Boztosun, Abdullah Cumhuriyet Üniversitesi - Tıp Fakültesi - Kadın Doğum Anabilim Dalı, Turkey , Mutlu, Ahmet Emin Cumhuriyet Üniversitesi - Tıp Fakültesi - Kadın Doğum Anabilim Dalı, Turkey , Bıyık, Yasin Cumhuriyet Üniversitesi - Tıp Fakültesi - Kadın Doğum Anabilim Dalı, Turkey , Yeniocak, Hidayet Cumhuriyet Üniversitesi - Tıp Fakültesi - Kadın Doğum Anabilim Dalı, Turkey , Yanık, Ali Cumhuriyet Üniversitesi - Tıp Fakültesi - Kadın Doğum Anabilim Dalı, Turkey

Evaluation of intra-abdominal surgical approaches in cases with postpartum haemorrhage

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Aim. We aimed to review patients who underwent intra-abdominal surgical intervention due to postpartum hemorrhage in our clinic. Method. Cases with postpartum hemorrhage, who were treated with intraabdominal surgical approach between January 2009 and December 2011 were retrospectively evaluated. Results. Of the 44 patients with postpartum hemorrhage, intra-abdominal surgical intervention was performed after vaginal delivery in 10 patients (22.8%), whereas 34 (77.2%) patients underwent intraabdominal surgical intervention during or after cesarean. Maternal mortality rate due to postpartum hemorrhage was found to be 0.017%. Hysterectomy and bilateral hypogastric artery ligation were firstly preferred approaches with rates of 31.8%, while atonia (47.7%) and placenta previa (25.0%) were found as the most common causes of hemorrhage. Postpartum hysterectomy rate was found as 47.7% for all cases. Our results showed that hysterectomy was preferred at a rate of 62.5% for hemorrhage causes other than atonia, while it was preferred at a rate of 30% in atonia, which were found to be significant (p=0,032). Numbers of cesarean were significantly higher in patients with placental adhesion anomaly or placenta previa than other patients (1.23±1.14 vs. 0.55±0.75; p=0.043). Conclusion: The hysterectomy rate in cases with postpartum hemorrhage was high in our trial. This high ratio can be explained by placental adhesion abnormalities associated with increased number of cesarean sections. For this reason, perhaps reducing the rates of cesarean section would be the most effective way in the primary prevention of postpartum hemorrhage. However; hysterectomy should be the last method to be applied in case of failure after conservative methods.

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Postpartum hemorrhage , management , hysterectomy , bilateral hypogastric artery ligation , B , Lynch

Cumhuriyet Medical Journal

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