Endovasküler Müdahaleler
Özet
Postpartum kanama (PPK), dünya genelinde maternal mortalitenin önde gelen nedenlerinden biridir ve hızlı tanı, uygun kaynak kullanımı ile etkin müdahale hayati önem taşır. Geleneksel yöntemlerin yanı sıra REBOA ve uterin/hipogastrik arter embolizasyonu gibi endovasküler yaklaşımlar giderek daha fazla kullanılmaktadır. REBOA, özellikle plasenta akreata spektrumu ve şiddetli PPK olgularında histerektomiyi önleyebilir. Uterin veya hipogastrik arter embolizasyonu ise hemodinamik olarak stabil, medikal tedaviye yanıtsız hastalarda etkili bir seçenektir. Gelfoam ve NBCA gibi materyaller kullanılmakta olup başarı oranı %90–97 arasında bildirilmiştir. Komplikasyon oranı düşüktür ve doğurganlık genellikle korunur. Ancak, işlem süreleri ve koagülopati gibi faktörler sınırlayıcı olabilir. Genel olarak bakıldığında, medikal tedaviye dirençli olgularda bu minimal invaziv yöntemler, multidisipliner iş birliği ile umut verici sonuçlar sunmaktadır.
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