İlker KAHRAMANOĞLU, Asli AZEMI, Hasan TURAN, Fuat DEMİRKIRAN

Obstetrik hemorajide hipogastrik arter ligasyonu: tek cerrah deneyiminin kohort analizi

GirişHipogastrik arter ligasyonu, ciddi postpartum kanamada hayat kurtarıcı bir işlemdir. Gerektiğinde mümkün olan en hızlı şekilde uygulanmalıdır. Bu çalışmada, tek cerrahın postpartum kanama kontrolünde hipogastrik arter ligasyonu deneyimi sunulmuştur.MetodBu retrospektif kohort çalışmaya, 2015-2018 yılları arası, acil koşullarda aynı cerrah tarafından hipogastrik arter ligasyonu uygulanan hastalar dahil edilmiştir. Tüm vakalarda aynı işlem tekniği uygulanmıştır. Veriler, hastane kayıtlarından elde edilmiştir.BulgularToplam 6 hasta, analize dahil edilmiştir. Hipogastrik arter ligasyonu endikasyonları şu şekilde olmuştur: 3 vaka (%50) uterin atoni, 2 vaka (%33.3) plasenta previa ve 1 vaka (%16.7) ablasyo plasenta. İntraoperatif komplikasyon bulunmadı. Altı hastadan biri relaparotomiye alındığı için, hipogastrik arter ligasyonun başarı oranı %83.3 olarak bulundu. 13 aylık ortanca takip süresince, sadece bir hasta gebe kalmak istedi ve kaldı.SonuçHipogastrik arter ligasyonu, postpartum kanama kontrolünde etkili bir yöntemdir. Retroperitona direk hipogastrik arter üzerinden girmek, işlemi hızlandırabilir.

Anahtar Kelimeler:

hipogastrik arter, internal iliak arter, hemoraji

Hypogastric artery ligation for obstetrical haemorrhage: cohort analysis of a single surgeon experience

IntroductionHypogastric artery ligation (HAL) is a life-saving procedure for severe postpartum haemorrhage (PPH). It should be performed as fast as possible when needed. In this study, a single surgeon’s experience in HAL for controlling PPH was presented.MethodsCases in whom HAL performed in emergency setting by the same surgeon in between 2015 and 2018 were included in this retrospective cohort study. The technnique of the procedure was the same for all cases. Data were extracted from hospital’s records.ResultsA total of 6 patients were included into the analysis. Indications for HAL were as follows: uterine atony in 3 (50%) cases, placenta previa in 2 (33.3%) cases and ablatio placenta in one case (16.7%). There were no intraoperative complication. The success rate of HAL was 83.3%, as one of the 6 patient underwent re-laparotomy. Within a median follow-up time of 13 months, only one patient attempted to concieve and succeeded.ConclusionHAL is an effective procedure for the management of PPH. Entering to the retroperitonneum directly over the hypogastric artery may fasten the procedure.

Keywords:

hypogastric artery, internal iliac artery, haemorrhage,

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