VAJİNAL DOĞUMUN KORKULAN KOMPLİKASYONLARINDAN OMUZ DİSTOSİSİNE YAKLAŞIMDA TERSİYER MERKEZ TECRÜBELERİMİZ

Öz

Amaç: Bu çalışmada 5 yıllık süre içerisinde gerçekleşen omuz distosisi vakalarının mevcut risk faktörlerini, vakaların yönetimini ve perinatal sonuçlarını inceleyerek bir tersiyer merkez verisi sunmak hedeflenmiştir. Gereçler ve yöntem: 2013-2018 yılları arası vajinal doğum yapan 44522 hasta arasından, doğumunda omuz distosi yaşanan 479 hasta değerlendirilmiştir. Vakalara doğum dosyalarında mevcut bulunan “omuz distosisi olan bebeklerde izlem formu” kullanılarak retrospektif olarak ulaşılmıştır. Sosyodemografik özelliklerin yanısıra ultrasonografik özellikler , doğuma dair özellikler, distosi yönetiminde uygulanan yaklaşımlarla birlikte bebeklerin doğum sonrası özellikleri ve sekel durumları 2 yıllık ortopedik takipleriyle birlikte değerlendirilmiştir. Bulgular: Kadınların yaş ortalaması 28.17, SAT’a göre gebelik haftası ortalaması 38.29 hafta, gravida ortalaması 2.34’tür. Kliniğimizin 5 yıllık değerlendirmesinde omuz distosisi oranı %1,07 olarak bulunmuştur. Vakaların %5.1’inde maternal komplikasyon görülmüş olup, %14.6’sında brakiyal pleksus hasarı bulunmakta, %9.6’sının klavikula kırığı bulunmakta, %1.3’ünün sekeli ise bulunmaktadır. Mc Robert’s + Suprapubik bası manevrası uygulananların %33’ünde brakiyal pleksus hasarı izlendiği ve arka omuz doğrultulması, Mc Robert’s ve Rubin manevralarında ise klaviküla kırığı görülme oranı diğerlerinden yüksek olduğu sonuçlarına ulaşılmıştır. Sonuç: Doğum öncesi tecrübeli obstetrisyenler tarafından yapılan sonografik ölçümler de maternal ve neonatal morbiditeler açısından fikir vericidir. Ayrıca omuz distosisiyle karşılaşılan vakalarda manevralar uygulanırken en güvenli manevraların seçilip doğru şekilde uygulanması maternal ve fetal komplikasyon oranlarını en aza indirmeye katkı sağlayabilir.

Anahtar Kelimeler

• Omuz distosisi
• Vajinal Doğum
• Manevralar

OUR TERTIARY CENTER EXPERIENCES IN APPROACHING SHOULDER DYSTOCIA FROM THE FEARED COMPLICATIONS OF VAGINAL DELIVERY

Öz

Aim: In this study, it was aimed to present a tertiary center data by examining the current risk factors, management of cases and perinatal outcomes of shoulder dystocia cases that occurred over a 5-year period. Materials and methods: Among 44522 patients who delivered vaginally between 2013 and 2018, 479 patients with shoulder dystocia at birth were evaluated. Cases were reached retrospectively using the “follow-up form in infants with shoulder dystocia” available in the birth files. In addition to sociodemographic features, ultrasonographic features, features of delivery, approaches applied in dystocia management, and postnatal features and sequelae of babies were evaluated together with their 2-year orthopedic follow-up. Results: The mean age of the women was 28.17, the mean gestational week according to LMP was 38.29, and the mean gravida was 2.34. In the 5-year evaluation of our clinic, the rate of shoulder dystocia was found to be 1.07%. In 5.1% of the cases, maternal complications were found, 14.6% had brachial plexus damage, 9.6% had clavicle fracture and 1.3% had sequelae. It was concluded that brachial plexus damage was observed in 33% of those who underwent Mc Robert's + Suprapubic compression maneuver, and the incidence of clavicle fracture was higher in posterior shoulder delivery and Mc Robert's and Rubin maneuvers. Conclusion: Sonographic measurements made by experienced obstetricians before birth are also informative in terms of maternal and neonatal morbidities. In addition, when performing maneuvers in cases with shoulder dystocia, choosing the safest maneuvers and applying them correctly may contribute to minimizing maternal and fetal complication rates.

Anahtar Kelimeler

• Shoulder dystocia
• Vaginal Birth
• Maneuvers

Kaynakça

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