HAM\u0130LEL\u0130KTE APAND\u0130S\u0130T AMEL\u0130YATI BEBE\u011eE ZARAR VER\u0130R M\u0130?<\/strong><\/p>\n

Akut apandisit (apandis),appendix vermiformis, ad\u0131 verilen organ\u0131n iltihaplanmas\u0131 sonucu meydana gelen bir hastal\u0131kt\u0131r. Apandisit her ya\u015f grubunda g\u00f6r\u00fclebildi\u011fi gibi genellikle 20-30 ya\u015flar\u0131 aras\u0131nda daha s\u0131k g\u00f6r\u00fcl\u00fcr.Gebelikte apandisit (apandisit iltihab\u0131), 1000- 1500 gebelikte g\u00f6r\u00fclen bir rahats\u0131zl\u0131kt\u0131r. Apandisit g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 hamile olmayanlara g\u00f6re artmam\u0131\u015ft\u0131r.<\/p>\n

Fakat yanl\u0131\u015f te\u015fhis geciken cerrahi tedavi gebelerde daha s\u0131k g\u00f6r\u00fcl\u00fcr. Gebelikte akut apandisit \u015fikayetleri ile klini\u011fe ba\u015f vuran hastalarda erken tan\u0131 ve tedavi hem anne hemde bebek i\u00e7in hayati \u00f6neme sahiptir. Bu durumda genel cerrahi uzman\u0131 ve kad\u0131n do\u011fum uzman\u0131n\u0131n uyum i\u00e7erisinde \u00e7al\u0131\u015fmalar\u0131n\u0131n \u00f6nemi b\u00fcy\u00fckt\u00fcr. Gebeli\u011fin 1\u2019inci trimesterinde ve erken 2\u2019inci trimesterinde apandisit belirtileri ve bulgular\u0131, gebelik d\u00f6nemi d\u0131\u015f\u0131ndaki apandisit belirtileri ve bulgular\u0131 ile benzerlik g\u00f6sterir. Fakat gebeli\u011fin ileri ki d\u00f6nemlerinde a\u011fr\u0131 b\u00fcy\u00fcyen uterus nedeni ile yer de\u011fi\u015ftirir ve sa\u011f alt kadrandan, sa\u011f \u00fcst kadrana do\u011fru \u00e7\u0131kar ve o b\u00f6lgede yerle\u015fir. Bu a\u011fr\u0131 gebeli\u011fin son aylar\u0131nda yan a\u011fr\u0131s\u0131 zannedilebilir.<\/p>\n

HAM\u0130LEL\u0130KTE (GEBEL\u0130KTE) APAND\u0130S\u0130T BEL\u0130RT\u0130LER\u0130<\/strong><\/p>\n

Apandisitin tipik bulgular\u0131 olan yemek yeme istememe, bulant\u0131, kusma gibi \u015fikayetler bir\u00e7ok hamilede g\u00f6r\u00fclebilece\u011fi i\u00e7in apandisit te\u015fhisi gecikmektedir. Apandisit a\u011fr\u0131s\u0131 gebeli\u011fin erken d\u00f6neminde sa\u011f alt kar\u0131n b\u00f6lgesinde (kadranda) hissedilir. Fakat ileri ki aylarda apandisit a\u011fr\u0131s\u0131 sa\u011f \u00fcst kar\u0131n b\u00f6lgesinde (kadranda) hissedilir. Apandisitin genel belirtileri karn\u0131n orta k\u0131sm\u0131nda g\u00f6be\u011fin \u00fcst\u00fcnde ge\u00e7meyen k\u00fcnt a\u011fr\u0131, bu a\u011fr\u0131 hareket etme, \u00f6ks\u00fcrme, g\u00fclme gibi ani hareketler ve elle dokunma ile artar. Bunlar\u0131n yan\u0131 s\u0131ra bulant\u0131 ve i\u015ftahs\u0131zl\u0131k gibi belirtiler de g\u00f6r\u00fclen belirtiler aras\u0131ndad\u0131r.<\/p>\n

HAM\u0130LEL\u0130KTE (GEBEL\u0130KTE) APAND\u0130S\u0130T TE\u015eH\u0130S\u0130<\/strong><\/p>\n

Doktor muayenesinde ya da doktora giderken uyaran bir hareket ile veya elle yap\u0131lan muayene ile hissedilen a\u011fr\u0131 kendini s\u0131kan gebelerde daha seyrek g\u00f6r\u00fcl\u00fcr. Alevlenme g\u00f6stermi\u015f appendix hamilelik nedeni ile periton zar\u0131na temas etmeyebilir ve bu bulgular\u0131n olu\u015fmas\u0131n\u0131 \u00f6nleyebilir. Hamilelik d\u00f6nemi apandisit belirtilerinde ate\u015f y\u00fckselmesi her hamilede ve\/veya her apandisit geli\u015fmesinde g\u00f6r\u00fclmeyebilir. Eritrosit sedimantasyon h\u0131z\u0131 art\u0131\u015f\u0131 ve l\u00f6kositoz normalde de gebelerde g\u00f6r\u00fclebilir.<\/p>\n

Hamilelerde akut apandisit te\u015fhisi pyelonefrit (b\u00f6brek iltihab\u0131), safra iltihab\u0131, b\u00f6brek ta\u015f\u0131, Akdeniz ate\u015fi hastal\u0131\u011f\u0131n\u0131n ataklar\u0131, pankreas iltihab\u0131, tubovaryen apse, peptik ulkus, ba\u011f\u0131rsak t\u0131kanmas\u0131, preeklampsi, yumurtal\u0131k torsiyonu ve b\u00f6brek ta\u015f\u0131 d\u00fc\u015f\u00fcrme gibi baz\u0131 hastal\u0131klar ile de kar\u0131\u015fabilir. Bu nedenle ay\u0131r\u0131c\u0131 tan\u0131 \u00f6nemlidir. Gebe hastalarda akut apandisit tan\u0131s\u0131n\u0131 koymada yard\u0131mc\u0131 tan\u0131 y\u00f6ntemlerinden en s\u0131k kullan\u0131lan ve i\u015flevsel y\u00f6ntem kar\u0131n ultrasonografisidir. Akut apandisitli hamilelerin idrar tahlillerinde hastalar\u0131n % 12\u2019sinde kanl\u0131 idrar, % 22\u2019sinde de idrarda bakteri bulgular\u0131 vard\u0131r. \u0130drar tahlillerinde bulunan bu bulgular apandisit olmad\u0131\u011f\u0131 anlam\u0131na gelmez. Gebe hastalarda kar\u0131n tomografisi radyasyon i\u00e7erdi\u011fi i\u00e7in \u00e7ok fazla tercih edilmez.<\/p>\n

APAND\u0130S\u0130T PATLAMASI BEBE\u011eE ZARAR VER\u0130R M\u0130?<\/strong><\/p>\n

Hamilelikte geli\u015fen apandisit vakalar\u0131nda anne adaylar\u0131nda g\u00f6r\u00fclen \u00f6l\u00fcm oranlar\u0131n\u0131n d\u00fc\u015f\u00fck olmas\u0131na ra\u011fmen, \u00f6zellikle apandisit delinmesi (patlamas\u0131) sonucu anne karn\u0131ndaki bebek \u00f6l\u00fcm oranlar\u0131 daha y\u00fcksektir. Patlama olmam\u0131\u015f apandisit varl\u0131\u011f\u0131nda anne karn\u0131ndaki bebek \u00f6l\u00fcm oran\u0131 (fetal mortalite) % 1.5\u2019den az iken, apandisitin patlamas\u0131 sonucu bu oran % 30\u2019a kadar y\u00fckselmektedir.<\/p>\n

Hamilelik d\u00f6nemi apandisit varl\u0131\u011f\u0131nda, apandisitin patlama riski genellikle 3\u2019\u00fcnc\u00fc trimesterde g\u00f6r\u00fcl\u00fcr ki bu d\u00f6nemde te\u015fhisin konulmas\u0131 daha da zordur. Apandisit patlamas\u0131 oran\u0131 gebe olmayan kad\u0131nlara oranla gebe olan kad\u0131nlarda daha fazlad\u0131r. Bu nedenle hamilelik d\u00f6neminde g\u00f6r\u00fclen apandisit belirtileri mutlaka dikkate al\u0131nmal\u0131 ve do\u011fru te\u015fhis konulup acil tedavi edilmelidir.<\/p>\n

HAM\u0130LEL\u0130KTE APAND\u0130S\u0130T TEDAV\u0130S\u0130 VE AMEL\u0130YATI NASIL YAPILIR?<\/strong><\/p>\n

Apandisit te\u015fhisi konuldu\u011funda hamile ve g\u00f6r\u00fclen bulgular h\u0131zl\u0131 bir \u015fekilde de\u011ferlendirilmeli ve h\u0131zl\u0131 bir \u015fekilde operasyon a\u015famas\u0131na ge\u00e7ilmelidir. G\u00fcn\u00fcm\u00fczde do\u011fru kabul g\u00f6rm\u00fc\u015f olan g\u00f6r\u00fc\u015f, bekleyerek daha k\u00f6t\u00fc sonu\u00e7lar\u0131n ortaya \u00e7\u0131kmas\u0131n\u0131 f\u0131rsat vermek de\u011fil, apandisit \u015f\u00fcphesi ile ameliyat edilen gebelerin 1\/3\u2019\u00fcnde ameliyat s\u0131ras\u0131nda te\u015fhisin kesinle\u015fmesinin \u00e7ok daha do\u011fru oldu\u011fu y\u00f6n\u00fcndedir.<\/p>\n

Apandisit \u015f\u00fcphesi oldu\u011funda h\u0131zla ger\u00e7ekle\u015ftirilecek bir apendektomi ameliyat\u0131 anne aday\u0131n\u0131n ve bebe\u011fin ya\u015fam\u0131n\u0131 kurtaracak en do\u011fru karard\u0131r. Gebelik, apendektomi cerrahisini geciktirmek i\u00e7in engel de\u011fildir. Apandisit ameliyat\u0131 esnas\u0131nda genel cerrahi uzman\u0131, rahim b\u00f6lgesine m\u00fcmk\u00fcn oldu\u011funca az temas ederek ameliyat\u0131 bitirmeye \u00e7al\u0131\u015f\u0131r. Cerrahi s\u0131ras\u0131nda hastan\u0131n pozisyonu olduk\u00e7a \u00f6nemlidir. Hastay\u0131 yakla\u015f\u0131k 30 derece sola \u00e7evirmek b\u00fcy\u00fcm\u00fc\u015f uterus taraf\u0131ndan vena cava inferiorun bas\u0131s\u0131n\u0131 \u00f6nlemek i\u00e7in yard\u0131mc\u0131d\u0131r ve cerrahi yakla\u015f\u0131m\u0131 kolayla\u015ft\u0131r\u0131r.<\/p>\n

Son y\u0131llarda gebelerde de kapal\u0131 cerrahi olan (laparoskopik cerrahi) ile ba\u015far\u0131l\u0131 sonu\u00e7lar elde edilmi\u015ftir. Ameliyat sonras\u0131 rahim kas\u0131lmalar\u0131n\u0131 \u00f6nlemek ve erken do\u011fum ve d\u00fc\u015f\u00fck riskini engellemek amac\u0131 ile ila\u00e7 tedavisi verebilir. Hamilenin bu tip bir ila\u00e7 kullan\u0131p kullanmamas\u0131 gerekti\u011fine hamileyi takip eden kad\u0131n do\u011fum uzman\u0131 karar verir.<\/p>\n","protected":false},"excerpt":{"rendered":"

HAM\u0130LEL\u0130KTE…<\/p>\n","protected":false},"author":4,"featured_media":6769,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1523],"tags":[3960,3954,3955,3958,3959,3957,3956,3961],"_links":{"self":[{"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/posts\/6765"}],"collection":[{"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/comments?post=6765"}],"version-history":[{"count":0,"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/posts\/6765\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/media\/6769"}],"wp:attachment":[{"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/media?parent=6765"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/categories?post=6765"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.coolkadin.com\/wp-json\/wp\/v2\/tags?post=6765"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}