Approach to cases with postpartum haemorrhage: Retrospective analysis of 41 cases

Abstract

Objective: To assess treatment approaches and outcomes in 41 cases with postpartum haemorrhage (PPH). Methods: Screening the electronic database of the hospital identified 41 cases admitted to the obstetrics clinic with a diagnosis of PPH (ICD codes: O72, O72, O72.2) between January 1, 2010, and June 30, 2013. The clinical findings and the results of the surgical and medical treatments used were noted in all the patients. Results: Forty-one cases with PPH were detected who had been managed at the clinic during a 3-year period. Normal spontaneous vaginal delivery (26 patients; 63.4%) was the most common type of delivery. Uterine atony was the most common cause of PPH in 30 patients (73.2%). Medical therapy was the most common therapeutic approach in PPH caused by uterine atony (16 patients; 53.3%), followed by total abdominal hysterectomy (TAH) plus bilateral hypogastric artery ligation (9 patients; 30.0%), uterine packing sutures plus bilateral hypogastric artery ligation (BHAL) (4 patients; 13.3%) and intrauterine balloon tamponade (IUBT) (one patient; 2.4%). Only one of 3 patients with uterine rupture underwent a hysterectomy. Three patients in whom placental adhesion anomalies were detected were treated by a combination of manual removal of the placenta, uterine curettage and IUBT. Conclusion: The results suggest that care should be taken regarding PPH in pregnant women, even in those without any risk factors. In particular, the third phase of labour should be carefully monitored. Medical treatment and organ-sparing surgery are generally associated with positive outcomes in patients with stable haemodynamic status. J Clin Exp Invest 2014; 5 (1): 18-23

Keywords

• Surgical treatment, medical treatment, postpartum haemorrhage

Postpartum hemoraji vakalarına yaklaşım: 41 olgunun retrospektif analizi

Öz

Amaç: Kliniğimizde tedavi edilen 41 postpartum hemoraji (PPH) olgusunun tedavi yöntemleri ve sonuçlarını değerlendirmek. Yöntemler: Hastanemiz elektronik kayıt sisteminden 1 Ocak 2010 ile 30 Haziran 2013 tarihleri arasında "International Classification of Diseases" hastalık kodlarına göre Postpartum kanama (O72, O72.1, O72.2) tanısı ile obstetri servisine yatışı yapılan hastalar taranarak 41 hasta kaydına ulaşıldı. Tüm hastaların tedavi sırasındaki klinik durumları ve uygulanan cerrahi ve medikal tedavi sonuçları not edildi. Bulgular: Üç yıllık dönem içerisinde PPH nedeniyle hastanemizde tedavi altına alınan 41 olgu saptandı. Doğum şekli olarak en çok 26 hasta (%63,4) ile normal doğum saptanırken, 12 hastada (%29,3) sezaryen, 3 hastada (%7,3) ise vakum yardımıyla vajinal doğum yaptırıldığı görüldü. PPH neden olma bakımından en sık rastlanılan klinik durum 30 hastada (%73,2) görülen uterin atoni olarak tespit edildi. Atoni nedeniyle gelişen PPH'de en sık uygulanan tedavi şekli 16 hastada (%53,33) görülen medikal tedavi iken ardından 9 hasta (%30,00) total abdominal histerektomi + bilateral hipogastrik arter ligasyonu (BHAL), 4 hasta (%13,33) uterin paketleme sütürü + BHAL ve 1 hastada ise (%2,44) intrauterin balon tamponat (İUBT) uygulamasının yapıldığı tespit edildi. Uterin rüptür saptanan 3 olgudan sadece birinde histerektomi yapıldı. Plasental yapışma anomalisi saptanan 3 hasta elle halas, uterin küretaj ve İUBT uygulaması ile tedavi edildi. Sonuç: Sonuç olarak risk faktörü bulunmayan gebelerde bile PPH açısından dikkatli olunmalı ve özellikle doğum 3. evresi dikkatle izlenmelidir. Hemodinamik açıdan durumu stabil olan hastalarda medikal tedavi ve organ koruyucu cerrahi genelde olumlu sonuçlar vermektedir.

Anahtar Kelimeler

• Cerrahi tedavi, medikal tedavi, postpartum hemoraji

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