Abstract
Amaç: Bu çalışmanın amacı, primer postpartum kanama
(PPK) nedeniyle bilateral hipogastrik arter ligasyonu (BHGAL) uygulanan hastaların
obstetrik özelliklerini ve maternal sonuçlarını değerlendirmektir.
Materyal ve metod: Mayıs
2005 ile Mayıs 2018 tarihleri arasında tersiyer bir merkezde postpartum dönemde
vajinal doğum (VD) sonrası, sezaryan (C/S) esnasında ya da sonrasında PPK nedeniyle
BHGAL uygulanan hastaların dijital kayıtları ve hastane arşiv dosyaları
retrospektif olarak incelendi. Hastaların demografik özellikleri, parite,
gestasyonel hafta, operasyon süresi, yatış süresi, tahmini kan kaybı,
laboratuvar değerleri, transfüzyon yapılan kan miktarları, önceki C/S öyküsü,
yoğun bakım gereksinimi gibi parametrelere bakıldı. BHGAL’nun, kanama
kontrolünü sağlamadaki etkinliği, endikasyonları, beraberinde uygulanan ek
cerrahileri, intraoperatif ve postoperatif komplikasyonları değerlendirildi.
Bulgular: Belirtilen
sürede hastanemizde 276008 doğum olmuştur. PPK olan hastaların 41’ine VD
sonrasında, 19’una ise C/S esnasında ya da C/S sonrasında BHGAL uygulandı.
Atoni nedeniyle PPK olan 28 hastanın 25’ inde kanama BHGAL ile kontrol altına
alınırken, 3 hastaya BHGAL ile birlikte histerektomi yapıldı. BHGAL’nun uterin
atonide etkinliği %89,2 iken, tüm vakalar değerlendirildiğinde ise başarısı
%33,3 olarak bulundu. BHGAL en sık atoni nedeniyle uygulandığı ve BHGAL
uygulanan hastalarda en sık komplikasyonun dissemine intravasküler koagülasyon
(DİK) olduğu görüldü. İşlemin kendisine bağlı ise bir hastada iliak ven
yaralanması tespit edildi.
Sonuç: BHGAL’in atoni nedenli PPK’daki kontrolü, diğer
PPK nedenlerinin kontrolünden daha etkindir. Bu hastalarda komplikasyonların
çoğu işleme bağlı olmayıp PPK’nın komplikasyonlarından kaynaklanmaktadır. Bu
yüzden BHGAL, yeterli cerrahi bilgi ve donanıma sahip ellerde uygulandığında
hayat kurtarıcı bir yöntem olmaya devam etmektedir.
References
- 1. Anger H, Durocher J, Dabash R, Winikoff B. How well do postpartum blood loss and common definitions of postpartum hemorrhage correlate with postpartum anemia and fall in hemoglobin? PLoS One 2019;14:e0221216. doi:10.1371/journal.pone.0221216.
- 2. Ngwenya S. Postpartum hemorrhage: Incidence, risk factors, and outcomes in a low-resource setting. Int J Womens Health 2016;8:647–50. doi:10.2147/IJWH.S119232.
- 3. Dahlke JD, Mendez-Figueroa H, Maggio L, Hauspurg AK, Sperling JD, Chauhan SP, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015;213:76.e1-76.e10. doi:10.1016/j.ajog.2015.02.023.
- 4. Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol 1985;66:353–6.
- 5. Papp Z, Tóth-Pál E, Papp C, Sziller I, Gávai M, Silhavy M, et al. Hypogastric artery ligation for intractable pelvic hemorrhage. Int J Gynecol Obstet 2006;92:27–31. doi:10.1016/j.ijgo.2005.08.022.
- 6. Unal O, Kars B, Buyukbayrak EE, Karsidag AYK, Turan C. The effectiveness of bilateral hypogastric artery ligation for obstetric hemorrhage in three different underlying conditions and its impact on future fertility. J Matern Neonatal Med 2011;24:1273–6. doi:10.3109/14767058.2011.574751.
- 7. Selçuk, İ., Uzuner, B., Boduç, E., Baykuş, Y., Akar, B., Güngör T. Step-by-step ligation of the internal iliac artery. J Turk Ger Gynecol Assoc 2019;20:123–8.
- 8. Nizard J, Barrinque L, Frydman R, Fernandez H. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage. Hum Reprod 2003;18:844–8. doi:10.1093/humrep/deg161.
- 9. Mızrak T, Özdemir A, Güler A, Atlı Ö, Taner C DG. Hayatı Tehdit Eden Obstetrik Nedenli Hemorajilerde Hipogastrik Arter Ligasyonu. Kocatepe Tıp Derg 2004;5:41–4. doi:10.18229/ktd.65463.
- 10. Chelli D, Boudaya F, Dimassi K, Gharbi B, Najjar I, Sfar E, et al. Hypogastric artery ligation for post-partum hemorrhage. J Gynecol Obs Biol Reprod 2010;39:43–9. doi:10.1016/j.jgyn.2009.10.002.
- 11. Simsek Y, Yilmaz E, Çelik E, Türkçüoğlu I, Karaer A, Turhan U CO. Efficacy of internal iliac artery ligation on the management of postpartum hemorrhage and its impact on the ovarian reserve. J Turk Soc Obs Gynecol 2012;9:153–8.
- 12. Kurban Y, Uyar İ, Turan C GE. Obstetrik Vakalarda Hipogastrik Arter Ligasyonu: Tek Merkez Deneyimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Derg 2016;13:48–50.
- 13. Evsen MS, Sak ME, Bozkurt Y, Kapan M BÇ. Nedbesiz uterus rüptürü: Bölgesel insidans, nedenler ve tedavi. Dicle Tıp Derg 2008;35:259–63. doi:10.5798/diclemedj.0921.2008.
- 14. Hilali N, Incebiyik A, Camuzcuoglu A, Vural M, Kocarslan S, Karakaş E, Camuzcuoglu H. Conservative management of two cases of morbidly adherent placenta. Harran Üniversitesi Tıp Fakültesi Derg 2014;11:304–8.
- 15. Durmaz A, KÖMÜRCÜ N. Postpartum Kanamada Risk Belirleme, Önleme ve Yönetim: Kanıta Dayalı Uygulamalar. Sağlık Bilim ve Meslekleri Derg 2018;5:494–502. doi:10.17681/hsp.385553.
- 16. Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014;121:5–13. doi:10.1111/1471-0528.12636.
- 17. Yaman Tunc S, Agacayak E, Sak S, Basaranoglu S, Goruk NY, Turgut A, et al. Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity? J Matern Neonatal Med 2017;30:739–44. doi:10.1080/14767058.2016.1183638.
- 18. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012.
- 19. Kahramanoğlu İ, Azemi A, Turan H, Demirkıran F. Obstetrik hemorajide hipogastrik arter ligasyonu: tek cerrah deneyiminin kohort analizi. Zeynep Kamil Tıp Bülteni 2018;49. doi:10.16948/zktipb.432536.
- 20. Dogan O, Pulatoglu C, Yassa M. A new facilitating technique for postpartum hysterectomy at full dilatation: Cervical clamp. J Chinese Med Assoc 2018;81:366–9. doi:10.1016/j.jcma.2017.05.010.
Abstract
Background: The aim of this study
was to evaluate the obstetric characteristics and maternal outcomes of patients
undergoing bilateral hypogastric artery ligation (BHGAL) for primary postpartum
hemorrhage (PPH).
Materials and Methods: Digital records and hospital
archives of patients who underwent BHGAL in the postpartum period after vaginal
delivery (VD) or during or after cesarean section (C/S) in a tertiary center
between May 2005 and May 2018 were reviewed retrospectively. Demographic
characteristics, parity, gestational week, duration of operation,
hospitalisation time, estimated blood loss, laboratory values, transfused blood
volume, previous C/S history, and intensive care requirement of the patients
were evaluated. The efficacy of BHGAL in controlling bleeding, indications,
concomitant surgeries, and intraoperative and postoperative complications were
evaluated.
Results: There were 276.008
deliveries in our hospital in the specified period. Of the patients with PPH,
41 patients underwent BHGAL after VD and 19 patients underwent BHGAL during or
after C/S. In 25 of 28 patients with PPH due to atony, bleeding was controlled
by BHGAL, while 3 patients underwent hysterectomy together with BHGAL. While
the effectiveness of BHGAL in uterine atony was 89.2%, the success rate was
33.3% when all cases were considered. The most common cause of indication for
BHGAL was atony, and disseminated intravascular coagulation (DIC) was the most
common complication in patients undergoing BHGAL. Iliac vein injury was
detected in one patient due to the procedure itself.
Conclusions: BHGAL is more effective on
controlling PPH due to atony compared to the control of other PPH causes. Most
of the complications in these patients are not related to the procedure but are
due to the complications of PPH. Therefore, BHGAL continues to be a life-saving
method when applied by centers with adequate surgical knowledge and equipment.
References
- 1. Anger H, Durocher J, Dabash R, Winikoff B. How well do postpartum blood loss and common definitions of postpartum hemorrhage correlate with postpartum anemia and fall in hemoglobin? PLoS One 2019;14:e0221216. doi:10.1371/journal.pone.0221216.
- 2. Ngwenya S. Postpartum hemorrhage: Incidence, risk factors, and outcomes in a low-resource setting. Int J Womens Health 2016;8:647–50. doi:10.2147/IJWH.S119232.
- 3. Dahlke JD, Mendez-Figueroa H, Maggio L, Hauspurg AK, Sperling JD, Chauhan SP, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015;213:76.e1-76.e10. doi:10.1016/j.ajog.2015.02.023.
- 4. Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol 1985;66:353–6.
- 5. Papp Z, Tóth-Pál E, Papp C, Sziller I, Gávai M, Silhavy M, et al. Hypogastric artery ligation for intractable pelvic hemorrhage. Int J Gynecol Obstet 2006;92:27–31. doi:10.1016/j.ijgo.2005.08.022.
- 6. Unal O, Kars B, Buyukbayrak EE, Karsidag AYK, Turan C. The effectiveness of bilateral hypogastric artery ligation for obstetric hemorrhage in three different underlying conditions and its impact on future fertility. J Matern Neonatal Med 2011;24:1273–6. doi:10.3109/14767058.2011.574751.
- 7. Selçuk, İ., Uzuner, B., Boduç, E., Baykuş, Y., Akar, B., Güngör T. Step-by-step ligation of the internal iliac artery. J Turk Ger Gynecol Assoc 2019;20:123–8.
- 8. Nizard J, Barrinque L, Frydman R, Fernandez H. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage. Hum Reprod 2003;18:844–8. doi:10.1093/humrep/deg161.
- 9. Mızrak T, Özdemir A, Güler A, Atlı Ö, Taner C DG. Hayatı Tehdit Eden Obstetrik Nedenli Hemorajilerde Hipogastrik Arter Ligasyonu. Kocatepe Tıp Derg 2004;5:41–4. doi:10.18229/ktd.65463.
- 10. Chelli D, Boudaya F, Dimassi K, Gharbi B, Najjar I, Sfar E, et al. Hypogastric artery ligation for post-partum hemorrhage. J Gynecol Obs Biol Reprod 2010;39:43–9. doi:10.1016/j.jgyn.2009.10.002.
- 11. Simsek Y, Yilmaz E, Çelik E, Türkçüoğlu I, Karaer A, Turhan U CO. Efficacy of internal iliac artery ligation on the management of postpartum hemorrhage and its impact on the ovarian reserve. J Turk Soc Obs Gynecol 2012;9:153–8.
- 12. Kurban Y, Uyar İ, Turan C GE. Obstetrik Vakalarda Hipogastrik Arter Ligasyonu: Tek Merkez Deneyimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Derg 2016;13:48–50.
- 13. Evsen MS, Sak ME, Bozkurt Y, Kapan M BÇ. Nedbesiz uterus rüptürü: Bölgesel insidans, nedenler ve tedavi. Dicle Tıp Derg 2008;35:259–63. doi:10.5798/diclemedj.0921.2008.
- 14. Hilali N, Incebiyik A, Camuzcuoglu A, Vural M, Kocarslan S, Karakaş E, Camuzcuoglu H. Conservative management of two cases of morbidly adherent placenta. Harran Üniversitesi Tıp Fakültesi Derg 2014;11:304–8.
- 15. Durmaz A, KÖMÜRCÜ N. Postpartum Kanamada Risk Belirleme, Önleme ve Yönetim: Kanıta Dayalı Uygulamalar. Sağlık Bilim ve Meslekleri Derg 2018;5:494–502. doi:10.17681/hsp.385553.
- 16. Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014;121:5–13. doi:10.1111/1471-0528.12636.
- 17. Yaman Tunc S, Agacayak E, Sak S, Basaranoglu S, Goruk NY, Turgut A, et al. Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity? J Matern Neonatal Med 2017;30:739–44. doi:10.1080/14767058.2016.1183638.
- 18. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012.
- 19. Kahramanoğlu İ, Azemi A, Turan H, Demirkıran F. Obstetrik hemorajide hipogastrik arter ligasyonu: tek cerrah deneyiminin kohort analizi. Zeynep Kamil Tıp Bülteni 2018;49. doi:10.16948/zktipb.432536.
- 20. Dogan O, Pulatoglu C, Yassa M. A new facilitating technique for postpartum hysterectomy at full dilatation: Cervical clamp. J Chinese Med Assoc 2018;81:366–9. doi:10.1016/j.jcma.2017.05.010.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 25, 2019 |
| Submission Date | November 25, 2019 |
| Acceptance Date | December 9, 2019 |
| Published in Issue | Year 2019 Volume: 16 Issue: 3 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty