ABSTRACT
Resumen Objetivo: Determinar el punto de corte del índice de choque obstétrico asociado con trasfusión masiva en mujeres con hemorragia obstétrica. Materiales y métodos: Estudio retrospectivo, transversal y analítico efectuado con base en la revisión de los expedientes clínicos de pacientes que ingresaron a la unidad de cuidados intensivos. Cálculo del índice de choque obstétrico al momento del diagnóstico de hemorragia obstétrica. Análisis de los signos vitales, gasometría, tipo de componentes sanguíneos trasfundidos y cantidad de líquidos administrados. Resultados: Se incluyeron 105 pacientes con hemorragia obstétrica; en 65 (61%) el resultado del índice de choque fue ≥ 0.9, de éstas 38 (58%) requirieron trasfusión masiva. El índice de choque obstétrico ≥ 0.9 se asoció, significativamente, con trasfusión masiva (p < 0.001). La pérdida sanguínea fue de 3000 mL (RIC 2000 mL) en pacientes con índice de choque obstétrico ≥ 0.9 vs 2500 mL (RIC 1000 mL) en pacientes con índice de choque obstétrico < 0.9 (p = 0.04). Las mujeres con índice de choque obstétrico ≥ 0.9 mostraron mayor requerimiento de trasfusión de concentrados globulares (p = 0.03) y plaquetarios (p = 0.01). Conclusiones: Un índice de choque obstétrico ≥ 0.9 se asoció con altos requerimientos de trasfusión sanguínea y mayor incidencia de eventos adversos graves, por lo que se recomienda este valor como el punto de corte para predicción de la necesidad de trasfusión masiva.
Abstract Objective: To determine the cut-off point of obstetric shock index associated with massive transfusion in women with obstetric hemorrhage. Materials and methods: We designed a cross-sectional study in women who were admitted to the intensive care unit. The obstetric shock index was calculated at the time of the diagnosis of obstetric hemorrhage. We analyzed vital signs, arterial blood gas, loss of blood, fluid replacement and transfused blood products. Results: One hundred and five women with obstetric bleeding were included, in 65 (61%) the obstetric shock index was ≥ 0.9, of whom 38 (58%) needed massive transfusion. Obstetric shock index ≥ 0.9 was significantly associated with massive transfusion (p < 0.001). The blood loss was of 3000 mL (RIC 2000 mL) in the patients with obstetric shock index ≥ 0.9 compared to 2500 mL (RIC 1000 mL) in patients with obstetric shock index < 0.9 (p = 0.04). Women with obstetric shock index ≥ 0.9 showed more significant requirement of transfusion of package red blood (p = 0.03) and platelets (p = 0.01). Conclusions: An obstetric shock index ≥0.9 was associated with high transfusión requirements and a higher incidence of serious adverse events, this value is recommended as the cut-off point for predicting the need for massive transfusion.
ABSTRACT
Se presenta el caso de una paciente de 24 años que ingresa al Hospital Regional de Lambayeque con una gestación doble bicorial biamniótica de 34 semanas 4 días por ecografía de II trimestre, en cuya ecografía al ingreso se evidenciaba una imagen dependiente de placenta probable teratoma placentario. Es hospitalizada con diagnósticos: Amenaza de parto pretérmino, feto 2 en transverso. Habiendo recibido tocólisis y maduración pulmonar se culmina la gestación por cesárea por parto pretérmino, obteniéndose dos recién nacidos de adecuado peso para la edad gestacional con dos placentas y una masa sólida de tejido embrionario con cordón procedente de una de las placentas, cuya anatomía patológica concluye: feto acárdico amorfo, producto de una perfusión feto fetal.
ABSTRACT
It is well known that autotransfusion can reduce or eliminate the use of homologous transfusion and can overcome the side effects of homologous transfusion. Also, many studies have been reported that autotransfusion showed better postoperative courses than homologous transfusion. We have reported the concept and benefit of autotransfusion in spinal surgery. So we would also compare the autotransfusion and homologous transfusion in total hip replacement arthroplasty, and would find out the effect of autotransfusion. From March 1993 to February 1995, autotransfusion group(38 hips) and homologous transfusion group(30 hips) were compared and eight patients(8 hips) who required homologous blood among autotransfusion group were excluded in comparison. The results were as follows: 1. Total transfusion amounts were 1013±174cc in autotransfusion group and 1088±601cc in homologous transfusion group. There were no statistically significed difference between both groups. 2. Total amounts and duration of postoperative drainage were significantly less in autotransfusion group, especially in the cases of postoperative autotransfusion with Orth-evac. 3. There was no difference of preoperative hemoglobin level in both groups, but the level was recovered more promptly in autotransfusion group. 4. In autotransfusion group, 3 hips(10%) showed fever and chilling sensation. Among them, 2 hips were transfused postoperatively with Orth-evac. In homologous transfusion group, 8 hips(27%) experienced one or more than one of transfusion side effects. 5. Homologous blood was also required in eight patients of autotransfusion group. Four patients of them were hypertensive and one was revision case. In conclusion, we think we can expect better postoperative recovery and also reduce or eliminate homologous transfusion with autotransfusion. But, hematologically and physiologically, further study will be necessary.