Postpartum Kanamada Balon Tamponad, Cerrahi Müdahaleler ve Packing
Özet
Postpartum kanama (PPK), maternal mortalitenin önde gelen sebeplerindendir. Medikal tedaviye yanıtsız olgularda hızlıca balon tamponad veya cerrahi girişimlere geçilmelidir. Uterin balon tamponad, atoni veya plasenta previa/akreata gibi nedenlerle gelişen kanamalarda uygulanabilir. Bakri, Rusch, Ebb gibi sabit hacimli; Ellavi, Zukovski gibi serbest akışlı balonlar kullanılabilir. Balonlar 2-24 saat arasında rahim içinde bırakılır, antibiyotik ve uterotonik tedaviye devam edilir. Foley kateter veya gazlı bez ile de tamponad yapılabilir. Son yıllarda vakum bağlantılı tamponad sistemleri de kullanılmaya başlanmıştır. Cerrahi müdahaleler arasında aşamalı uterus devaskülarizasyonu, uterin arter veya internal iliak arter ligasyonu ve kompresyon sütürleri (B-Lynch, Hayman, H-Hayman, Pereira, Cho) yer alır. Bu yöntemler fertilite koruyucu olup, başarısız olursa histerektomi uygulanır. Subtotal histerektomi genellikle daha hızlı olduğundan tercih edilir, ancak kanamanın yerine göre total histerektomi gerekebilir. Aktif kanama devam ederse pelvik packing ile basınç sağlanabilir, ayrıca geçici olarak manuel aortik kompresyon uygulanabilir. Sonuç olarak, PPK yönetiminde hızlı tanı, uygun algoritma ve deneyimli ekibin koordineli çalışması, maternal morbidite ve mortaliteyi azaltmada kritik öneme sahiptir.
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