Gebeliğin İkinci ve Üçüncü Trimester Kanamalarına Güncel Yaklaşım
Özet
Gebeliğin ikinci ve üçüncü trimesterinde görülen vajinal kanama, hafif servikovajinal odalar anne ve fetal yaşam tehlikesi olmayan obstetrik acillere kadar geniş bir klinik spektrumu kapsamaktadır. Bu dönemde güvenli yaklaşımın onaylanması, etiyolojik tanı araştırması yapılırken annenin resüsitasyonu ve fetal değerlendirmenin eş zamanlı olarak sürdürülmesi sağlandı. Kanamanın görünen miktarının gerçek kaybı her zaman yansıtılabileceğinden hemodinamik durum, uterus tonusu, ağrı, kontraksiyonlar, membran bütünlüğü ve fetal kalp hızı birlikte değerlendirilmelidir. Plasenta previa ultrasonografiyle dışlanıncaya kadar dijital normal muayeneden kaçınılması kritik öneme sahiptir. Transvajinal ultrasonografi plasenta yerleşiminin değerlendirilmesinde temel incelemesinde birlikte normal ultrasonografik bulgular plasenta dekolmanını dışlamaz. Ayırıcı tanıda plasenta previa, plasenta dekolmanı, vasa previa, uterin rüptür, servikal yetmezlik, doğum eylemi, servikovajinal lezyonlar ve yeri belirlenemeyen antepartum kanamalar yer alır. Yönetim; kanamanın nedeni ve metabolizması, doğum haftası, anne-fetal hareketlilik ve doğum merkezi olanaklarına göre bireyselleştirilmelidir. RhD-negatif gebelerde anti-D immünglobülin alır, uygun olgularda antenatal kortikosteroid ve fetal nöroproteksiyon amacıyla odacık kullanımı, koagülopatinin erken kayıtlılığı ve bilinen masif obstetrik hemoraji protokolünün aktifleştirilmesi yönetiminin önemli ekipmanlarıdır. Bu bölümde ikinci ve üçüncü trimester kanamalarının klinik değerlendirmesi, tanısal tanı ve güncel tedavi, obstetrik triyaj ve doğumhane pratiğine yönelik algoritmik bir terapiyle alınmıştır.
Anahtar Kelimeler: Antepartum kanama, plasenta previa, plasenta dekolmanı, vasa previa, uterin rüptür, obstetrik hemoraji.
Konu Alanı: Tıp -> Tıp (diğer) -> Kadın Hastalıkları ve Doğum
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