Uterine rupture: Regional incidence, causes and treatment

Yıl 2008, Cilt: 35 Sayı: 4, 259 - 263, 01.12.2008

Mehmet Sıddık Evsen M. Erdal Sak Yasar Bozkurt Murat Kapan Çetin Bakır

Öz

Unscarred uterine rupture is most commonly seen in women having very high parity. In present study, unscarred uterine ruptures in Diyarbakır Maternity Hospital, throughout the last 3 years, were reviewed. In that time period, 26 (0.047%) unscarred uterine rupture were detected among a total of 55013 deliveries. Rupture was occurred at lower side wall of uterus in 25 (95.6%) patients. Causes of uterine rupture were cephalopelvic disproportion (53.8%), excessive use of uterotonics (26.9%) and malpresentation (19.2%). Treatment modalities were total/subtotal hysterectomy in 18 (69.2%) patients, uterine repair in 8 (30.8%), unilateral salphingooferectomy in 7 (26.9%) and hypogastric artery ligation in 5 (19.2%) of patients. Maternal mortality occurred in one patient however perinatal fetal mortality was 13 (50.0%). High hysterectomy ratios of our patients resulted from older age and high parity. In conclusion, maternal and fetal mortality can be decreased in unscarred uterine ruptures, by regular antenatal follow-up and appropriate emergent treatment.

Anahtar Kelimeler

Unscarred uterine rupture, maternal mortality, perinatal mortality, incidence

Nedbesiz uterus rüptürü: Bölgesel insidans, nedenler ve tedavi

Öz

Nedbesiz uterus rüptürüne kadınların yüksek sayılarda dogum yaptıgı bölgelerde daha sık rastlanılmaktadır. Bu çalısmada Diyarbakır dogumevinde 3 yıl içinde saptanan nedbesiz uterus rüptürleri incelendi. Bu süre içinde gerçeklesen 55013 dogumdan 26\'sında (%0.047) nedbesiz uterus rüptürü saptandı. Böylece insidansın 2119 dogumda 1 oldugu görüldü. Hastaların %95.6\'sında (25 hasta) rüptür uterusun alt yan servikal duvarında idi. Rüptür nedenleri sıklık sırasına göre; 14 (%53.8) hastada bas-pelvis uygunsuzlugu, 7 hastada (%26.9) kontrolsüz indüksiyon uygulanması, 5 hastada (%19.2) malprezentasyon idi. Tedavi olarak bu hastalardan 18\'ine (%69.2) total veya subtotal histerektomi, 8\'ine (%30.8) uterus onarımı, 7\'sine (%26.9) tek taraflı salpingooferektomi ve 5\'ine (%19.2) bilateral hipogastrik arter ligasyonu uygulandı. Bir hasta dısında maternal mortalite gelismedi ancak 13\'ünde (%50.0) perinatal fetal mortalite gelisti. Hastalarımızda yüksek oranda histerektomi yapılmıs olması maternal ileri yas ve hastaların çocuk sayılarını tamamlamıs olmaları nedenleriyle gerçeklesti. Yeterli antenatal bakım, acil ve uygun cerrahi tedavi ile nedbesiz uterus rüptürü sonucu gelisebilecek maternal ve fetal mortalite azaltılabilir.

Anahtar Kelimeler

nedbesiz uterus rüptürü, maternal mortalite, perinatal mortalite, sıklık

Kaynakça

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