğumda yönetim şemasının anahtar bir rolü vardır çünkü gebeliğin terminasyonu genellikle altta yatan obstetrik bozukluğu ortadan kaldırır. Erken tanı ve aktif tedavi protokolleri, mortalite ve morbiditeyi azaltır. Gebelikteki koagulasyon kaskadında görülen fizyolojik değişikliklerden dolayı, gebe olmayan erişkinler için geliştirilen ISTH DİK skorlaması yerine gebeliğe spesifik bir DİK skorlamasının geliştirilmesi tanı koymayı kolaylaştırabilir.

Anahtar Kelimeler:

Dik, postpartum kanama, obstetrik bozukluklar, skorlama sistemi, kan transfüzyonu

Disseminated intravascular coagulation in obstetric patients: maternal and fetal results

AIM: In our study, it was aimed to obtain guiding information to prevent complications that may develop in advance and to decrease maternal and fetal morbidity and mortality by evaluating the antepartum of patients who developed DIC due to obstetric reasons. MATERIALS AND METHODS: Obstetric patients who were hospitalized in obstetrics and perinatology clinics and developed disseminated intravascular coagulation (DIC) were retrospectively analyzed. DIC scoring of the patients was made according to the International Society on Thrombosis and Haemostasis (ISTH) criteria. Maternal and fetal outcomes from the patients were documented. RESULTS: During the 6-year period in which the data were analyzed, DIC was detected in 57 pregnants out of 108281 deliveries, and the incidence of DIC was found to be 0.052%. The categories of pregnancy complication preceding DIC: placental invasion and implantation anomalies, postpartum hemorrhage (atonia), placental abruption, hypertensive disease of pregnancy and others were found. Its rate in maternal morbidity was 38.6% and maternal mortality rate was 1.75% with 1 patient. 35% of the patients had laparotomy / re-laparotomy and 21% of these patients had hysterectomy. The average birth weight of the newborn is 2341.3 grams. Neonatal intensive care need is 34.5%, stillbirth rate is 25.5%. Neonatal mortality rate was determined as 3.6%. CONCLUSION: The management scheme plays a key role in delivery because termination of pregnancy often eliminates the underlying obstetric disorder. Early diagnosis and active treatment protocols reduce mortality and morbidity. Because of the physiological changes seen in the coagulation cascade during pregnancy, using a pregnancy-specific DIC score instead of the ISTH DIC score developed for non-pregnant adults may facilitate diagnosis.

Keywords:

Dic, postpartum hemorrhage, obstetric disorder, scoring system, blood transfusion,

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