Mgbapụta ime

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Uterine atony
Atonic uterus (held by surgeon)
SymptomsUncontrolled postpartum bleeding, decreased heart rate, pain, soft non-contracted uterus
Complicationspostpartum hemorrhage, DIC, hypovolemic shock, renal failure, hepatic failure, and death
Usual onsetthird stage of labor
Causestrauma, complicated labor, medications, uterine distention, caesarean section
Risk factorsObesity, uterine distention, placental disorders, multiple gestation, prior PPH, coagulopathies
Diagnostic methodPhysical exam and observed blood loss
Differential diagnosisuterine inversion, obstetric laceration
PreventionRisk stratification and identification, active management of third stage of labor
TreatmentUterine massage, Oxytocin, uterotonics, tamponade or packing, surgical intervention
MedicationOxytocin (Pitocin), Carbetocin, Methergine, Hemabate or Carboprost, Misoprostol, Dinoprostone
Prognosis2-3 times risk of recurrence
Frequency80% of postpartum bleeding

Uterine atony bu odida nke uterus imepe ofuma mgbe achoro imu nwa.mmepe nke uterus mgbe ana amu NWA na akwado blood vessels nke n'eme ka o hara igbachi Ike na ebochi hemorrhage ma kwalite ijiko obara.

Ya bu oburu na uterus emepeghi ofuma oga ebute acute hemorrhage.

Ihe ize ndụ[dezie | dezie ebe o si]

E nwere ọtụtụ ihe ize ndụ maka atony akpa nwa na ọtụtụ n'ihi ụdị ọrụ nne na-enwe dị ka ọrụ ogologo oge, ọrụ na-erughị awa 3, ntụgharị akpa nwa, ojiji nke magnesium sulfate, na ojiji nke oxytocin. Mgbapụta nke akpa nwa nke ihe ndị dị ka ihe karịrị otu nwa e bu n'afọ kpatara, polyhydramnios, macrosomia nwa e bu, fibroids uterine, chorioamnionitis nwekwara ike ibute mbelata ọrụ akpa nwa na atony. Nchịkọta anụ ahụ placental ma ọ bụ nsogbu placental, dị ka placenta na-arapara n'ahụ, placenta previa, na placenta abruption na-eme ka ihe ize ndụ nke nne na-enwe PPH. Body mass index (BMI) n'elu 40 na coagulopathies bụ ihe ize ndụ a maara. [1] [2][3]

A na-ejikarị Magnesium sulfate eme ihe na ndị ọrịa nwere eclampsia" id="mwIw" rel="mw:WikiLink" title="Pre-eclampsia">preeclampsia na eclampsia, nwere ike igbochi mgbanaka akpa nwa n'amaghị ama. Na mgbakwunye, preeclampsia nwere ike ibute nsogbu ọbara dịka thrombocytopenia, platelet abnormalities, na disseminated intravascular coagulation.[4] Ịmụ nwa, ọkachasị mgbe ogologo oge gachara, nwere ike ime ka ike gwụ uru ahụ nke akpa nwa ma kwụsị ịkpụ ma ọ bụ ịkpụkọta nwere ike igbochi n'ebe a na-awa ahụ.[2]

Ọrịa na-efe efe[dezie | dezie ebe o si]

Uterine atony na ebido 1 na omumu 40 n'obodo United States ma n'ebute kwa 80% ma ope Karia mpe nsogbu nke postpartum hemorrhage. [5][3]

Ọgwụgwọ na njikwa[dezie | dezie ebe o si]

Mgbochi[dezie | dezie ebe o si]

Tupu a mụọ nwa, a ga-enyocha ndị ọrịa niile maka ihe ize ndụ ma nye ha ohere ịpụ ọbara mgbe a mụsịrị nwa dabere na ndụmọdụ American College of Obstetricians and Gynecologists. Ọ bụrụ na nwanyị ahụ nọ n'ihe ize ndụ dị n'etiti, a ga-edepụta ọbara ma nyochaa ya. Ndị a na-enyocha dị ka ndị dị oke egwu kwesịrị ka edetu ha ma jikọta ha.[6]

A na-etinye njikwa nke atọ nke ọrụ n'ọrụ mgbe niile ma na-ewere ya dị ka ụkpụrụ maka nlekọta ndị ọrịa. Enwere ike iji ya belata ihe ize ndụ nke PPH.[7][8] Nchịkwa na-arụsi ọrụ ike nke nzọụkwụ nke atọ gụnyere ịhịa aka n'akpa nwa na obere oxytocin IV. Ma a na-enye ya obere oge tupu ma ọ bụ mgbe a mụsịrị placenta na-adabere na mmasị onye na-eweta ya. A na-atụ aro na iji Uterotonic, dị ka oxytocin, ga-enyere aka belata ọbara na mkpa maka mmịnye ọbara mgbe ọ mụsịrị nwa.[9]

A na-eme ịhịa aka n'akpa nwa site na itinye aka n'afọ dị ala ma jiri ịhịa aka ugboro ugboro ma ọ bụ ịpị aka na mgbalị ịkpali akpa nwa. A na-eche na mmegharị ahụ na-akpali mgbanaka akpa nwa ma nwee ike ịkpata ntọhapụ nke prostaglandins mpaghara iji nyere aka na hemostasis.[10]

Ọgwụgwọ[dezie | dezie ebe o si]

Ọ bụrụ na atony nke akpa nwa na-eme ọbụna mgbe e mepụtara usoro mgbochi niile, a ga-etinye usoro ọgwụgwọ n'ọrụ. A ga-anọgide na-eji ịhịa aka na mkpakọ akpa nwa, mgbe a na-enye ọgwụ. A ga-ebido intravenous catheter iji nye mmiri, ọgwụ, na ihe ndị dị n'ọbara [11]

E nwere ọtụtụ ụdị ọgwụ dị iche iche nke uterotonic nke enwere ike inye, nke ọ bụla nwere uru na ọghọm nke ya.[12] Ọzọkwa, iji ọgwụgwọ ngwakọta nke akpa nwa bụ ihe a na-emekarị ma nwee ike ịdị irè karị n'ịchịkwa ọbara ọgbụgba karịa otu ọgwụgwọ. Njikọ ụfọdụ nwere ike ịgụnye oxytocin gbakwunyere misoprostol, oxytocin tinyere ergometrine, na carbetocin.[13]

Ọgwụ ndị a na-eji maka PPH gụnyere ndị a:[2]

  1. Oxytocin (Pitocin) Mmetụta nke ndị na-anabata oxytocin na uru ahụ dị n'akpa nwa na-eduga na mgbanaka.[14] Ọnụ ọgụgụ nke ndị a na-anabata ihe na-abawanye n'oge ime na ịmụ nwa. E nwekwara ihe ndị ọzọ na fundus karịa na akụkụ akpa nwa dị ala.[15] Oxytocin nwere mmalite ngwa ngwa, n'ime nkeji ole na ole, mana ọ na-efunahụkwa ịdị irè ngwa ngwa n'ihi obere ọkara ndụ. A na-enye ọgwụ ahụ na mmiri ngwa ngwa ma nwee ike ịkpata ọbara mgbali elu. Oxytocin naanị bụ ọgwụgwọ a na-ejikarị eme ihe na US. Otú ọ dị, ọ bụrụ na a naghị achịkwa ọbara ọgbụgba mgbe e nyechara oxytocin, mgbe ahụ, a na-enye uterotonic nke abụọ.[13]
  2. Carbetocin: Ihe yiri oxytocin, na-arụ ọrụ n'ụzọ yiri nke oxytocin mana ọkara ndụ dị ogologo.[16] Ọ na-ejikọta na ndị na-anabata uru ahụ nke akpa nwa, dị ka oxytocin ma a kọọrọ na ọ na-emepụta nkwonkwo akpa nwa kwụsiri ike, na-esote nkwonkwo rhythmic. Ọ dịghị na US mana ọ dị n'ọtụtụ mba maka igbochi atony uterine na ọbara ọgbụgba.
  3. Methylergonovine: Nke a bụ ergot alkaloid ma nwee ọtụtụ usoro ọrụ iji mee ka ngwa ngwa, mgbanaka akpa nwa na-aga n'ihu nke na-eduga na mgbanaka akpa.[17] Ọ nwere ike ịkpata vasoconstriction na ndị ọrịa nwere ọbara mgbali elu ma ọ bụ ọbara mgbali ala metụtara ime ime. [18]
  4. 15-methyl-PGF2-alpha (Hemabate, Carboprost) Ọ dị irè nke ukwuu mana ọ dị oke ọnụ. Ọ nwere ike ịkpata bronchospasm ma a ga-ezere ya na ụkwara ume ọkụ. Ọ nwere ike ịkpata afọ ọsịsa, ahụ ọkụ, ma ọ bụ tachycardia.   [citation needed]
  5. Misoprostol (Cytotec): Ọgwụ a na-akpọ prostaglandin E1 analog oral nke nwere ike ịkpali mgbanaka akpa nwa. Misoprostol adịghị mkpa ka a na-etinye ya na friji n'ihi na ọ na-ekpo ọkụ. Ọ dị mfe inye ya ma e jiri ya tụnyere oxytocin na ergot alkaloids n'ebe ndị na-enweghị ihe ọ bụla ebe friji na agịga na-adịghị.[19] Ọ nwere ike ịkpata oke ọkụ.
  6. Dinoprostone (Prostin E2): Prostaglandin ọzọ na misoprostol. [2]

Mgbe a na-enye ọgwụ ahụ, a ga-elezi anya n'ebe nne ahụ nọ iji kwado na ọbara ọgbụgba akwụsịla. Ọ bụrụ na ọbara ọgbụgba akwụsịghị ma ọ bụ nyocha ahụike egosighi ihe ịrịba ama nke ọrụ akpa nwa e weghachiri n'ime nkeji iri atọ nke inye ọgwụ, a na-atụ aro itinye aka ozugbo.[20]

Usoro tamponade gụnyere ngwugwu akpa nwa (na-agbasa n'ime akụkụ ahụ nwanyị) na gauze nke nwekwara catheter Foley n'ebe iji nye ohere maka nsị. Ọ dị ọnụ ala ma dị mfe inweta ya.[9] Balloon tamponade bụ usoro a tụrụ aro maka tamponade na ntuziaka maka njikwa PPH.[21] Enwere ike iji balọn bakri na tamponade (nakwa na ngwugwu nke akụkụ ahụ nwanyị) na ntinye Foley catheter iji mee ka ọ dịkwuo mfe ịdọrọ mmiri. [1] [22] Vacuum-induced uterine tamponade bụ usoro ọhụrụ nke na-eji vacuum dị ala iji wepụ ọbara site na oghere akpa nwa ma mee ka ọ dịkwuo mfe ịtachi akpa nwa [23]

Usoro nchịkwa ịwa ahụ gụnyere:

  • Ntinye mkpakọ dị ka B-Lynch[20]
  • Uterine curettage iji wepụ ihe ndị e chekwara n'afọ [1] [24]
  • Njikọ akwara akpa nwa, na ma ọ bụ na-enweghị njikọ nke arịa tube-ovarian. [1] [25] Njikọ nke eriri afọ na eriri afọ nwere ike belata ọbara ọgbụgba site n'ibelata nrụgide nke ọbara na-aga n'ime akpa nwa. Ọ gaghị achịkwa ọbara ọgbụgba kpamkpam mana ọ nwere ike belata ọbara ọgbụrụ mgbe a na-anwa ime ihe ndị ọzọ.
  • Njikọ Akwara akpịrị. Njikọ abụọ nke akwara iliac dị n'ime na-ebelata nrụgide nke ọbara na-aga n'ime akpa nwa yiri njikọ akwara akpa nwa. Otú ọ dị, ọ bụghị usoro a na-ahụkarị n'ihi ogo nke ihe isi ike na ihe ize ndụ.[26]
  • Ọpụpụ nke akpịrị

Nsogbu[dezie | dezie ebe o si]

PPH nwere ike ịkpata ọtụtụ nsogbu gụnyere: [2][6]

  • ọnwụ
  • Ọrịa na-akpata oyi n'ahụ
  • ọrịa coagulopathy na-agbasa n'ime akwara
  • Ọrịa akụrụ
  • Ọrịa imeju
  • Nsogbu iku ume nke ndị okenye

Na mba ndị na-enweta ego dị ala, e nwere ọtụtụ ihe ndị ọzọ na-arụ ọrụ na ihe ize ndụ PPH. Ọnọdụ nri na-edozi ahụ, enweghị nlekọta ahụike, na obere ọbara bụ ihe ndị ọzọ na-eme ka ọrịa na ọnwụ dịkwuo njọ.[27]

Anemia postpartum bụ ihe a na-ahụkarị mgbe ihe omume nke atony uterine na ọbara ọgbụgba postpartum gasịrị. Oké ụkọ ọbara n'ihi PPH nwere ike ịchọ mmịnye ọbara ọbara na mkpụrụ ndụ uhie, dabere na oke ụkọ ọbara na ogo mgbaàmà nke ụkọ ọbara. Omume a na-ahụkarị bụ inye ụmụ nwanyị nwere mgbaàmà ọbara na hemoglobin na-erughị 7 g / dl. N'ọtụtụ ọnọdụ nke ọbara ọgbụgba na-emetụta akpa nwa, ọnụọgụ nke iron furu efu anaghị eji ọbara a na-amịnye. Ya mere, a ga-atụle ígwè a na-eji ọnụ eme ihe. Ọgwụgwọ iron nke nne na nna bụ nhọrọ ka ọ na-eme ka mgbake dị ngwa. Otú ọ dị, ọtụtụ ụmụ nwanyị na-arịa obere ụkọ ọbara na-edozi ụkọ ọbara ngwa ngwa na iron naanị ha ma ha anaghị achọ iron parenteral.[1][2]

Ihe omuma[dezie | dezie ebe o si]

Umunwaanyi nwere buru PPH di ugboro abuo maobu ato n'ime PPH mgbe ha di ime. [28] [29]

Ihe odide[dezie | dezie ebe o si]

  1. ↑ (April 2009) "Uterine atony: definition, prevention, nonsurgical management, and uterine tamponade". Seminars in Perinatology 33 (2): 82–7. DOI:10.1053/j.semperi.2008.12.001. PMID 19324236. 
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 (February 2014) "Treatment for primary postpartum haemorrhage". The Cochrane Database of Systematic Reviews 2014 (2): CD003249. DOI:10.1002/14651858.CD003249.pub3. PMID 24523225.  Kpọpụta njehie: Invalid <ref> tag; name ":2" defined multiple times with different content
  3. ↑ 3.0 3.1 (2013) "Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery". American Journal of Obstetrics and Gynecology 209 (1): 51.e1–6. DOI:10.1016/j.ajog.2013.03.011. ISSN 1097-6868. PMID 23507549.  Kpọpụta njehie: Invalid <ref> tag; name ":9" defined multiple times with different content
  4. ↑ (2016) "Thrombocytopenia in Pregnancy". Maedica 11 (1): 55–60. ISSN 1841-9038. PMID 28465752. 
  5. ↑ (2017-01-24) "Bakri balloon placement in the successful management of postpartum hemorrhage in a bicornuate uterus: A case report". International Journal of Surgery Case Reports 31: 218–220. DOI:10.1016/j.ijscr.2017.01.055. PMID 28189983. 
  6. ↑ 6.0 6.1 (December 2019) "Obstetric Hemorrhage Outcomes by Intrapartum Risk Stratification at a Single Tertiary Care Center". Cureus 11 (12): e6456. DOI:10.7759/cureus.6456. PMID 32025387.  Kpọpụta njehie: Invalid <ref> tag; name ":5" defined multiple times with different content
  7. ↑ (2007-05-01) "Management of the third stage of labor". Journal of Midwifery & Women's Health 52 (3): 254–61. DOI:10.1016/j.jmwh.2007.02.012. PMID 17467592. 
  8. ↑ (2007-03-15) "Prevention and management of postpartum hemorrhage". American Family Physician 75 (6): 875–882. ISSN 0002-838X. PMID 17390600. 
  9. ↑ 9.0 9.1 (February 2019) "Active versus expectant management for women in the third stage of labour". The Cochrane Database of Systematic Reviews 2 (2): CD007412. DOI:10.1002/14651858.cd007412. PMID 30754073.  Kpọpụta njehie: Invalid <ref> tag; name ":6" defined multiple times with different content
  10. ↑ WHO recommendation on the use of uterine massage for the treatment of postpartum haemorrhage | RHL (en). extranet.who.int. Archived from the original on October 3, 2020. Retrieved on 2020-10-20.
  11. ↑ (November 2011) "Update on the new modalities on the prevention and management of postpartum haemorrhage". Fetal and Maternal Medicine Review 22 (4): 247–264. DOI:10.1017/S0965539511000143. ISSN 0965-5395. 
  12. ↑ (2004) "Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour". The Cochrane Database of Systematic Reviews 2018 (1): CD000201. DOI:10.1002/14651858.CD000201.pub2. PMID 14973949. 
  13. ↑ 13.0 13.1 (2018-04-25) "Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis" (in en). Cochrane Database of Systematic Reviews 4 (4): CD011689. DOI:10.1002/14651858.CD011689.pub2. PMID 29693726.  Kpọpụta njehie: Invalid <ref> tag; name ":8" defined multiple times with different content
  14. ↑ (2010) "The use of uterotonic drugs during caesarean section" (in en). International Journal of Obstetric Anesthesia 19 (3): 313–319. DOI:10.1016/j.ijoa.2010.04.011. PMID 20627531. 
  15. ↑ (2000) "Pharmacology of Oxytocin and Prostaglandins". Clinical Obstetrics and Gynecology 43 (3): 455–468. DOI:10.1097/00003081-200009000-00006. ISSN 0009-9201. PMID 10949750. 
  16. ↑ (2009) "Prevention of postpartum haemorrhage with the oxytocin analogue carbetocin" (in en). European Journal of Obstetrics & Gynecology and Reproductive Biology 147 (1): 15–20. DOI:10.1016/j.ejogrb.2009.06.018. PMID 19616358. 
  17. ↑ (2001) "History and use of oxytocics" (in en). European Journal of Obstetrics & Gynecology and Reproductive Biology 94 (1): 8–12. DOI:10.1016/S0301-2115(00)00311-0. PMID 11134819. 
  18. ↑ (2015) "Second-line uterotonics and the risk of hemorrhage-related morbidity". American Journal of Obstetrics and Gynecology 212 (5): 642.e1–7. DOI:10.1016/j.ajog.2015.01.008. ISSN 1097-6868. PMID 25582104. 
  19. ↑ (2007) "Prevention of postpartum hemorrhage with misoprostol" (in en). International Journal of Gynecology & Obstetrics 99: S198–S201. DOI:10.1016/j.ijgo.2007.09.012. PMID 17961574. 
  20. ↑ 20.0 20.1 (2018) "Uterine flexion suture: modified B-Lynch uterine compression suture for the treatment of uterine atony during cesarean section". International Journal of Women's Health 10: 487–492. DOI:10.2147/IJWH.S170460. PMID 30197543. Songthamwat S, Songthamwat M (2018). "Uterine flexion suture: modified B-Lynch uterine compression suture for the treatment of uterine atony during cesarean section". International Journal of Women's Health. 10: 487–492. doi:10.2147/IJWH.S170460. PMC 6113941. PMID 30197543. Kpọpụta njehie: Invalid <ref> tag; name "Songthamwat 2018" defined multiple times with different content
  21. ↑ (2015) "Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines" (in en). American Journal of Obstetrics and Gynecology 213 (1): 76.e1–76.e10. DOI:10.1016/j.ajog.2015.02.023. PMID 25731692. 
  22. ↑ (2017) "Bakri balloon placement in the successful management of postpartum hemorrhage in a bicornuate uterus: A case report". International Journal of Surgery Case Reports 31: 218–220. DOI:10.1016/j.ijscr.2017.01.055. PMID 28189983. 
  23. ↑ (2020) "Novel suction tube uterine tamponade for treating intractable postpartum haemorrhage: description of technique and report of three cases" (in en). BJOG: An International Journal of Obstetrics & Gynaecology 127 (10): 1280–1283. DOI:10.1111/1471-0528.16169. ISSN 1470-0328. PMID 32043686. 
  24. ↑ (2010) "Surgical Remedies for Postpartum Hemorrhage" (in en). Clinical Obstetrics and Gynecology 53 (1): 182–195. DOI:10.1097/GRF.0b013e3181cc4139. ISSN 0009-9201. PMID 20142655. 
  25. ↑ (March 2010) "Bilateral uterine artery ligation plus B-Lynch procedure for atonic postpartum hemorrhage with placenta accreta". International Journal of Gynaecology and Obstetrics 108 (3): 187–90. DOI:10.1016/j.ijgo.2009.08.035. PMID 19944417. 
  26. ↑ (1985) "Hypogastric Artery Ligation for Obstetric Hemorrhage" (in en-US). Obstetrics & Gynecology 66 (3): 353–356. ISSN 0029-7844. PMID 3875064. 
  27. ↑ (April 2006) "WHO analysis of causes of maternal death: a systematic review". Lancet 367 (9516): 1066–1074. DOI:10.1016/S0140-6736(06)68397-9. PMID 16581405. 
  28. ↑ (2014) "Patterns of recurrence of postpartum hemorrhage in a large population-based cohort". American Journal of Obstetrics and Gynecology 210 (3): 229.e1–8. DOI:10.1016/j.ajog.2013.10.872. ISSN 1097-6868. PMID 24351791. 
  29. ↑ (June 2007) "Postpartum hemorrhage: a recurring pregnancy complication". Seminars in Perinatology 31 (3): 159–66. DOI:10.1053/j.semperi.2007.03.001. PMID 17531897. 
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