Obstetrik hemorajide hipogastrik arter ligasyonu: tek cerrah deneyiminin kohort analizi

Öz

Giriş

Hipogastrik arter ligasyonu, ciddi postpartum kanamada hayat kurtarıcı bir işlemdir. Gerektiğinde mümkün olan en hızlı şekilde uygulanmalıdır. Bu çalışmada, tek cerrahın postpartum kanama kontrolünde hipogastrik arter ligasyonu deneyimi sunulmuştur.

Metod

Bu retrospektif kohort çalışmaya, 2015-2018 yılları arası, acil koşullarda aynı cerrah tarafından hipogastrik arter ligasyonu uygulanan hastalar dahil edilmiştir. Tüm vakalarda aynı işlem tekniği uygulanmıştır. Veriler, hastane kayıtlarından elde edilmiştir.

Bulgular

Toplam 6 hasta, analize dahil edilmiştir. Hipogastrik arter ligasyonu endikasyonları şu şekilde olmuştur: 3 vaka (%50) uterin atoni, 2 vaka (%33.3) plasenta previa ve 1 vaka (%16.7) ablasyo plasenta. İntraoperatif komplikasyon bulunmadı. Altı hastadan biri relaparotomiye alındığı için, hipogastrik arter ligasyonun başarı oranı %83.3 olarak bulundu. 13 aylık ortanca takip süresince, sadece bir hasta gebe kalmak istedi ve kaldı.

Sonuç

Hipogastrik arter ligasyonu, postpartum kanama kontrolünde etkili bir yöntemdir. Retroperitona direk hipogastrik arter üzerinden girmek, işlemi hızlandırabilir.

Anahtar Kelimeler

• hipogastrik arter,internal iliak arter,hemoraji

Hypogastric artery ligation for obstetrical haemorrhage: cohort analysis of a single surgeon experience

Abstract

Introduction

Hypogastric artery ligation (HAL) is a life-saving procedure for severe postpartum haemorrhage (PPH). It should be performed as fast as possible when needed. In this study, a single surgeon’s experience in HAL for controlling PPH was presented.

Methods

Cases in whom HAL performed in emergency setting by the same surgeon in between 2015 and 2018 were included in this retrospective cohort study. The technnique of the procedure was the same for all cases. Data were extracted from hospital’s records.

Results

A total of 6 patients were included into the analysis. Indications for HAL were as follows: uterine atony in 3 (50%) cases, placenta previa in 2 (33.3%) cases and ablatio placenta in one case (16.7%). There were no intraoperative complication. The success rate of HAL was 83.3%, as one of the 6 patient underwent re-laparotomy. Within a median follow-up time of 13 months, only one patient attempted to concieve and succeeded.

Conclusion

HAL is an effective procedure for the management of PPH. Entering to the retroperitonneum directly over the hypogastric artery may fasten the procedure.

Keywords

• hypogastric artery,internal iliac artery,haemorrhage

Kaynakça

1. Referans1. World Health Organization (2009) Guidelines for Management of Postpartum Haemorrhage and Retained Placenta. WHO, Geneva, Switzerland.http://apps.who.int/rhl/archives/guideline_pphmanagement_kumars_com/en/index.htmlReferans2. Kaya B, Damarer Z, Daglar K, Unal O, Soliman A, Guralp O. Is there yet a role for internal iliac artery ligation in obstetric hemorrhage with the current gain in popularity of other uterus sparing techniques? J Matern Fetal Neonatal Med. 2017 Jun;30(11):1325-1332.Referans3. Camuzcuoglu H, Toy H, Vural M, Yildiz F, Aydin H. Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy. J Obstet Gynaecol Res. 2010; 36(3): 538- 43.Referans4. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies, BMJ 2007;335:806–8. Referans5. Countdown to 2015: Maternal, Newborn and Child Survival [Internet]. WHO and UNICEF, 2012. Available at: http://www.countdown2015mnch.org/documents/2012Report/2012- Complete.pdf. Referans6. Miller S, Lester F, Hensleigh P. Central European University. Prevention and Treatment of Postpartum Hemorrhage: New Advances for Low-Resource Settings. The Journal of Midwifery & Women’s Health, 2004, 49(4):283–92. Referans7. Burchell RC: Internal iliac artery ligation: Hemodynamics. Obstet Gynecol 1964 ;24: 737-9.Referans8. Sentilhes L, Vayssiere C, Deneux-Tharaux C, Aya A, Bayoumeu F, Bonnet M, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF) in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). European Journal of Obstetrics & Gynecology and Reproductive Biology 2016;198:12-21.Referans9. Joshi V, Otiv S, Majumder R, Nikam Y, Shrivastava M. Internal iliac artery ligation for arresting postpartum haemorrhage.BJOG 2007;114:356–361.