RESUMO
Resumen OBJETIVO: evaluar los resultados de la cirugía de control de daños en hemorragia obstétrica en un hospital de tercer nivel. MATERIAL Y MÉTODO: estudio retrospectivo, descriptivo y transversal efectuado en pacientes con hemorragia obstétrica que requirieron cirugía de control de daños en el Hospital de Ginecoobstetricia 3 del Centro Médico Nacional La Raza, de enero a diciembre del 2015. Para el análisis estadístico se utilizaron medidas de tendencia central y el programa SPSS, versión 16.0. RESULTADOS: se identificaron 16 pacientes con edad promedio de 34.5 años, y 33.3 semanas de gestación. La causa de la hemorragia fue: atonía uterina 31%, inserción placentaria anómala 44%, ruptura uterina 13%, otras 13%. La cirugía inicial fue programada en 6%, y de urgencia en 94%. El promedio de compresas fue de 7.6, y de ligadura de arterias hipogástricas 88%. El tiempo promedio entre la primera y segunda cirugía fue de 27.3 horas. En 81% de los casos se logró el tratamiento definitivo en la segunda cirugía. Los días de estancia en la unidad de cuidados intensivos fueron 5.3, y de estancia hospitalaria 10.9. Hubo complicaciones en 81% de los casos y las principales complicaciones quirúrgicas representaron 63%, las infecciosas 31% y las renales 81%. Se documentó una muerte materna. CONCLUSIONES: si no se consigue el control definitivo del sangrado la cirugía de control de daños debe efectuarse lo más pronto posible. En Obstetricia hay un elevado porcentaje de complicaciones quirúrgicas, infecciosas y derivadas de la hemorragia masiva.
Abstract OBJECTIVE: To evaluate the results of the damage control surgery in obstetric hemorrhage in a third level hospital. MATERIAL AND METHOD: Retrospective study. Medical records from patients with obstetric hemorrhage who required damage control surgery at the Obstetrics and Gynecology hospital number 3, "Centro Médico Nacional La Raza", a third level unit in Mexico city, from January to December 2015. Measures of central tendency were performed for the statistical analysis using Software SPSS, version 16.0. RESULTS: 16 patients were identified. The mean age of the participants was 34.5 years and for the gestational age was 33.3 weeks. The etiology of the hemorrhage included: uterine atony in 31%, abnormal placentation in 44%, uterine rupture in 13%, other causes in 13%. Planned programmed surgery was performed in 6%, while emergency surgery in 94%. The mean number of compress towels used was 7.6, and hypogastric arteries ligation was necessary in 88%. The mean time between the first and second surgeries was 27.3 hours. A definitive treatment was achieved at the second surgery in 81% of cases. The mean time of ICU stay was 5.3 days, and in hospital was 10.9 days. Complications were identified in 81% of cases, being the principal: surgical (63%), infectious (31%) and renal (81%). One death was documented. CONCLUSIONS: Damage control surgery should be done early by not achieving definitive control of bleeding. In obstetrics there is a high percentage of surgical complications, infectious and those resulting from massive hemorrhage.
RESUMO
OBJECTIVE: To present clinical cases examining the effectiveness and safety of pelvic packing with vaginal traction for inhibiting obstetric hemorrhage among women receiving treatment at a public obstetrics and gynecology tertiary care hospital in Mexico. METHODS: In a retrospective observational descriptive study, eight cases of obstetric hemorrhage treated by pelvic packing with vaginal traction between January 2012 and December 2013 at Hospital de la Mujer, Mexico City, Mexico, were reviewed. RESULTS: The mean patient age was 28.8±6.8 years. The average blood loss was 4535±897 mL. Uterine atony was the cause of bleeding among six patients: histopathologic examination revealed two cases of placenta accreta, one case of placenta percreta, two cases of uteroplacental apoplexy, and one case of myomatosis. For two patients, placental separation was difficult and required surgical management. The packing technique was effective for all patients. No patients presented with infection or required re-operation for bleeding management. No deaths occurred. CONCLUSION: For management of bleeding among patients with underlying coagulation disorders, pelvic packing can be useful when standard techniques such as hysterectomy, tubal hypogastric ligation, and/or pharmacologic therapy are unsuccessful.
Assuntos
Hemorragia Pós-Parto/terapia , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
Pelvic fractures in hemodynamically unstable patients are associated with high rates of morbidity and mortality. The optimal management strategy for hemorrhage control remains controversial. We present a clinical case that was successfully treated with retroperitoneal pelvic packing. The technique is described and discussed.
Las fracturas de pelvis con inestabilidad hemodinámica se asocian a altas tasas de morbilidad y mortalidad. No existe consenso sobre la mejor manera de controlar hemorragia asociada. Se presenta un caso manejado exitosamente mediante la realización de un packing pelviano retroperitoneal. Se describe la técnica quirúrgica y se discuten sus alcances.