RESUMO

PURPOSE: To describe the use of a local hemostatic agent (LHA) for the management of postpartum hemorrhage (PPH) due to bleeding of the placental bed in patients taken to caesarean section at Fundación Santa Fe de Bogotá University Hospital. SAMPLE: A total of 41 pregnant women who had a caesarean section and developed PPH. METHODS: A cross-sectional study. Analysis of all cases of PPH during caesarean section presented from 2006 up to and including 2012 at Fundación Santa Fe de Bogotá University Hospital. MAIN OUTCOME MEASURE: Emergency hysterectomy due to PPH. RESULTS: The proportion of hysterectomies was 5 vs. 66 % for the group that received and did not receive management with a LHA respectively (PR 0.07, CI 95 % 0.01-0.51 p < 0.01). For the group managed without a LHA, 80 % of patients needed hemoderivatives transfusion vs. 20 % of patients in the group managed with a LHA (PR 0.24, CI 95 % 0.1-0.6 p < 0.01). A reduction in the mean days of hospitalization in addition to a descent in the proportion of patients admitted to the intensive care unit (ICU) was noticed when comparing the group that received a LHA versus the one that did not. CONCLUSION: An inverse association between the use of a LHA in patients with PPH due to bleeding of the placental bed and the need to perform an emergency obstetric hysterectomy was observed. Additionally there was a significant reduction in the mean duration of hospital stay, use of hemoderivatives and admission to the ICU.

Assuntos

RESUMO

Objetivo: realizar una revisión de la literatura sobre la epidemiología, etiología, diagnóstico y manejo de la ruptura de vasos uterinos en el embarazo.Materiales y métodos: Se presenta el caso de una mujer de 32 años quien desarrolla un hemoperitoneo espontáneo en el puerperio inmediato, secundario a la ruptura de los vasos uterinos superficiales en el Hospital Universitario Fundación Santa Fe de Bogotá, instituto de cuarto nivel, que atiende pacientes del aseguramiento contributivo privado. Se realizó una laparotomía e histerectomía de urgencia en la que se encontró tejido endometrial en cara posterior del útero y en fondo de saco posterior con sangrado venoso activo. Se realizó una búsqueda bibliográfica en las bases de datos electrónicas Medline/Pubmed, Ebsco, Ovid y ProQuest a partir de los términos hemoperitoneum, pregnancy, uterine vessel rupture y endometriosis sin limitación de idioma y diseño epidemiológico, publicados desde 1966 hasta la fecha.Resultados: se encontraron 34 artículos de interés, de estos se seleccionaron un total de 13: una guía de práctica clínica, 2 artículos de revisión y 10 reportes de casos. Conclusión: el hemoperitoneo durante el embarazo, como resultado de ruptura de los vasos uterinos, es una complicación rara, de etiología no clara y cuadro clínico poco específico. Para el manejo es necesario realizar un enfoque multidisciplinario, intervención quirúrgica temprana y correcta reposición del volumen intravascular.

Objective: To undertake a review of the literature on the epidemiology, etiology, diagnosis and management of uterine vessel ruptures in pregnancy.Materials and methods: A case of a 32 year old woman with spontaneous hemoperitoneum in the immediate post-partum period secondary to a rupture of superficial uterine vessels at Hospital Universitario Fundación Santa Fe, a high complexity institution that provides care to patients with private contributive health insurance coverage. Emergency laparotomy and hysterectomy were performed with a finding of endometrial tissue in the posterior aspect of the uterus and the posterior cul-de-sac, and active venous bleeding. A search of the literature was done in Medline/Pubmed, Ebsco, Ovid and ProQuest, using the terms "hemoperitoneum", "pregnancy", "uterine vessel rupture" and "endometriosis" with no language limitation and epidemiologic design, published since 1966 to this date. Results: Out of 34 articles of interest, 13 were selected: 1 clinical practice guideline, 2 review articles and 10 case reports. Conclusion: Hemoperitoneum in pregnancy, secondary to uterine vessel rupture is a rare complication of unclear etiology and non-specific clinical presentation. Management requires a multidisciplinary approach with early surgical intervention and correct intravascular volume replacement.

Assuntos

RESUMO

Interstitial pregnancy is a dangerous and uncommon variation of ectopic pregnancy occurring in the interstitial part of the fallopian tube and extending beyond the muscular layer of the uterus. This ectopic pregnancy-related mortality rate has been reported to be as high as 2%-2,5% due to complications involving bleeding and hypervascularity. No prospective clinical trials have evaluated available treatment options for interstitial ectopic pregnancy due to its low incidence; there is thus no consensus regarding optimal treatment. Surgical treatment can be divided into conservative approaches, such as cornuectomy or cornuostomy, and radical approaches such as hysterectomy. However, intraoperative hemorrhage is an ever-present risk, regardless of the surgical approach adopted. This paper presents a case involving a patient who underwent laparoscopic resection of an interstitial twin ectopic pregnancy; a barbed suture pursestring was used which proved useful during the surgical technique and improved hemostasia.

Assuntos