ORİJİNAL ARAŞTIRMALAR
Tersiyer Bir Referans Hastanesinin Postpartum Histerektomi Endikasyonları
Postpartum Hysterectomy Indications of a Tertiary Referral Center
Received Date : 23 Sep 2019
Accepted Date : 26 Nov 2019
Available Online : 08 Jun 2020
Burcu KISAa, Ümit Yasemin SERTa, Hatice KANSU ÇELİKa, Özlem UZUNLARa
aUniversity of Health Sciences Ankara Bilkent City Hospital, Department of Gynecology and Obstetrics, Ankara, TURKEY
Doi: 10.24074/tjrms.2019-71498 - Makale Dili: EN
TJRMS. 2019;3(1):6-11
ÖZET
Çalışmanın amacı, tersiyer bir referans hastanesinde gerçekleştirilen postpartum histerektomilerin, insidans, endikasyon, risk faktörleri ve patolojik inceleme sonuçlarının değerlendirilmesidir. Gereç ve Yöntemler: Çalışmada, 2009 ve 2013 yılları arasında yapılan 125 postpartum histerektomi vakası retrospektif olarak değerlendirilmiştir. Histerektomi endikasyonları, doğum şekli, hastaların demografik özellikleri, komplikasyonlar ve patolojik değerlendirme sonuçları incelenmiştir. Bulgular: Çalışma süresince total postpartum histerektomi sıklığı bin canlı doğumda 1.19 olarak saptanmıştır. Bu oran sezeryan doğum ve vajinal doğum için sırasıyla 3 ve 0,13 olarak bulunmuştur. Normal doğum planlanırken sezeryana giden ve postpartum histerektomi uygulanan hastaların tüm canlı doğumlara oranı bin canlı doğumda 0,04 (5/104256) olarak saptanmıştır. Sezeryan ve vajinal doğum sonrası total histerektomi endikasyonları, atoni (%17.6), plasenta previa (%20.8), plasenta akreata (%8.8), plasenta perkreata (%36.8), plasenta inkreata (%12) ve uterin rüptür (%4) olarak saptandı. Plasental invazyon anomalileri ve rüptür, sezeryan doğumda vajinal yolla doğuma kıyasla anlamlı olarak daha fazla saptandı (p<0.001). Sonuç: Acil postpartum histerektomi hayati önemi olan bir cerrahi işlemdir. Klinisyenler özellikle geçirilmiş sezeryanı olan hastaların postpartum kanamalarında dikkatli olmalıdır.
Anahtar Kelimeler: Postpartum histerektomi; atoni; plasenta perkreata; sezeryan
ABSTRACT
Aim of the study is to determine the incidence, indications, risk factors, results of pathological investigations and outcomes of peripartum hysterectomies in a tertiary referral center. Material and Methods: We conducted a retospective review of 125 postpartum hysterectomy cases between 2009 and 2013. Hysterectomy Indications, way of delivery, demographic data of patients, complications and results of pathologic eveluation were studied. Statistical analyses for vaginal delivery and caesarean section was performed. Results: The frequency of total postpartum hysterectomy was found 1,19 in one thousands live birth during the study period. This rate was found 3 and 0.13 for caesarean section and vaginal birth respectively. The frequency of postpartum hysterectomy of patients who have gone to caesarean section while vaginal birth was being planned, was found 0.04 (5/104256) in all one thousands live birth. The indications for hysterectomy was uterine atony (17.6%), placenta previa (20.8%), placenta accreta (8.8%), placenta percreta (36.8%), placenta increta (12%) and uterine rupture (4%). Placenta invasion anomalies and uterine rupture were found significantly more frequent in caesarean section than vaginal birth (p<0.001). Conclusion: Emergency postpartum hysterectomy remains a life-saving surgical intervention. Clinicians should be alert for postpartum bleeding especially with previous caesarean sections.
Keywords: Postpartum hysterectomy; atony; placenta percreta; caesarean section
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