OBSTETRİDE SEPSİS VE SEPTİK ŞOK
Özet
Obstetrik sepsis; gebelik, doğum, abortus veya postpartum dönemde enfeksiyona bağlı gelişen organ disfonksiyonu olarak tanımlanır ve postpartum kanama ile hipertansif hastalıklardan sonra küresel anne ölümlerinin yaklaşık %11'inden sorumlu, önlenebilir bir maternal ölüm nedenidir. Gebeliğe özgü kardiyovasküler, immünolojik ve solunumsal adaptasyonlar enfeksiyon bulgularını maskeleyerek tanıyı geciktirmekte; bu durum genç ve uzun süre kompanse kalan hastalarda dekompansasyonun ani ve hızlı seyretmesine yol açmaktadır. Sepsis-3 tanımı ve SIRS, SOFA, qSOFA gibi ölçütler gebe popülasyonda doğrulanmadığından, omSIRS, qSOFA-P ve MEOWS gibi obstetrik popülasyona uyarlanmış tarama ve erken uyarı araçlarına gereksinim duyulmaktadır. Bu bölümde maternal sepsis ve septik şokun tanımları, küresel ve ulusal epidemiyolojisi, maternal, obstetrik ve sosyoekonomik risk faktörleri, gebeliğe özgü patofizyolojik değişiklikler, güncel tanı kriterleri ve skorlama sistemleri ile "altın saat" kavramı temelinde yönetim ilkeleri güncel literatür doğrultusunda ele alınmıştır. Yönetimde kültür ve laktat örneklemesinin ardından gecikmesiz geniş spektrumlu antimikrobiyal tedavi, obstetrik popülasyona uyarlanmış ölçülü sıvı resüsitasyonu, erken norepinefrin desteği ve zamanında kaynak kontrolü vurgulanmaktadır. Prognoz akut dönemle sınırlı olmadığından, post-sepsis sendromu, yoğun bakım sonrası sendrom ve plasental disfonksiyon riski açısından taburculuk sonrası izlem yönetimin ayrılmaz bir parçası olarak planlanmalıdır.
Anahtar Kelimeler: Maternal sepsis, Septik şok, Puerperal enfeksiyon, Organ disfonksiyonu, Maternal mortalite
Konu Alanı: Tıp -> Tıp (diğer) -> Kadın Hastalıkları ve Doğum
https://dosyamerkez.saglik.gov.tr/Eklenti/52859/0/siy2024tr31122025pdf.pdf
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