Fizyolojik ve Anatomik Temeller
Özet
Postpartum kanamanın fizyopatolojisini anlamak için gebelik ve doğum sürecinde meydana gelen anatomik ve fizyolojik değişikliklerin bütüncül olarak değerlendirilmesi önemlidir. Gebelik boyunca uterus, serviks ve pelvik yapılarda belirgin yapısal değişiklikler gerçekleşir; uteroplasental dolaşım artar, miyometriyal hipertrofi ile hiperplazi belirginleşir. Kardiyovasküler sistemde maternal plazma hacminin artışı, kardiyak debinin yükselmesi ve sistemik vasküler direncin azalması fetoplasental dolaşımı destekler. Bununla birlikte gebelikte koagülasyona eğilim artar. Böylece doğumdaki kan kaybına fizyolojik bir tampon mekanizması oluşturulur. Doğum fizyolojisinde servikal olgunlaşma, düzenli ve senkronize uterin kontraksiyonlar sonucu fetüsün ve plasentanın doğumu temel basamakları oluşturur. Miyometriyal liflerin kasılma ve retraksiyonu, hemostazın sağlanmasında kritik rol oynar. Doğum sonrasında uterus kasılarak hızla küçülür. Bu involüsyon spiral arterlerin trombozunave endometriyal rejenerasyonla birlikte hemostaza katkı sağlar. Bu süreçlerin herhangi birbasamağındaki aksama postpartum kanamanın gelişmesine zemin hazırlar. Dolayısıyla gebelikteki anatomik ve fizyolojik adaptasyonlar, kardiyovasküler ve hemostatik değişiklikler, doğum fizyolojisi ve involüsyon süreçlerinin uyumlu işleyişi maternal morbidite ve mortalitenin önlenmesinde belirleyici rol oynamaktadır.
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