| Abstract | CILJ: Cilj ovog istraživanja bio je ispitati uzroke i uspješnost zbrinjavanja ranog primarnog postpartalnog krvarenja (PPPH) u tercijarnom perinatalnom centru te istražiti rizične čimbenike i perinatalni ishod novorođenčadi.
MATERIJALI I METODE: Provedeno je retrospektivno kliničko istraživanje kroz desetogodišnji period (2010.-2019.). Korišteni su arhivski podaci Klinike za ginekologiju i porodništvo Kliničke bolnice Sveti Duh. Dijagnoza PPPH postavljana je kada je došlo do gubitka krvi većeg od 500 mL nakon vaginalnog poroda, odnosno do gubitka krvi većeg od 1000 mL nakon poroda carskim rezom unutar 24 sata od poroda.
REZULTATI: Od ukupno 29 543 poroda, PPPH je dijagnosticiran kod 215 (0,73%) rodilja. Prosječna dob rodilja bila je 31,60 godina, a njih 58,14% je bilo prvorotki. 7,44% rodilja začelo je metodama potpomognute oplodnje. Porod je induciran u 22,33% rodilja, vakuum ekstrakcija učinjena je u 7,44% poroda, a carskim rezom porođeno je 24,65% rodilja. 37,67% rodilja primilo je epiduralnu analgeziju. Atonija maternice dijagnosticirana je u 75,81% rodilja (u 46,98% rodilja kao samostalan uzrok), a od toga se u 13,62% rodilja radilo o atoniji donjeg uterinog segmenta (LUSA). Ruptura maternice bila je jedan od uzroka PPPH u 2,33% rodilje, a razdori mekog porođajnog puta u 25,12% rodilja. Zaostala posteljica zabilježena je u 11,16% rodilja. U 5,12% rodilja dijagnosticirana je invazivna malplacentacija. DIK je zabilježen kod 7 (3,26%) rodilja, a opstetrički hemoragijski šok kod 8 (3,72%) rodilja. Konzervativni medikamentozni postupak bio je dostatan za zbrinjavanje PPPH u 133 (61,86%) rodilje. Tamponada je bila dostatan zahvat u 4 rodilje, B-Lynch hemostatski šav i hemostatsko višestruko kvadratno šivanje po Cho-u u po 10 rodilja, drugi hemostatski šavovi maternice u 5 rodilja, a u 2 rodilje O'Leary ligatura uterinih žila. Kombinacija tih metoda izvedena je u 5 rodilja. Peripartalna histerektomija učinjena je kod 11 (5,12%) rodilja. U liječenju krvarenja uzrokovanog s LUSA, 37 rodilja uspješno je zbrinuto transvaginalnim kirurškim zahvatima (Hebisch-Huch ligatura, Habek hemostatski šavovi, Losickaja ligatura) s ili bez tamponade. 14,73% novorođenčadi bilo je makrosomno, 6,25% novorođenčadi doživjelo je intrapartalnu fetalnu hipoksiju, a jedno je dijete umrlo netom nakon poroda. Nije zabilježena niti jedna smrt majke u istraživanom desetogodišnjem periodu.
ZAKLJUČAK: Etiološko zbrinjavanje PPPH omogućuje ciljano liječenje koje pomaže u očuvanju fertilnosti i života žene. Liječenje PPPH uzrokovane s LUSA transvaginalnim kirurškim putem pokazalo se uspješnim i poštednim. Prevalencija peripartalne histerektomije niža je od prosječne prevalencije u razvijenim europskim zemljama, a zahvati koji se koriste u liječenju PPPH nemaju značajan utjecaj na zdravlje žene i očuvanu fertilnost. |
| Abstract (english) | OBJECTIVE: The aim of this study was to examine the causes and care success of early primary postpartum hemorrhage (PPPH) in a tertiary perinatal center and to investigate risk factors and perinatal outcome of newborns.
MATERIALS AND METHODS: A retrospective clinical study was conducted over a ten-year period (2010-2019). Archive data of the Gynecology and Obstetrics Clinic of the University Clinic Sveti Duh were used. The diagnosis of PPPH was made when there was blood loss of more than 500 mL after vaginal delivery or blood loss of more than 1000 mL after cesarean delivery within 24 hours of delivery.
RESULTS: Out of a total of 29,543 births, PPPH was diagnosed in 215 (0.73%) parturients. The average age of parturients was 31.60 years and 58.14% of them were first-time mothers. 7.44% of parturients conceived using assisted reproductive technology. Labor was induced in 22.33% of parturients, vacuum extraction was done in 7.44% of births and 24.65% of parturients gave birth by caesarean section. 37.67% of women in labor received epidural analgesia. Uterine atony was diagnosed in 75.81% of parturients (in 46.98% of parturients as an independent cause), and of these, in 13.62% of parturients it was lower uterine segment atony (LUSA). The rupture of the uterus was one of the causes of PPPH in 2.33% of parturients and ruptures of the soft birth canal in 25.12% of women in labor. Retained placenta was recorded in 11.16% of parturients. Invasive malplacentation was diagnosed in 5.12% of parturients. DIK was recorded in 7 (3.26%) parturients, and obstetric hemorrhagic shock in 8 (3.72%) parturients. The conservative medication procedure was sufficient to treat PPPH in 133 (61.86%) parturients. Tamponade was a sufficient intervention in 4 parturients, B-Lynch hemostatic suture and hemostatic multiple square sutures according to Cho both in 10 parturients, other uterine hemostatic sutures in 5 parturients, and O'Leary ligature of uterine vessels in 2 parturients. The combination of these methods was performed in 5 parturients. Peripartum hysterectomy was performed in 11 (5.12%) parturients. In the treatment of bleeding caused by LUSA, 37 parturients were successfully treated with transvaginal surgical procedures (Hebisch-Huch ligature, Habek hemostatic sutures, Losickaja ligature) with or without tamponade. 14.73% of newborns were macrosomic, 6.25% of newborns experienced intrapartum fetal hypoxia and one child died just after delivery. Not a single death of the mother was recorded in the investigated ten-year period.
CONCLUSION: Etiological management of PPPH enables targeted treatment that helps preserve fertility and the life of a woman. Treatment of PPPH caused by LUSA by transvaginal surgical procedures has been shown to be successful and sparing. The prevalence of peripartum hysterectomy is lower than the average prevalence in developed European countries and the procedures used in the treatment of PPPH do not have a significant impact on a woman's health and preserved fertility. |
