Postpartum Hemorajiler
Özet
Postpartum hemoraji (PPK), doğum sonu anne ölümlerinin küresel düzeyde en yaygın nedeni olup acil tıbbi müdahale gerektiren obstetrik bir durumdur. Geleneksel olarak vajinal doğumda 500 ml, sezaryende ise 1000 ml ve üzeri kan kaybı olarak tanımlansa da güncel sağlık kuruluşları tanı kriterlerini kümülatif kan kaybı ve hipovolemi bulgularına göre güncellemiştir. Kanamanın önlenmesinde myometrium kasılması ve pıhtılaşma faktörlerinin devreye girdiği fizyolojik hemostaz mekanizması kritik öneme sahiptir. PPK etiyolojisi; tonus (uterus atonisi, inversiyonu), travma (laserasyonlar, rüptür), doku (plasenta retansiyonu ve yapışma anomalileri) ve trombin (pıhtılaşma bozuklukları) olmak üzere "Dört T" kategorisinde sınıflandırılmaktadır. Erken dönem PPK’nın en yaygın nedeni %75-90 oranında uterus atonisi iken, geç dönem PPK genellikle doku retansiyonundan kaynaklanır. Kanama yönetiminde kan kaybının görsel veya nitel tespiti ile Benedetti klinik bulguları belirleyicidir. Önleme ve tedavide, doğumun üçüncü evresinin aktif yönetimi, başta oksitosin olmak üzere uterotoniklerin kullanımı, traneksamik asit uygulaması, fundal masaj ve bimanuel kompresyon gibi mekanik yöntemler ile multidisipliner ekip koordinasyonu hayati rol oynamaktadır.
Postpartum hemorrhage (PPH) is the most common cause of maternal mortality globally and represents an obstetric emergency that requires immediate medical intervention. Although traditionally defined as a blood loss of 500 ml or more after vaginal delivery and 1000 ml or more following a cesarean section, contemporary healthcare organizations have updated their diagnostic criteria based on cumulative blood loss and signs of hypovolemia. The physiological hemostasis mechanism, involving myometrial contraction and the activation of clotting factors, is critical in preventing hemorrhage. The etiology of PPH is classified under the "Four Ts": tone (uterine atony, inversion), trauma (lacerations, rupture), tissue (retained placenta and attachment anomalies), and thrombin (coagulation disorders). While uterine atony is the primary cause of early PPH, accounting for 75-90% of cases, late PPH is generally caused by tissue retention. In hemorrhage management, visual or qualitative assessment of blood loss alongside Benedetti clinical findings are decisive factors. In prevention and treatment, active management of the third stage of labor, the utilization of uterotonics (primarily oxytocin), administration of tranexamic acid, mechanical methods like fundal massage and bimanual compression, and the coordination of a multidisciplinary team play a vital role.
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