Erken Doğum Komplikasyonlarına Bağlı Kanama
Özet
Postpartum kanama dünya genelinde maternal morbidite ve mortalitenin en önemli sebeplerindendir. Plasenta retansiyonu, doğumun üçüncü evresinde plasentanın spontan ayrılmaması veya çıkarılamaması olarak tanımlanır ve preterm doğum başta olmak üzere çeşitli risk faktörleriyle ilişkilidir. Klinik bulgular, ultrason ve laboratuvar değerlendirmeleri tanıya katkı sağlar. Yönetimde oksitosin, kontrollü kord traksiyonu ve gerekirse manuel ekstraksiyon uygulanır; şiddetli kanamsı olan olgularda acil cerrahi girişim gerekebilir. En ciddi komplikasyonlar postpartum kanama ve enfeksiyondur. Uterin inversiyon ise uterin fundusun kaviteye kollabe olmasıyla ortaya çıkan nadir fakat yaşamı tehdit eden bir obstetrik acildir. Akut dönemde ani kanama, ağrı ve vajenden kitle ile kendini gösterir. Tanı çoğunlukla klinik bulgularla konur. Tedavide hemodinamik stabilizasyon, uterusun manuel veya cerrahi repozisyonu ve uterotoniklerin uygun zamanda kullanımı esastır. Her iki durumun da erken tanı ve etkin yönetimi, maternal mortalite ve morbiditeyi önemli ölçüde azaltır.
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