Peripartum Hemorajisi Olan Hastada Anestezi
Özet
Peripartum hemoraji, maternal morbidite ve mortalitenin önemli bir nedeni olup yönetiminde multidisipliner ve planlı bir yaklaşım gerektirir. Kanama riski yüksek olan veya transfüzyonu komplike olabilecek hastalarda antenatal anestezi konsültasyonu yapılmalı; kanama diyatezi, kan ürünlerinin reddi, kırmızı kan hücresi antikorları ve olası zor entübasyon önceden değerlendirilmelidir. Müdahaleli ve sezaryen doğumlarda hemodinamik açıdan stabil hastalar için nöroaksiyal anestezi (spinal, epidural, CSE) tercih edilen tekniktir; ancak gelişebilecek derin hipotansiyon riskine karşı hastalar IV sıvı ve vazopressörlerle resüsite edilmelidir. Hemodinamik stabilite sağlanamayan veya koagülopatisi olan hastalarda ise genel anestezi tercih edilmelidir. 20. gebelik haftasından sonraki antepartum kanamalarda en sık plasenta previa ve plasental abrupsiyon görülür. Postpartum hemoraji (PPK) ise dünya çapında anne ölümlerinin en yaygın nedeni olup aşama bazlı acil yönetim planı gerektirir. PPK vakalarında doğumdan sonraki ilk üç saat içinde oksitosin ve diğer uterotoniklerle birlikte traneksamik asit (TXA) uygulanması kanamaya bağlı ölümü azaltır. Plasentanın elle çıkarılması veya uterin inversiyon durumlarında nitrogliserin veya volatil anesteziklerle hızlı uterin gevşeme sağlanabilir. Morbid yapışık plasenta tanılı sezaryen histerektomilerde masif kanama beklendiğinden, kan bankasıyla travma paketi koordine edilmeli, iki geniş çaplı IV kateter, santral venöz hat ve arteriyel kateter ile hasta deneyimli multidisipliner bir ekip tarafından yönetilmelidir.
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