Hypogastric Artery Ligation In Obstetric Cases: Single Institute Experience

Öz

Aim: The aim of this study is to evaluate the effectivness and reliability of hypogastric artery ligation HAL in obstetric cases.Material and Methods: 19 patients were included in study. Patients were subjected to HAL because of haemorrhagical obstetric reasons at Ankara Keciören Education and Training Hospital between January 2012 to February 2015. Patients demographic status, HAL indications, age, gravidity, parity, gestational age at birth, weight of the newborns, type of delivery, coagulation tests, preoperative and postoperative hemoglobin Hb and platelet Plt values, length of hospital to stay and hysterectomy rates were determined.Results: Mean age of patients was 33.06±5.08 21-40 . Mean gravidity and parity were 3.7±1.6 - 1.8±1.0, respectively. Mean gestational age at birth was 36.4±3.5 weeks. Number of patients who had normal vaginal and cesarean delivery were 8 %64.7 and 11 35,3% respectively. HAL indications were placenta previa 9 patients, 52.9% , placenta accreta 3 patients , 17.6% , uterine atony 5 patients, 26.3% , ablatio placenta 1 patient , 5.9% and placenta increta 1 patient, 5.9% . Hysterectomy was performed to 5 29.4% patients. No maternal or fetal mortality were recorded. Mean Hb and Plt values were; preoperative 10.9±1.3 gr/dl and 240.8±31.3 and postoperative 9.1±1.7 gr/dl, and 177.0±43.0, respectively. One of the patients developed disseminated intravascular cuagulation and acute renal failure.Conclusion: Hysterectomy was needed in 15.3% of patients with postpartum haemorrhage however HAL was enough for 84.7%

Anahtar Kelimeler

• Uterine Atony,obstetric heamorrhage,hypogastric artery ligation HAL

Obstetrik Vakalarda Hipogastrik Arter Ligasyonu: Tek Merkez Deneyimi

Öz

Amaç: Bu çalışmanın amacı obstetrik kanamalı olgularda HAL yapılan hastaları değerlendirmektir.Gereç ve Yöntemler: Çalışmaya 19 hasta alındı. Ocak 2012- Şubat 2015 yılları arasında Keçiören Eğitim ve Araştırma Hastanesinde obestetrik nedenli kanamalardan dolayı HAL yapılan hastalar değerlendirildi. Hastalar demografik durum, HAL endikasyonu, yaş, gravida, parite, gestasyonel yaş, doğum haftası, fetal ağırlık, doğum şekli, koagulayon testleri, pre-postop hemoglobin ve platelet değerleri, hastanede kalış süresi ve histerektomi oranları değerlendirildiBulgular: Hastaların ortalama yaşı 33,06±5,08 21-40 , ortalama gravida ve paritesi sırasıyla 3.7±1.6 ve 1.8±1.0 idi. Ortalama gestasyonel yaş ve doğum haftası 36,4±3,5 idi. Normal vajinal doğum ve sezeryan doğum yapan hastaların sayısı sırasıyla 8 %36.9 ve 11 %63.1 idi. Hipogastrik arter ligasyonu endikasyonu sırasıyla plasenta previa 9 hasta %52.9 , Plasenta previa tanısı alan 9 hastanın 5’i eski veya mükerer sezaryen , plasenta akreta 3 hasta %17.6 , Uterin atoni 5 hasta %26.3 ablatio plasenta 1 hasta %5.9 ve plasenta inkreta 1 hasta %5.9 idi Hastaların 4’üne %21.0 histerektomi yapıldı. Maternal ve fetal mortalite görülmedi. Ortalama hemoglobin ve platelet değerleri sırasıyla preoperatif 10,9 ± 1,3 gr/dl ve 240,8 ± 31,3 mm³, postoperatif 9,1 ± 1,7gr/dl ve 177,0 ± 43,0mm³ idi. Sadece bir hastada akut renal yetmezlik ve DİC geliştiSonuç: Postpartum kanamalı hastalarda hipogastrik arter ligasyonu %84,7 hastada kanamayı durdururken, % 15,3 hastada HAL`e ek olarak histerektomi gerekmiştir.

Anahtar Kelimeler

• Uterine atoni,obstetrik kanama,hipogastrik arter ligasyonu

Kaynakça

1. Fatu C, Franco D, Puisor M, Fatu CI: Changes in the arterial pressure after ligation of the hypogastric artery. Rev Med Chir Soc Med NatIasi 1996;100:149-50.
2. Burchell RC: Internal iliac artery ligation: Hemodynamics. Obstet. Gyne- col 1964 ;24: 737-9.
3. Wagaarachchi PT, Fernando L: Fertility following ligation of internal iliac arterie for life-threatening obstetric haemorrhage. Human Reprod 2000 ;15: 1311-3.
4. Fatu C, Franco D, Puisor M, Fatu CI: The morphophysiological consequ- ences of experimental ligation of the hypogastric arteries. Rev Med Chir Soc Med Nat Lasi 1996;100:177-9.
5. Hudon L, Belfort MA, Broome DR: Diagnosis and management of pla- centa percreta: a review. Obstet Gynecol Surv 1998;53: 509-17.
6. Holub Z, Pertl J, Voracek J: The surgical technic of ligation of the hypo- gastric artery. Cesk Gynecol 1998;53:763-5.
7. Tajes RV. Ligation of the hypogastric arteries and its complication in re- section of cancer of the rectum. Am J Gastroenterol 1956;26:612-614.
8. Chamberlain GVP. The clinical aspects of massive haemorrhage. In: Patel N, editör. Maternal Mortality- TheWayForward. London:RCOG, 1992:54- 62.

9. Abou Zahir C, Royston E, Maternal Mortality: Global Factbook. Geneva: World Health Organization 1991.
10. Rajaram P, Raghavan SS, Bupathy A. Et al.:Internal iliac artery ligation in obstetrics and gynecology. Ten years experience. Asia Oceania J Obstet Gynaecol 199;19:71-5.
11. Haurmonte JB, Sentilhes L, Mace P, Cravello L, Boubli L, d’Ercole C. Surgical treatment of postpartum haemorrhage. J Gynecol Obstet Biol Reprod(Paris) 2014 ;43:1083-1103.
12. Özgünen FT. Sezaryen. In: Özgünen FT, Evrüke C. (Editors). Maternal Fetal Tıp ve Perinatoloji, Ankara: Medical Network 2001: 1322-1330.
13. Ledee N, Ville Y, Musset D, Mercier F, Frydman R, Fernandez H: Manage- ment in intractable obstetric haemorrhage: an audit study on 61 cases. Eyr J Obstet Gynecol Reprod Biol 2001; 94:189-96.
14. Fox H: Pathology of maternal death. In: Fox H, Welis M.(Editors). Obstet- rical and Gynecological Pathalogy, London: 1995:1837-1851.