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

Yıl 2014, Cilt: 5 Sayı: 1, 18 - 23, 01.03.2014

Adnan İncebiyik Aysun Camuzcuoglu Nese Gul Hilali Ahmet Kucuk Hasan Husnu Yuce Harun Aydogan Hakan Camuzcuoglu Mehmet Vural

https://doi.org/10.5799/ahinjs.01.2014.01.0352

Cited By: 1

Öz

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

Anahtar Kelimeler

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

Kaynakça

• Cengiz H, Yasar L, Ekin M, et al. Management of intrac- table postpartum haemorrhage in a tertiary center: A 5-year experience. Niger Med J 2012;53:85-88.
• Gronvall M, Tikkanen M, Tallberg E, et al. Use of Bakri balloon tamponade in the treatment of post- partum hemorrhage: a series of 50 cases from a ter- tiary teaching hospital. Acta Obstet Gynecol Scand 2013;92:433-438.
• Sheikh L, Najmi N, Khalid U, Saleem T. Evaluation of compliance and outcomes of a management proto- col for massive postpartum hemorrhage at a tertiary care hospital in Pakistan. BMC Pregnancy Childb 2011;13;11-28.
• Knight M, Callaghan WM, Berg C, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collabourative Group. BMC Pregnancy Childb 2009;27:9-55.
• Camuzcuoglu H, Toy H, Vural M, et al. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy. J Obstet Gynaecol Res 2010;36:538-543.
• Mehrabadi A, Hutcheon JA, Lee L, et al. Trends in post- partum hemorrhage from 2000 to 2009: a population- based study. BMC Pregnancy Childb 2012;12:108- 111.
• Calvert C, Thomas SL, Ronsmans C, et al. Identify- ing regional variation in the prevalence of postpartum haemorrhage: a systematic review and meta-analysis. PloS One 2012;7:411-414.
• Lee NK, Kim S, Lee JW, et al. Postpartum hemor- rhage: Clinical and radiologic aspects. Eur J Radiol 2010;74:50-59.
• Edhi MM, Aslam HM, Naqvi Z, Hashmi H. Post partum haemorrhage: causes and management. BMC Res Notes 2013;6:236-237.
• Matsubara S. Available hemostatic measures for postpartum hemorrhage in rural settings. Rural Re- mote Health 2012;1:12-14.
• Kong MC, To WW. Balloon tamponade for postpartum haemorrhage: case series and literature review. Hong Kong Med J 2013; doi: 10.12809/hkmj133873.
• Koh E, Devendra K, Tan LK. B-Lynch suture for the treatment of uterine atony. Singapore Med J 2009;50:693-697.
• Chelmow D. Postpartum haemorrhage: prevention. Clin Evid 2011;4:10-14.
• Koh E, Devendra K, Tan LK. B-Lynch suture for the treatment of uterine atony. Singapore Med J 2009;50:693-697.
• National Collabourating Centre for Women’s and Chil- dren’s Health (UK). Intrapartum Care: Care of healthy women and their babies during childbirth. National In- stitute for Health and Clinical Excellence: Guidance. London: RCOG Press; 2007 Sep. 2007.
• Lee D, Johnson J. Hysterotomy for retained pla- centa in a septate uterus: a case report. Case Rep Obstet Gynecol Volume 2012, Article ID 594140, doi:10.1155/2012/594140.
• Morlando M, Sarno L, Napolitano R, et al. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scand 2013;92:457-460.
• Vitthala S, Tsoumpou I, Anjum ZK, Aziz NA. Use of Bakri balloon in post-partum haemorrhage: A series of 15 cases. Aust Nz J Obstet Gyn 2009;49:191-194.
• Kumru P, Demirci O, Erdogdu E, et al. The Bakri balloon for the management of postpartum hemor- rhage in cases with placenta previa. Eur J Obstet Gyn 2013;167:167-170.
• Georgiou C. Balloon tamponade in the manage- ment of postpartum haemorrhage: a review. BJOG 2009;116:748-757.
• Fargeaudou Y, Morel O, Soyer P, et al. Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation. Eur Rad 2010;20:1777- 1785.
• Tapisiz OL, Altinbas SK, Yirci B, et al. Emergency peripartum hysterectomy in a tertiary hospital in An- kara, Turkey: a 5-year review. Arch Gynecol Obstet 2012;286:1131-1134.
• Zeteroglu S, Ustun Y, Engin UY, et al. Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey. Eur J Obstet Gynecol Reprod Biol 2005;120:57-62.
• Yucel O, Ozdemir I, Yucel N, Somunkiran A. Emer- gency peripartum hysterectomy: a 9-year review. Arch Gynecol Obstet 2006;274:84-87.
• Evsen MS, Sak ME, Ozkul O, et al. Emergency peri- partum hysterectomy. Dicle Med J 2009;1:23-27.