ABSTRACT
Hemorragia pós-parto é a maior causa de histerectomia periparto. Esta revisão descreve e ilustra as técnicas de ligaduras vasculares utilizadas no tratamento cirúrgico da hemorragia pós-parto. São apresentados os detalhes técnicos da ligadura das artérias uterinas, da ligadura das conexões útero-ovarianas, da ligadura tríplice de Tsirulnikov, das ligaduras sequenciais de AbdRabbo e de Morel e da ligadura das artérias ilíacas internas. Também são revistos os fatores que dificultam o sucesso dessas técnicas. As ligaduras vasculares são estratégias eficientes para o controle hemorrágico durante cesarianas e devem integrar o conjunto de técnicas que preservam o útero no tratamento da hemorragia pós-parto.(AU)
Postpartum hemorrhage is the major cause of peripartum hysterectomy. This review describes and illustrates the techniques of vascular ligations used in the surgical treatment of postpartum hemorrhage. The technical details of the uterine arteries ligation, of the ligation of the utero-ovarian connections, of the Tsirulnikov triple ligation, of the AbdRabbo and Morel sequential ligations and of the internal iliac arteries ligation are presented. The factors that hinder the success of these techniques also are reviewed. Vascular ligations are efficient strategies for hemorrhagic control during cesarean sections and should integrate the set of techniques that preserve the uterus in the treatment of postpartum hemorrhage.(AU)
Subject(s)
Humans , Female , Pregnancy , Uterine Artery/surgery , Postpartum Hemorrhage/surgery , Ligation/methods , Databases, Bibliographic , Fertility Preservation/methods , Postpartum Hemorrhage/mortalityABSTRACT
OBJECTIVES: Female breast cancer patients generally have limited knowledge regarding issues related to preservation of ovarian function and fertility. The present study aimed to explore the change in the understanding of these issues when female breast cancer patients are educated and counseled about ovarian function and fertility after anticancer treatment.METHODS: One hundred nine young female breast cancer patients completed a questionnaire, which revealed their thoughts and opinions before and after receiving the education about ovarian function and fertility. Their responses were analyzed to determine the impact of the education on their perception and understanding of the aforementioned issues.RESULTS: The objective survey had four main themes: planning and desire for children, degree of baseline understanding of the effects of anticancer therapy on fertility and ovarian function, resultant change in cognition after education about cancer treatment and its relationship with fertility, and need for education regarding the types of therapies received and their effects on subsequent ovarian function and fertility before treatment.CONCLUSIONS: The preservation of ovarian function and fertility is an important factor that must be included in the discussion prior to initiation of anticancer therapy. Although the study results do not have high educational effectiveness or a high satisfaction with education, there is a need for information and education regarding the impact of anticancer treatment on preservation of ovarian function and fertility.
Subject(s)
Child , Female , Humans , Breast Neoplasms , Breast , Cognition , Education , FertilityABSTRACT
O objetivo deste estudo foi buscar evidências sobre a interferência do uso do SIU-LNG em mulheres submetidas a ciclos de hiperestimulação ovariana para preservação de fertilidade. Através de uma revisão integrativa, com busca nas bases de dados Lilacs, Pubmed e Cochrane, utilizamos algumas palavras-chaves, relacionando inicialmente 43 artigos, totalizando após aplicação dos critérios de inclusão e exclusão em 30 estudos. Os artigos abordados foram selecionados baseados nos itens: autor principal, ano de publicação, desenho do estudo, nível de evidência científica e assunto principal. Os estudos foram separados conforme os seguintes temas de abrangência: preservação de fertilidade, preservação de fertilidade e métodos contraceptivos, SIU-LNG e preservação de fertilidade, SIU-LNG e farmacocinética e SIU-LNG e gestação. Existem poucos estudos na literatura avaliando mulheres usuárias do SIU-LNG submetidas à estimulação ovariana em ciclos de reprodução assistida. Em dois estudos disponíveis, ambos com doadoras de oócitos, não foram observadas diferenças estatisticamente significantes entre as doadoras usuárias do SIU-LNG em relação aos controles, quando comparados os parâmetros descritos: número de ampolas de gonadotrofinas utilizadas na estimulação, número de folículos recrutados, número de oócitos, taxas de fertilização, taxas de clivagem e número de embriões por receptora. O impacto do uso do SIU-LNG em mulheres submetidas à estimulação ovariana em ciclos de preservação oocitária ainda não está claro, assim como o protocolo ideal. As evidências atuais são insuficientes para definir o real efeito do uso do SIU-LNG durante os ciclos de estimulação ovariana. Entretanto, o SIU-LNG não parece ter efeito negativo sobre o crescimento folicular, sobre a qualidade oocitária e a qualidade embrionária, podendo ser utilizado durante este processo. Há a necessidade de estudos randomizados controlados avaliando uma nova opção terapêutica nos ciclos de reprodução assistida.(AU)
The objective of this study was to search for evidence on the interference of the use of LNG-SIU in women submitted to cycles of ovarian hyperstimulation for preservation of fertility, through an integrative review, with search in the databases Lilacs, Pubmed and Cochrane. Using related keywords 43 articles were examined, totaling, after inclusion and exclusion criteria, in 30 studies. The articles were classified according to a synoptic table organized in topics: main author, year of publication, study design, level of scientific evidence and main subject. The studies were separated according to the topics covered: preservation of fertility, preservation of fertility, and contraceptive methods, SIU-LNG and preservation of fertility, SIU-LNG and pharmacokinetics and SIU-LNG and gestation. It was observed that there are few studies in the literature evaluating women users of LNG-IUS who undergo ovarian stimulation in cycles of assisted reproduction. In two of them, both induding oocyte donors, no statistically significant differences were observed among donors using the LNG-IUS as compared to controls regarding the described parameters: number of gonadotrophin ampules used in stimulation, number of recruited follicles, number of oocytes, fertilization rates, cleavage rates and number of embryos per recipient. The impact of the use of IUS-LNG in women submitted to ovarian stimulation in oocyte preservation cycles is still unclear, as it is the ideal protocol. Current evidence is insufficient to define the real effect of the use of LNG-SIU during cycles of ovarian hyperstimulation in assisted reproduction. However, although there is little research available, the LNGSIU does not seem to have a negative effect on follicular growth, on oocyte quality and on embryo quality, and it can be used during this process. There is a need for randomized controlled trials and other research in this context to evaluate a new therapeutic option in the cycles of assisted reproduction.(AU)