Peripartum Hemorajisi Olan Hastada Anestezi
Synopsis
Peripartum hemorrhage is a major cause of maternal morbidity and mortality, requiring a multidisciplinary and planned approach in its management. Antenatal anesthesia consultation should be scheduled for patients with a high risk of bleeding or complicated blood transfusion; bleeding diathesis, rejection of blood products, red blood cell antibodies, and potential difficult intubation must be evaluated in advance. For operative and cesarean deliveries, neuraxial anesthesia (spinal, epidural, CSE) is the preferred technique for hemodynamically stable patients; however, patients must be resuscitated with IV fluids and vasopressors against the risk of deep hypotension. General anesthesia should be preferred in patients with hemodynamic instability or coagulopathy. After the 20th week of gestation, placenta previa and placental abruption are the most common causes of antepartum hemorrhage. Postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide and requires a stage-based emergency management plan. In PPH cases, administering tranexamic acid (TXA) alongside oxytocin and other uterotonics within the first three hours after delivery reduces bleeding-related mortality. Rapid uterine relaxation can be achieved with nitroglycerin or volatile anesthetics in conditions such as manual removal of the placenta or uterine inversion. Since massive hemorrhage is expected in cesarean hysterectomies with morbidly adherent placenta, trauma package preparation must be coordinated with the blood bank, and the patient should be managed by an experienced multidisciplinary team using two large-bore IV catheters, a central venous line, and arterial catheterization.
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