RESUMEN
OBJECTIVE: To report the authors' experience in bilateral hypogastric (internal iliac) artery ligation which was performed for controlling intractable postpartum hemorrhage in a secondary care center. MATERIALS AND METHODS: The patients that required bilateral hypogastric artery ligation for severe intractable postpartum hemorrhage from November 2007 to August 2009 were included in this retrospective study. Data were retrieved from patients' hospital records. RESULTS: A total of 26 cases required hypogastric artery ligation during the study period. Causes of postpartum hemorrhage included uterine atony, placental abruption, uterine rupture, and placenta accreta. Hemorrhage was effectively controlled in 20 of 26 cases (76.9%) and hysterectomy was avoided. Iliac vein injury occurred in one patient (3.8%) as an operative complication. There was one maternal death. CONCLUSION: Hypogastric artery ligation is an effective therapeutic option for severe postpartum hemorrhage and should be kept in mind during obstetric emergency conditions.
Asunto(s)
Arterias/cirugía , Preservación de la Fertilidad , Hemorragia Posparto/cirugía , Adulto , Servicios Médicos de Urgencia , Femenino , Humanos , Ligadura , Embarazo , Estudios Retrospectivos , Atención Secundaria de Salud , Adulto JovenRESUMEN
OBJECTIVES: Gestational choriocarcinoma associated with ectopic pregnancy is an extremely rare event. Here we report one of these cases. CASE: A 38-year-old, gravida 4, parity 3, patient was admitted to the emergency room with the complaint of abdominal pain. Peritoneal irritation signs were present and serum hCG level was found to be greater than 15000 mUI/ml. Transvaginal ultrasound images were compatible with ruptured tubal ectopic pregnancy. Hemoperitoneum and ruptured tuba were found at laparatomy and a right salpingectomy was performed. The histopathological evaluation reported the lesion as primary tubal choriocarcinoma. The patient was referred to a tertiary care center for treatment and follow-up. CONCLUSION: Adequate monitoring of beta-hCG titers and careful examinations of pathologic specimens are important to avoid misdiagnosis of ectopic gestational trophoblastic disease.