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POSTPARTUM HEMORAJİ: KANITA DAYALI GÜNCEL YÖNETİM VE MASİF TRANSFÜZYON PROTOKOLLERİ

Tuğba Erel Muğurtay
Uzm. Dr., Sağlık Bilimleri Üniversitesi Sancaktepe Şehit Prof. Dr. İlhan Varank Eğitim ve Araştırma Hastanesi
Erişim Durumu
Özel Erişim
Yayınlanma Tarihi
01 September 2026
Sayfa Sayısı
154-184
DOI

Özet

Postpartum hemoraji (PPH), dünya çapında maternal morbidite ve mortalitenin en önde gelen, ancak önlenebilir nedenlerinden biridir. Bu bölüm; PPH yönetimindeki geleneksel yaklaşımları modern obstetrik anestezi ve cerrahi kanıtlarla sentezleyerek, güncel uluslararası kılavuzlar (ACOG, RCOG, FIGO, WHO) ışığında kapsamlı bir klinik algoritma sunmaktadır. Kan kaybının görsel tahmininden kantitatif ölçümüne geçiş, erken tanının temelini oluşturur. Etkili bir PPH yönetimi; etiyolojiye yönelik "4T" prensibinin hızlıca değerlendirilmesini, profilaktik ve terapötik uterotoniklerin akılcı kullanımını ve kanamanın ilk 3 saati içerisinde traneksamik asit uygulamasını şart koşar. Farmakolojik müdahalelere yanıtsız olgularda en kritik paradigma değişimi, yüksek hacimli kristaloid infüzyonunun terk edilerek hasar kontrol resüsitasyonu stratejisine geçilmesidir. Masif Transfüzyon Protokollerinin erken aktivasyonu, ampirik dengeli transfüzyon (1:1:1) ve viskoelastik testler eşliğinde hedefe yönelik fibrinojen replasmanı, koagülopatinin önlenmesinde hayati öneme sahiptir. Tıbbi tedaviye dirençli tablolar zaman kaybedilmeksizin; intrauterin balon tamponad sistemleri, uterin kompresyon sütürleri, devaskülarizasyon teknikleri, ileri endovasküler müdahaleler ve nihai olarak peripartum histerektomi gibi basamaklı mekanik/cerrahi prosedürlerle yönetilmelidir. Sonuç olarak başarılı bir hemostaz; yalnızca medikal veya cerrahi müdahalelerle değil, kapalı çevrim iletişim stratejilerini kullanan multidisipliner bir kriz kaynak yönetimi ile mümkündür.

Anahtar Kelimeler: Postpartum hemoraji, hasar kontrol resüsitasyonu, masif transfüzyon protokolü, uterin balon tamponad, viskoelastik testler, obstetrik kanama yönetimi

Konu Alanı: Tıp -> Tıp (diğer) -> Kadın Hastalıkları ve Doğum

Bu Bölüme Atıf Yap
Erel Muğurtay, T. (2026). POSTPARTUM HEMORAJİ: KANITA DAYALI GÜNCEL YÖNETİM VE MASİF TRANSFÜZYON PROTOKOLLERİ. In YURTCU, N. (Ed.), Obstetrik ve Jinekolojik Acillerde Multidisipliner Güncel Yaklaşım (pp. 154-184). Vizetek Yayıncılık. https://doi.org/10.54637/vizetek.9786253823962

Kaynaklar

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Kitap Bölümü (PDF)
POSTPARTUM HEMORAJİ: KANITA DAYALI GÜNCEL YÖNETİM VE MASİF TRANSFÜZYON PROTOKOLLERİ
Bu Bölüme Atıf Yap:
Erel Muğurtay, T. (2026). POSTPARTUM HEMORAJİ: KANITA DAYALI GÜNCEL YÖNETİM VE MASİF TRANSFÜZYON PROTOKOLLERİ. In YURTCU, N. (Ed.), Obstetrik ve Jinekolojik Acillerde Multidisipliner Güncel Yaklaşım (pp. 154-184). Vizetek Yayıncılık. https://doi.org/10.54637/vizetek.9786253823962
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