MEDİKAL TEDAVİYE YANITSIZ OBSTETRİK KANAMALI OLGULARDA SIRALI UTERİN ARTER DEVASKÜLARİZASYON SONUÇLARI Stepwise Uterine Artery Ligation Results In Patients With Postpartum Bleeding Unresponsive To Medical Treatment

Year 2019, Volume: 9 Issue: 3, 32 - 38, 16.09.2019

Emre Volkan Kasımoğulları , Sefik Eser Özyürek Tolga Karacan Hüseyin Kıyak Hasan Fehmi Yazıcıoglu

Abstract

ÖZET

Amaç: Sezaryen ameliyatlarinda karsilasilan ve kontrol edilemeyen kanamalari yonetmede proksimal ve distal

uterin arter ligasyonun terapotik etkinligini tanimlamak

Dizayn: Retrospective study.

Gereç ve Yöntem: Sezaryen ile dogum yapan ve peroperatif kontrol altina alinamayan kanama ile karsilasilan

65 kadin incelendi.Bu hastalarin tedavisinde proksimal uterin arter ligasyonu ,distal uterin arter ligasyonu ya

da hem proksimal hem de uterin arter ligasyonu altta yatan nedenlere gore uygulandi.Bunlara ragmen kanamanin

persiste ettigi olgulara bilateral hipogastrik arter ligasyonu ve kanama halen devam ediyorsa histerektomi

uygulandi.

Sonuçlar: 61 hastanin kanamasi yalnizca uterin arter ligasyonu ile( proksimal uterin arter ligasyonu,distal uterin

arter ligasyonu ya da distal/proksimal uterin arter ligasyonu) kontrol altina alindi.4 akreta tanili hastaya

uterin arter ligasyonuna ek olarak hipogastrik arter ligasyonu ve histerektomi operasyonu uygulandi .Distal

uterin arter ligasyonu cogunlukla uterin atoni nedenli kanamalarda etkin iken ,proksimal uterin arter ligasyonu

ya da distal ve proksimal uterin arter ligasyonu plasenta previa ya da akreta nedenli kanamalarda tedavi

saglamistir.32 akreta tanili hastanin 24 tanesine hem proksimal uterin arter ligasyonu hem distal uterin arter

ligasyonu ,4 tanesine proximal uterin arter ligasyonu, 4 tanesine de histerektomi uygulanmistir.

Tartışma: Sezaryen sirasinda karsilasilan kontrol altina alinamayan kanamalarda uterin arter ligasyon teknigi

basarili,emniyetli ve hayat kurtarici bir islemdir.Ozellikle plasenta akreta ya da previa gibi uterusu korumanin

cok guc oldugu vakalarda bulgularimiz proksimal arter ligasyonunun yararli oldugunu göstermistir.

Anahtar kelimeler: Uterin arter Ligasyonu; Proksimal uterin arter Ligasyonu; Distal uterin arter Ligasyonu;

Obstetrik kanama; Plasenta akreta; Uterin atoni

ABSTRACT

Objective: To describe the therapeutical efficiency of proximal and distal uterine artery ligations performed to

treat uncontrolled bleeding encountered during cesarean section operations.

Design: Retrospective study.

Materials and Method: 65 parturient women delivered by cesarean section. An uncontrolled peroperative

bleedings were encountered. Uterine artery ligations were performed proximally , distally or both segments

depending on the etiology. In cases where the bleeding could not be controlled, hypogastric artery ligations ;

and if persistent, a hysterectomy was performed.

Results: 61 patients were treated with uterine artery ligations (proximal uterine artery ligation, distal uterine

artery ligation or distal/proximal uterine artery ligation). An additional hypogastric artery ligation was required

in 4 accreta cases where a hysterectomy was needed, as well. While distal uterine artery ligations could treat

most atony cases, proximal uterine artery or distal/proximal uterine artery ligation were effective in treating

bleeding due to placenta accreta and/or previa. Of 32 accreta cases; 24 were treated with distal/proximal

uterine artery ligation; 4 with proximal uterine artery ligation, only; and in 4, a hysterectomy was performed.

Discussion: Uterine artery ligation techniques are successful, safe and life saving interventions for treating

uncontrolled bleeding during cesarean section. Especially in conditions where uterus preservation is

considered to be difficult due to placenta accreta and/or previa, our findings show that proximal uterine

artery ligation can provide an added benefit for the patient.

Keywords: Uterine artery ligation,; proximal uterine artery ligation; distal uterine artery ligation; obstetrical

bleeding;placenta accreta;uterine atony

Keywords

MEDİKAL TEDAVİYE YANITSIZ OBSTETRİK KANAMALI OLGULARDA SIRALI UTERİN ARTER DEVASKÜLARİZASYON SONUÇLARI Stepwise Uterine Artery Ligation Results In Patients With Postpartum Bleeding Unresponsive To Medical Treatment

References

• 1. WHO. Maternal mortality in 2000. Estimates developed by WHO, UNICEF, and UNFPA. Geneva: Department of Reproductive Health and Research, World Health Organization; 2004.. 2. Arbab F, Boulie D, Bied V. et al.Uterine rupture in first and second trimestr of pregnancy after in vitro fertilization and embryo transfer.Hum Reprod 1996;11:1120-1122 3. Condous GS, Arulkumaran S. Medical and conservative surgical management of postpartum hemorrhage. J Obstet Gynaecol Can 2003;25(11):931–6. 4. Waters EG. Surgical management of partum hemorrhage with particular reference to ligation of uterine arteries. Am j Obstet Gynecol 1952;64:1143-8., 5. Nelson SH, Suresh NS. Lack of reactivity of uterine arteries from patients with obstetric hemorrhage. 1992;166:1436-43 Acta Obstet Gynecol Scand. 1998;77:186–90 6. Fawcus S, Moodley J. Postpartum haemorrhage associated with caesarean section and caesarean hysterectomy Best Practise &Res. Clin. Obst. and Gynecology 2012, 27: 233-249 7. Fawcus S, Mbombo N, Hofmeyr GJ Saving mothers, Chapter 4. The fifth report of the national confidential enquiry into maternal deaths in South Africa 2008-201. A short report. Pretoria: Department of Health. 2012. 8. Fawcus S & Mbombo N. Deaths from haemorrhage associated with caesarean section in South Africa, 2009. Abstract FIGO Cape Town, South Africa. 9. Zwart JJ, Richters JM, Ory F et al. Severe maternal morbidity during pregnancy, delivery, and puerperium in the Netehrlands: a nationwide population-based study of 371000 pregnancies. BJOG 2008: 115:842-850.