İbrahim UYAR, Can TURAN, Yüksel KURBAN, Emre GÜNAKAN

Obstetrik Vakalarda Hipogastrik Arter Ligasyonu: Tek Merkez Deneyimi

Amaç: Bu çalışmanın amacı obstetrik kanamalı olgularda HAL yapılan hastaları değerlendirmektir.Gereç ve Yöntemler: Çalışmaya 19 hasta alındı. Ocak 2012- Şubat 2015 yılları arasında Keçiören Eğitim ve Araştırma Hastanesinde obestetrik nedenli kanamalardan dolayı HAL yapılan hastalar değerlendirildi. Hastalar demografik durum, HAL endikasyonu, yaş, gravida, parite, gestasyonel yaş, doğum haftası, fetal ağırlık, doğum şekli, koagulayon testleri, pre-postop hemoglobin ve platelet değerleri, hastanede kalış süresi ve histerektomi oranları değerlendirildiBulgular: Hastaların ortalama yaşı 33,06±5,08 21-40 , ortalama gravida ve paritesi sırasıyla 3.7±1.6 ve 1.8±1.0 idi. Ortalama gestasyonel yaş ve doğum haftası 36,4±3,5 idi. Normal vajinal doğum ve sezeryan doğum yapan hastaların sayısı sırasıyla 8 %36.9 ve 11 %63.1 idi. Hipogastrik arter ligasyonu endikasyonu sırasıyla plasenta previa 9 hasta %52.9 , Plasenta previa tanısı alan 9 hastanın 5’i eski veya mükerer sezaryen , plasenta akreta 3 hasta %17.6 , Uterin atoni 5 hasta %26.3 ablatio plasenta 1 hasta %5.9 ve plasenta inkreta 1 hasta %5.9 idi Hastaların 4’üne %21.0 histerektomi yapıldı. Maternal ve fetal mortalite görülmedi. Ortalama hemoglobin ve platelet değerleri sırasıyla preoperatif 10,9 ± 1,3 gr/dl ve 240,8 ± 31,3 mm³, postoperatif 9,1 ± 1,7gr/dl ve 177,0 ± 43,0mm³ idi. Sadece bir hastada akut renal yetmezlik ve DİC geliştiSonuç: Postpartum kanamalı hastalarda hipogastrik arter ligasyonu %84,7 hastada kanamayı durdururken, % 15,3 hastada HAL`e ek olarak histerektomi gerekmiştir.

Anahtar Kelimeler:

Uterine atoni, obstetrik kanama, hipogastrik arter ligasyonu

Hypogastric Artery Ligation In Obstetric Cases: Single Institute Experience

Aim: The aim of this study is to evaluate the effectivness and reliability of hypogastric artery ligation HAL in obstetric cases.Material and Methods: 19 patients were included in study. Patients were subjected to HAL because of haemorrhagical obstetric reasons at Ankara Keciören Education and Training Hospital between January 2012 to February 2015. Patients demographic status, HAL indications, age, gravidity, parity, gestational age at birth, weight of the newborns, type of delivery, coagulation tests, preoperative and postoperative hemoglobin Hb and platelet Plt values, length of hospital to stay and hysterectomy rates were determined.Results: Mean age of patients was 33.06±5.08 21-40 . Mean gravidity and parity were 3.7±1.6 - 1.8±1.0, respectively. Mean gestational age at birth was 36.4±3.5 weeks. Number of patients who had normal vaginal and cesarean delivery were 8 %64.7 and 11 35,3% respectively. HAL indications were placenta previa 9 patients, 52.9% , placenta accreta 3 patients , 17.6% , uterine atony 5 patients, 26.3% , ablatio placenta 1 patient , 5.9% and placenta increta 1 patient, 5.9% . Hysterectomy was performed to 5 29.4% patients. No maternal or fetal mortality were recorded. Mean Hb and Plt values were; preoperative 10.9±1.3 gr/dl and 240.8±31.3 and postoperative 9.1±1.7 gr/dl, and 177.0±43.0, respectively. One of the patients developed disseminated intravascular cuagulation and acute renal failure.Conclusion: Hysterectomy was needed in 15.3% of patients with postpartum haemorrhage however HAL was enough for 84.7%

Keywords:

Uterine Atony, obstetric heamorrhage, hypogastric artery ligation HAL,

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