PERİPARTUM HİSTEREKTOMİ OLGULARININ DEĞERLENDİRİLMESİ: TÜRKİYE'NİN BATI BÖLGESİNDEKİ ÜÇÜNCÜ BASAMAK BİR SAĞLIK MERKEZİNİN DENEYİMLERİ

Yıl 2022, Cilt: 23 Sayı: 1, 25 - 32, 17.01.2022

Ümit Çabuş Cihan Kabukçu Deniz Aydın Ceylan

https://doi.org/10.18229/kocatepetip.788390

Öz

AMAÇ: Son üç yıl içinde kliniğimizde uygulanan peripartum histerektomi olgularını retrospektif olarak incelemeyi ve peripartum histerektominin insidansını, risk faktörlerini, endikasyonlarını, uygulanan cerrahi yöntemleri, komplikasyonları ve sonuçlarını değerlendirmeyi amaçladık.
GEREÇ VE YÖNTEM: Çalışmaya Ocak 2017 ve Ocak 2020 tarihleri arasında Pamukkale Üniversitesi Tıp Fakültesinde peripartum histerektomi uygulanan hastalar dahil edildi. Peripartum kanaması olan ancak konservatif yaklaşımlar uygulanarak (defektif plasenta insersiyon alanının sütürasyonu veya segmental rezeksiyonu, uterus kompresyon sütürleri, intrauterin balon uygulamaları, uterin veya internal iliak arter ligasyonu vb.) peripartum histerektomi yapılmayan hastalar çalışmaya dahil edilmedi. Hasta bilgileri, hasta dosyaları ve hastane kayıt sisteminden elde edildi. Hastaların demografik ve klinik verileri analiz edilerek değerlendirildi.
BULGULAR: Üç yıllık süre içinde kliniğimizde toplam 3220 doğum gerçekleşti. Bu hastalardan yirmibir tanesine peripartum histerektomi uygulanmış olup insidansı 6,5/1000 idi. Postpartum kanama grubunda peripartum histerektomi için en sık endikasyon plasenta yerleşim ve invazyon anomalileriydi (% 90,4) ve bu anomaliler arasında da en sık görülen histopatolojik tanı plasenta previa ve plasenta increta (% 33,33) birlikteliğiydi. Masif transfüzyon, mesane hasarı, relaparatomi ve yara yeri enfeksiyonu PH uygulanan hastalarda en sık görülen morbidite nedenleriydi.
SONUÇ: Günümüzde plasenta yerleşim ve invazyon anomalileri peripartum kanamaların en sık nedeni olmaya başlamıştır. Peripartum histerektomi ise abnormal plasentasyon için temel tedavi şekli olmaya devam etmektedir.

Anahtar Kelimeler

Postpartum kanama, Anormal plasentasyon, Peripartum histerektomi

EVALUATION OF PERIPARTUM HYSTERECTOMY CASES: EXPERIENCES OF A TERTIARY HEALTH CENTER IN WESTERN REGION OF TURKEY

Öz

OBJECTIVE: We aimed to retrospectively examine the cases of peripartum hysterectomy performed in our clinic in the last three years and to evaluate the incidence, risk factors, indications, surgical methods, complications, and results of peripartum hysterectomy.
MATERIAL AND METHODS: Patients who had undergone a peripartum hysterectomy in Pamukkale University Medical Faculty Hospital between January 2017 and January 2020 were included in the study. We excluded all patients with the massive peripartum hemorrhage who were treated with conservative approaches (such as suturing or segmental resection of the defective placenta insertion area, uterine compression sutures, intrauterine balloon applications, and uterine or internal iliac artery ligation) rather than hysterectomy. Data of the patients were obtained from patient files and hospital medical records. The demographic and clinical data of the patients were recorded and analyzed.
RESULTS: During the three years, a total of 3220 births took place in our hospital. Peripartum hysterectomy was performed in twenty-one patients; the incidence was 6.5/1000. The most common indication for peripartum hysterectomy in the postpartum hemorrhage group was placental location and invasion anomalies (90.4%) and among these anomalies, the most common histopathological diagnosis was the association of placenta previa and placenta increta (33.33%). Massive transfusion, bladder damage, relaparotomy, and wound infection were the major causes of morbidity in patients with peripartum hysterectomy.
CONCLUSIONS: Recently, placental location and invasion anomalies have become the most common cause of peripartum hemorrhages. Peripartum hysterectomy is the leading treatment method for patients with abnormal placentation.

Anahtar Kelimeler

postpartum hemorrhage, abnormal placentation, peripartum hysterectomy

Kaynakça

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