Sekonder Postpartum Kanama ve Nedenleri
Özet
Sekonder postpartum kanama (PPK), ilk 24 saatin ardından ve haftalarca sürebilen postpartum dönemde ortaya çıkar; insidansı yaklaşık %0,2–%2,5 olarak bildirilir. En yaygın nedenler rest plasenta (plasental kalıntı), plasenta yatağının subinvolüsyonu ve enfeksiyondur; nadir nedenler arasında kanama diyatezleri, uterin vasküler anomaliler (psödoanevrizma, arteriovenöz fistüller), malignensiler (koryokarsinom), adenomyozis, uterin divertikül veya sezaryen sonrası komplikasyonlar yer alır. Öykü dikkatle alınmalıdır: önceki PPK öyküsü, mevcut gebelik komplikasyonları, doğum şekli ve doğum sonrası cinsel/vajinal müdahale riskleri gibi bilgiler önemlidir. Laboratuvar taraması tam kan sayımı, PT, aPTT ve fibrinogeni içerir ve gerekli durumlarda von Willebrand hastalığı için testler düşünülür. Görüntüleme, sekonder PPK’nin temel değerlendirme aracıdır: ilk basamak ultrasonografi (transabdominal/transvajinal; 2D/3D, renkli Doppler) plasenta kalıntıları, subinvolüsyon veya uterin patolojiyi belirler; vaskülariteyi değerlendirmek için Doppler kullanılır. Sonuç belirsizse BT-anjiyografi veya MR-anjiyografi gibi ek görüntüleme teknikleri tercih edilebilir. Yönetim, nedene, şiddete ve hastanın hemodinamik durumuna göre yönlendirilir ve medikal tedavi, girişimsel radyoloji veya gerektiğinde cerrahi seçenekleri içerir. Erken tanı ve multidisipliner yaklaşım, maternal sonuçları iyileştirir.
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