Protocolo Clínico - Quirúrgico de Cesárea en la Unidad Técnica de Alto Riesgo Obstétrico / Clinical-Surgical Protocol for Cesarean Section in the Obstetric High Risk Technical Unit

El procedimiento quirúrgico cesárea con miras a la historia es considerada como un avance de suma importancia en la dismi-nución del riesgo de mortalidad materna y perinatal1.Es la intervención más realizada a nivel de especialidad lo que conlleva riesgos inherentes, quirúrgicos y anestésicos2,3.En el año 2015 la incidencia en el Ecuador de terminación del embarazo por cesárea es del 29,3% en el sector público, 49,9% en Seguridad Social y 69,9% en clínicas privadas4. Para la Or-ganización Mundial de la Salud (OMS) en el mismo año refiere que "En ninguna región del mundo se justifica la incidencia de cesárea superior al 10- 15%"5. La variabilidad de indicación de cesárea, hace que sea necesaria la creación de guías y protocolos, para de esta manera unificar los criterios médicos, de acuerdo a la mejor evidencia científica disponible.

The cesarean section surgical procedure is historically considered a very important advance in reducing the risk of maternal and perinatal mortality1.It is the most frequently performed intervention at the specialty level, which entails inherent surgical and anesthetic risks2,3.In 2015, the incidence in Ecuador of termination of pregnancy by cesarean section is 29,3% in the public sector, 49,9% in Social Security and 69,9% in private clinics4. For the World Health Or-ganization (WHO) in the same year, it states that "In no region of the world is the incidence of cesarean section higher than 10-15% justified" 5.The variability of the indication for cesarean section makes it ne-cessary to create guidelines and protocols, in order to unify me-dical criteria, according to the best scientific evidence available.

Demoras en atención materna y complicaciones hipertensivas en el Hospital Sabogal, Callao, Perú, 2021. Estudio de casos y controles / Delays in maternal care and hypertensive complications at the Sabogal hospital, Callao, Peru, 2021. Case-control Study

RESUMEN Objetivo: Evaluar si hay asociación entre demora II en atención materna y complicaciones de la hipertensión inducida por el embrazo (HIE) en el Hospital Alberto Sabogal en el contexto de pandemia por covid-19. Materiales y métodos: Estudio de casos y controles llevado a cabo en un hospital de referencia en la región de Callao, Perú. En el estudio se incluyeron mujeres de 19 años o más, atendidas por cesárea de urgencia debida a distocias fetales, sospecha de feto grande o cesáreas iterativas, y aquellas que tuvieron cesárea por emergencia atendidas en las áreas de obstetricia covid-19 y no covid-19 en los meses de enero a abril de 2021. Se excluyeron gestantes con enfermedades preexistentes, así como a quienes presentaban otras complicaciones obstétricas. Como casos se incluyeron pacientes con complicaciones de la hipertensión inducida por el embrazo (HIE) y como controles las que no tuvieron estas complicaciones. Se midió la edad, la procedencia, la ocupación, y el tipo de demora. Se usó un cuestionario según modelo de Thadeus y Maine, y revisión documentaria. Se evaluó la asociación entre demora II y complicaciones de la HIE a través de la odds ratio (OR). Resultados: Se encontró que los casos tuvieron un mayor riesgo de haber estado expuestos a demoras tipo II que los controles (OR: 7,72; IC 95 %: 3,44-17,35). Se identificó que la demora II se asoció con la procedencia de la paciente. Conclusión: En el periodo de la pandemia por co-vid-19 las mujeres que tuvieron complicaciones de la HIE estuvieron más expuestas a demoras tipo II que los controles en el Hospital Sabogal en Callao, Perú. Se requieren estudios prospectivos que confirmen esta asociación y los efectos de la congestión de los servicios hospitalarios por pacientes con covid-19 en otros desenlaces maternoperinatales en la región.

ABSTRACT Objective: To evaluate if there is association between delay II in maternal care and complications of Pregnancy-induced hypertension (PIH) at the Alberto Sabogal Hospital in the context of the Covid19 pandemic. Material and methods: Case-control study carried out in a reference hospital in the Callao region, Peru. The study included women aged 19 or over, treated for emergency caesarean section attended in the obstetric areas COVID-19 and non-COVID-19 in the months of January to April 2021. Pregnant women with pre-existing diseases, as well as those with other obstetric complication were excluded. Patients with complications of pregnancy-induced hypertension (PIH) were included as cases, and those without these complications as controls. Age, origin, occupation, type of delay and type of complication of PIH were measured. A questionnaire was used according to the Thadeus and Mayne model and documentary review. The association between delay II and complications of PIH was evaluated through the odds ratio (OR). Results: It was found that the cases had a higher risk of having been exposed to type II delays than the controls (OR: 7.72; 95% CI: 3.44-17.35). There was an association between delay II and hypertensive complications. It was identified that delay II was associated with the origin of the patient. Conclusion: In the period of the Covid-19 pandemic, women who had complications from PIH were more exposed to type II delays than controls at the Alberto Sabogal hospital in Callao, Peru. Prospective studies are required to confirm this association and the effects of congestion of hospital services by patients with covid-19 on other maternal-perinatal outcomes in the region.

Uterine compression suture for the treatment of postpartum hemorrhage resulting from uterine atony in 50 cases / 中国基层医药

Objective:To investigate the clinical efficacy of uterine compression suture in the treatment of postpartum hemorrhage resulting from uterine atony.Methods:100 patients with postpartum hemorrhage due to uterine atony who received treatment between May 2017 and May 2018 in the First People's Hospital of Yongkang were included in this study. They were randomly assigned to undergo either conventional uterine suture (control group, n = 50) or uterine compression suture (observation group, n = 50). Clinical efficacy was compared between the observation and control groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [94.0% (47/50) vs. 68.0% (34/50), χ2 = 12.421, P < 0.01]. There was no significant difference in operative time between observation and control groups [(62.99 ± 10.87) minutes vs. (60.98 ± 8.12) minutes, t = 1.048, P > 0.05]. The amount of blood loss within 2 and 24 hours postpartum, abdominal circumference, and uterine height in the observation group were (216.85 ± 16.85) mL, (356.19 ± 25.71) mL, (98.56 ± 5.86) cm and (35.17 ± 2.33) cm respectively, which were significantly less or lower than those in the control group [(485.29 ± 28.41) mL, (596.38 ± 34.18) mL, (108.59 ± 2.65) cm, and (38.45 ± 4.19) cm, t = 85.652, 65.325, 16.584, 3.256, all P < 0.05]. The incidence of complications in the observation group was significantly lower than that in the control group [4.0% (2/50) vs. 28.0% (14/50), χ2 = 12.032, P < 0.01]. Conclusion:Uterine compression suture for the treatment of postpartum hemorrhage resulting from uterine atony has greater clinical efficacy and leads to lower incidence of complications than conventional suture technique.

Embarazo posterior a cirugía conservadora del útero ante hemorragia obstétrica postparto. Presentación de un caso / Pregnancy after conservative surgery of the uterus after postpartum obstetric hemorrhage. Presentation of a case

RESUMEN El embarazo es un proceso natural que debe concebirse sin complicaciones; sin embargo, los desenlaces obstétricos fatales en gestaciones previas, son marcadores importantes de un riesgo incrementado de morbimortalidad materna y perinatal en los próximos embarazos. La hemorragia obstétrica posparto es una de las más frecuentes y severas complicaciones del periparto; como una alternativa terapéutica útil en esos casos, el manejo quirúrgico conservador de útero permite mantener la fertilidad en mujeres con paridad no satisfecha, y mejorar su calidad de vida, aunque en muchas ocasiones, por causas diversas, esto no es posible. Se presenta el caso de una paciente de 26 años de edad, con historia obstétrica de tres embarazos, un parto y un aborto (provocado); y el antecedente de complicación obstétrica hemorrágica en embarazo anterior por atonía uterina, la cual requirió tratamiento quirúrgico conservador con técnicas combinadas (suturas compresivas de Hayman, Ho-Cho y ligadura bilateral de las arterias uterinas). Dos años después, acudió a los servicios obstétricos con gestación de 16 semanas (alto riesgo obstétrico). Este artículo tiene el objetivo de exponer el informe de una paciente en la que se logró la concepción de un embarazo posterior a la realización de cirugía conservadora del útero.

ABSTRACT Pregnancy is a natural process that must be conceived without complications; however, fatal obstetric outcomes in previous pregnancies are important markers of an increased risk of maternal and perinatal morbidity and mortality in future pregnancies. Postpartum obstetric hemorrhage is one of the most frequent and severe complications of the peripartum; As a useful therapeutic alternative in these cases, conservative surgical management of the uterus allows fertility to be maintained in women with unsatisfied parity, and improves their quality of life, although in many cases, for various reasons, this is not possible. The case of a 26-year-old patient is presented, with an obstetric history of three pregnancies, one delivery and one abortion (provoked); and a history of hemorrhagic obstetric complication in previous pregnancy due to uterine atony, which required conservative surgical treatment with combined techniques (Hayman, Ho-Cho compression sutures and bilateral ligation of the uterine arteries). Two years later, she attended obstetric services with a 16-week gestation (high obstetric risk). This article aims to present the report of a patient in whom the conception of a pregnancy was achieved after performing conservative surgery on the uterus.

Factores sociodemográficos y obstétricos relacionados con aplicación del consentimiento informado en procedimientos de oclusión tubárica. Cartagena-Colombia / Sociodemographic and obstetric factors related to the application of informed consent in procedures of tubal occlusion. Cartagena-Colombia

Introducción: La forma como se aplica el consentimiento informado (CI) en algunas instituciones prestadoras de salud, donde se realizan procedimientos de oclusión tubárica bilateral (OTB) en Cartagena, podría verse influenciado por factores de tipo sociodemográfico y factores de tipo obstétrico, que al final determinan la forma como se aplica el Consentimiento informado y que este sea más que un requisito para desligar responsabilidades por parte de profesionales en su relación médico- paciente. Objetivo: Determinar la influencia de los factores sociodemográficos y obstétricos en la aplicación del consentimiento informado, en procedimientos de OTB, en centros de salud de Cartagena. Material y Métodos: Se realizó un estudio descriptivo transversal prospectivo. Las fuentes de información consultadas son fuentes primarias; se encuestaron 196 pacientes que se realizaron procedimientos de cesárea por urgencias más oclusión tubárica bilateral. Se efectuó análisis Univariado y Bivariado para establecer tendencia a la asociación mediante la prueba de Chi cuadrado. Resultados: Dentro de las características sociodemográficas y obstétricas asociadas estadísticamente con conocer lo que es el consentimiento informado están tener más de 24 años (p= 0,033); ser de procedencia urbana (p=0,046); vivir en estrato superior a estrato 1 y 2 (p=0,0001), tener estudios superiores a primaria (p=0,0001); no tener más de dos embarazos (p=0,029) y asistir a control prenatal (p=0,0001). Conclusiones: La mayoría de las pacientes poseen en términos generales desconocimiento sobre el CI. El estrato socioeconómico, el nivel de escolaridad y la procedencia influyen en el nivel de conocimiento que tienen del CI, lo mismo que algunos factores obstétricos(AU)

Introduction: The way in which informed consent (IC) is applied in some healthcare institutions where bilateral tubal occlusion (OTB) procedures are performed in Cartagena could be influenced by sociodemographic and obstetric factors which ultimately determine the way at which informed consent is applied, being this more than a requirement for the professionals to be free of liability in their doctor-patient relationship. Objective: To determine the influence of sociodemographic and obstetric factors on the application of informed consent in OTB procedures in health centers in Cartagena. Material and Methods: A prospective cross-sectional descriptive study was carried out. Primary sources of information were consulted; a total of 196 patients who underwent cesarean section procedures for emergencies plus bilateral tubal occlusion were surveyed. Univariate and bivariate analyzes were performed to establish a tendency to association using the Chi-square test. Results: Some sociodemographic and obstetric characteristics statistically associated with knowledge about informed consent are to be over 24 years old (p=0.033); to be of urban origin (p=0.046); to live in stratum higher than stratum 1 and 2 (p=0.0001), to have higher education than primary (p=0.0001); not to have more than two pregnancies (p=0.029) and to attend prenatal care (p=0.0001), among others. Conclusions: Most patients are generally unaware of IC. The socioeconomic stratum, level of schooling, origin and some obstetric factors have an influence on their level of knowledge of IC(AU)

Development and validation of a technology for obstetric intraoperative care safety / Elaboración y validación de tecnología para la seguridad de la atención intraoperatoria obstétrica / Elaboração e validação de tecnologia para segurança do cuidado intraoperatório obstétrico

ABSTRACT Objectives: to develop and validate an obstetric surgical safety checklist for intraoperative care. Methods: this is a methodological study with two phases: integrative review in databases, using selection criteria and descriptors to synthesize the evidence and develop the checklist; checklist content validation, with 37 judges, who answered a Likert-type questionnaire. For analysis, a >85% content validation index was applied. Results: the checklist's first moment reached a 96.1 content validation index; the second moment, 95.5; the third moment, 98.9. Thus, the validation index of all verifying sections present in the three surgical moments was 97.1. Cronbach's Alpha value was 95.57%. Conclusions: the checklist items were validated by judges, with improvement of some items and insertion of others.

RESUMEN Objetivos: desarrollar y validar una lista de verificación de seguridad quirúrgica obstétrica para la atención intraoperatoria. Métodos: estudio metodológico con dos fases: revisión integradora en bases de datos, utilizando criterios de selección y descriptores para sintetizar la evidencia y construir la lista; validación de contenido de la lista con 37 jueces, quienes respondieron un cuestionario utilizando la escala Likert. Para el análisis se aplicó el índice de validación de contenido> 85%. Resultados: el primer momento de la lista alcanzó un índice de validación de contenido de 96,1; el segundo momento, 95,5; el tercer momento, 98,9. Con eso, el índice de validación de todas las secciones de control presentes en los tres momentos quirúrgicos fue de 97,1. El valor Alfa de Cronbach fue del 95,57%. Conclusiones: los ítems de la lista fueron validados por los jueces, con mejora de algunos ítems e inserción de otros.

RESUMO Objetivos: elaborar e validar uma lista de verificação de segurança cirúrgica obstétrica para o atendimento intraoperatório. Métodos: estudo metodológico com duas fases: revisão integrativa em bases de dados, com a utilização de critérios de seleção e descritores para a síntese das evidências e construção da lista; validação de conteúdo da lista com 37 juízes, que responderam um questionário utilizando a escala Likert. Para análise, aplicou-se o índice de validação de conteúdo >85%. Resultados: o primeiro momento da lista alcançou um índice de validação de conteúdo de 96,1; o segundo momento, 95,5; o terceiro momento, 98,9. Com isso, o índice de validação de todas as seções de checagem presentes nos três momentos cirúrgicos foi de 97,1. O valor do Alpha de Cronbach foi de 95,57%. Conclusões: os itens da lista foram validados pelos juízes, com aperfeiçoamento de alguns itens e inserção de outros.

Clinical analysis of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy / 中国基层医药

Objective@#To investigate the clinical efficacy of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy.@*Methods@#From September 2016 to March 2018, 68 patients with cesarean scar pregnancy in the People's Hospital of He'nan Province were collected.According to different treatment methods, the patients were divided into observation group and control group.The observation group (42 cases) firstly received bilateral uterine artery embolization, then hysteroscopy pregnancy lesion was resected after 2-3 days.The control group (26 cases) directly received hysteroscopy endoscopic pregnancy lesion resection.@*Results@#There were 42 cases in the observation group, 2 cases(all of them III type)failed, of which 1 case was treated with laparoscopy, and 1 case was converted to transvaginal focus clearance.In the control group, 26 cases of cesarean scar pregnancy were treated directly by hysteroscopy, and 6 cases were failed(1 case of type I, 4 cases of type II, 1 case of type III), among which 3 cases were treated with uterine artery embolization.Then hysteroscopic surgery was performed in 2 cases, combined with laparoscopy for pregnancy focus debridement.One case of severe hemorrhage occurred in III type operation, which was immediately converted to open operation.The operation time, intraoperative blood loss, surgical success rate, length of hospital stay, blood β-HCG return to normal time, menstrual recovery time, postoperative vaginal bleeding, postoperative vaginal bleeding time in the observation group were (17.09±3.62)min, (32.6±5.6)mL, 95.2%(40/42), (4.76±1.63)d, (18.00±6.62)d, (30.28±4.23)d, (32.75±8.32)mL, (3.26±1.06)d, respectively, which in the control group were (49.51±3.41)min, (60.3±13.6)mL, 76.9%(20/26), (7.23±1.96)d, (22.00±6.91)d, (36.41±7.62)d, (46.23±11.73)mL, (6.42±2.45)d, respectively, the differences between the two groups were statistically significant(t=36.68, 14.09, χ2=5.189, t=5.62, 2.30, 4.27, 5.54, 7.35, all P<0.05).@*Conclusion@#Bilateral uterine artery embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy has some advantages including high successful rate, short operation time, less bleeding, hospitalization time and postoperative recovery, etc.It is a safe and effective treatment especially for type I and type II scar pregnancy.

Clinical analysis of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy / 中国基层医药

Objective To investigate the clinical efficacy of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy.Methods From September 2016 to March 2018, 68 patients with cesarean scar pregnancy in the People's Hospital of He'nan Province were collected .According to different treatment methods ,the patients were divided into observation group and control group .The observation group (42 cases) firstly received bilateral uterine artery embolization ,then hysteroscopy pregnancy lesion was resected after 2 -3 days.The control group (26 cases) directly received hysteroscopy endoscopic pregnancy lesion resection . Results There were 42 cases in the observation group,2 cases(all of them III type)failed,of which 1 case was treated with laparoscopy ,and 1 case was converted to transvaginal focus clearance .In the control group ,26 cases of cesarean scar pregnancy were treated directly by hysteroscopy ,and 6 cases were failed(1 case of type I,4 cases of type II,1 case of type III),among which 3 cases were treated with uterine artery embolization .Then hysteroscopic surgery was performed in 2 cases,combined with laparoscopy for pregnancy focus debridement .One case of severe hemorrhage occurred in III type operation ,which was immediately converted to open operation .The operation time,intraoperative blood loss ,surgical success rate , length of hospital stay , blood β-HCG return to normal time , menstrual recovery time,postoperative vaginal bleeding , postoperative vaginal bleeding time in the observation group were ( 17.09 ± 3.62)min,(32.6 ±5.6)mL,95.2％(40/42),(4.76 ±1.63)d,(18.00 ±6.62)d,(30.28 ±4.23)d,(32.75 ± 8.32)mL,(3.26 ±1.06)d,respectively,which in the control group were (49.51 ±3.41)min,(60.3 ±13.6)mL, 76.9％(20/26),(7.23 ±1.96)d,(22.00 ±6.91)d,(36.41 ±7.62)d,(46.23 ±11.73)mL,(6.42 ±2.45)d, respectively,the differences between the two groups were statistically significant (t=36.68,14.09,χ2 =5.189,t=5.62,2.30,4.27,5.54,7.35,all P <0.05).Conclusion Bilateral uterine artery embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy has some advantages including high successful rate , short operation time,less bleeding,hospitalization time and postoperative recovery ,etc.It is a safe and effective treatment especially for type I and type II scar pregnancy .

Management of disseminated intravascular coagulation associated with placental abruption and measures to improve outcomes

Placental abruption is a condition that should be carefully considered in perinatal management because it is associated with serious events in both the mother and neonate, such as intrauterine fetal death, cerebral palsy, obstetric critical bleeding, and uncontrollable bleeding. The concomitant presence of disseminated intravascular coagulation (DIC) more easily causes critical bleeding that may necessitate hysterectomy or multi-organ failure resulting in maternal death. Therefore, early management should be provided to prevent progression to serious conditions by performing both hemostatic procedures and DIC treatment. To take measures to improve the outcomes in both the mother and neonate, health guidance for pregnant women, early diagnosis, early treatment, development of the emergency care system, and provision of a system for transport to higher-level medical institutions should be implemented.

Caracterización de pacientes que requirieron histerectomía obstétrica de urgencia. Cienfuegos, 2013-2015 / Charaterization of patients who needed urgent obstetric hystrectomy. Cienfuegos. 2013-2015

Fundamento: La histerectomía obstétrica es una alternativa terapéutica ante procesos graves (hemorrágicos y/o sépticos), que de no solucionarse influirían directamente en la morbimortalidad materna. El conocimiento sobre el tema permite actuar de manera coherente y racional ante situaciones de riesgo.Objetivo: caracterizar las pacientes que requirieron histerectomía obstétrica de urgencia relacionada con el embarazo en Cienfuegos.Métodos: se realizó un estudio descriptivo, de serie de casos, de todas las pacientes a las cuales se realizó histerectomía obstétrica (N=37) en el Hospital Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, entre los años 2013-2015. Las variables analizadas fueron: edad de la paciente edad gestacional, paridad, eventos relacionados con el embarazo y el parto, tipo de parto y tipo de histerectomía obstétrica.Resultados: el grupo de pacientes de 31-35 años fue el más numeroso, representativo del 40,5 % de total. El 73 % de las mujeres histerectomizadas tuvieron partos anteriores y 10 (27 %) pacientes eran nulíparas. La atonía uterina constituyó la causa más habitual (45,9 %), sobre todo en el grupo de 31-35 años (41,2 %), seguida de la rotura uterina y el acretismo placentario. El tipo de histerectomía más utilizado fue la total sin anexectomía (43,3 %).Conclusión: generalmente los embarazos llegaron a término, y la atonía, como en la gran mayoría de los estudios similares, fue la indicación que predominó. Se corroboró que el parto por cesárea eleva el riesgo relativo para realizar la histerectomía.

Foundation: Obstetric hysterectomy is a therapeutic alternative on severe processes (hemorrhagic and/or septic) which if not solved would directly influenced in maternal morbi/mortality. Knowing about the topic allows to proceed rationally and coherently on risky situations.Objective: to charaterize the patients, series of cases who needed urgent obstetric hysterectomies in Cienfuegos 2013-2015.Methods: a descriptive study was developed, a series of cases of all the patients who were performed an obstetric hysterectomy (N=37) in the Hospital Dr. Gustavo Aldereguía Lima. Cienfuegos, from 2013 to 2015. The variables analyzed were patient age, gestational age, parity, events related to pregnancy, delivery, kind of birth and type of obstetric hysterectomy.Results: the group of patients between 31-35 years old was the most numerous, representing 40,5 % of the total. The 73% of the hysterectomized women had previous deliveries and 10 (27 %) patients were nulliparous. Uterine atony was de most frequent cause (45,9 %), mainly in the 31-35 year group (41,2 %), followed by uterine rupture and placenta accreta. The total hysterectomy without ophorectomy was the most used type(43,3 %).Conclusion: in general pregnancies arrived to the term and the atony, as in many of similar studies was the predominating indication. It was corroborated that birth by cesarean section increases the relative risk to perform a hysterectomy.

Tecnologia para segurança do cuidado intraoperatório obstétrico: validação de uma lista de verificação / Technology for the safety of intraoperative obstetric care: validation of a checklist

A segurança do paciente é uma preocupação no Centro Cirúrgico, especialmente na particularidade da obstetrícia, onde a utilização de uma lista de verificação tem o potencial para reduzir os eventos adversos. Os objetivos foram: Construir uma tecnologia - Lista de Verificação de Segurança Cirúrgica Obstétrica (LIVESCO) para o atendimento intraoperatório; Validar tal lista de verificação de segurança cirúrgica obstétrica utilizada no atendimento intraoperatório a partir dos seus itens; e Discutir os limites e possibilidades da aplicabilidade dessa tecnologia no campo de segurança da assistência obstétrica e suas contribuições aos cuidados de enfermagem. Estudo de validação, quantitativo, desenvolvido em duas fases: a primeira fase foi uma revisão integrativa para a construção da lista de verificação, que foi realizada nas bases de dados Lilacs, Medline, Cinahl e Scopus com a utilização de critérios de seleção e descritores específicos. O corpus final foi de onze artigos e a partir da síntese das evidências captou-se os itens para a construção da lista, cujo protótipo foi organizado em momentos cirúrgicos e em seções de checagem. A segunda fase foi a validação de conteúdo da lista com 37 juízes, especialistas da área, que responderam um questionário online no qual avaliaram o design da lista e o seu conteúdo quanto à relevância, concisão, precisão, pertinência e clareza com base numa escala Likert. Para análise, aplicou-se o índice de validação de conteúdo (>85%). Dois testes complementares foram realizados: o Alfa de Cronbach e o Kappa de Fleiss para avaliar a confiabilidade da lista e a concordância entre os juízes. Verificou-se que o Índice de Validade de Conteúdo foi: do design da lista de 95,0; do cabeçalho de 100,0; do primeiro momento da lista de 96,1; do segundo momento de 95,5; e do terceiro momento de 98,9. Com isso, o Índice de Validade de Conteúdo de todas as seções de checagem presentes nos três momentos cirúrgicos foi de 97,1, constatando-se que a lista apresentou relevância, concisão, precisão, clareza e pertinência nos itens presentes nas seções de checagem. O valor do Alpha de Cronbach da lista foi de 95,57% (quase-perfeita) e o valor do Kappa de Fleiss de 0,29 (concordância mediana). Os resultados da validação do conteúdo da lista evidenciaram itens que obtiveram o consenso entre os especialistas, além de recomendações acerca da inserção na lista de itens gerais e outros específicos da área obstétrica, cuja análise da pertinência foi feita no confronto com a literatura científica. Após essa fase, a versão final da lista foi criada. Espera-se que esta lista possa ser utilizada por unidades de saúde como um instrumento fortalecedor da cultura de segurança no ambiente cirúrgico, auxiliando as equipes cirúrgicas no atendimento à paciente obstétrica com segurança.

Patient safety is a concern in the Surgical Center, especially in obstetrics, where the use of a checklist has the potential to reduce adverse events. The objectives were: Building a technology - Surgical Obstetric Safety Checklist (Lista de Verificação de Segurança Cirúrgica Obstétrica, LIVESCO) for intra operative care; Validate this checklist of obstetric surgical safety used in intra operative care from its items; and Discuss the limits and possibilities of the applicability of this technology in the field of obstetric care security and its contributions to nursing care. Validation study, quantitative, developed in two phases: the first phase was an integrative review for the construction of the checklist, which was carried out in the Lilacs, Medline, Cinahl and Scopus databases using specific selection criteria and descriptors. The final corpus was eleven articles and from the synthesis of the evidence, the items for the construction of the list were captured, whose prototype was organized in surgical moments and in check sections. The second phase was the validation of the list's content with 37 judges, specialists in the field, who answered an online questionnaire in which they evaluated the list's design and its content regarding relevance, conciseness, precision, pertinence and clarity based on a Likert scale. For analysis, the content validation index (>85%) was applied. Two complementary tests were performed: Cronbach's Alpha and Fleiss' Kappa to assess the reliability of the list and the agreement between the judges. It was found that the Content Validity Index was: from the list design of 95.0; the header of 100.0; from the first moment on the 96.1 list; the second moment of 95.5; and the third moment, 98.9. Thus, the Content Validity Index of all checking sections present in the three surgical moments was 97.1, showing that the list presented relevance, conciseness, precision, clarity and relevance in the items present in the checking sections. The Cronbach's Alpha value in the list was 95.57% (almost perfect) and the Fleiss Kappa value was 0.29 (median agreement). The content validation results of the list showed items that obtained consensus among experts, in addition to recommendations about the inclusion in the list of general and other specific items in the obstetric area, whose analysis of relevance was made in comparison with the scientific literature. After this phase, the final version of the list was created. It is hoped that this list can be used by health units as an instrument to strengthen the safety culture in the surgical environment, assisting surgical teams in providing care to obstetric patients safely.

La seguridad del paciente es una preocupación en el Centro Quirúrgico, especialmente en obstetricia, donde el uso de una lista de control tiene el potencial de reducir los eventos adversos. Los objetivos fueron: Desarrollar una tecnología - Lista de control de seguridad obstétrica quirúrgica (LIVESCO, por su sigla en portugués) para la atención intraoperatoria; Aprobar esta lista de control de seguridad quirúrgica obstétrica utilizada en la atención intraoperatoria a partir de sus elementos; Discutir los límites y las posibilidades de su aplicabilidad en el campo de la seguridad de la atención obstétrica y sus contribuciones a la atención de enfermería. Estudio de validación, cuantitativo, desarrollado en dos etapas. En la primera, se llevó a cabo una revisión integradora para construir la lista de control, realizada en las bases de datos Lilacs, Medline, Cinahl y Scopus, utilizando criterios de selección y descriptores específicos. El corpus final fue de once artículos y, a partir de la síntesis de la evidencia, se recolectaron los elementos para construir la lista, cuyo prototipo se organizó en momentos quirúrgicos y en secciones de comprobación. En la segunda etapa, se validó el contenido de la lista con 37 expertos en el área, que respondieron a un cuestionario en línea en el que evaluaban el croquis de la lista y su contenido con respecto a la relevancia, concisión, precisión, pertinencia y claridad basadas en una escala Likert. Para el análisis, se aplicó el índice de validación de contenido (> 85%). Se realizaron dos pruebas complementarias: Alpha de Cronbach y Kappa de Fleiss para evaluar la confiabilidad de la lista y la concordancia entre los jueces. Se encontró que el Índice de Validez del Contenido era: 95, el croquis de la lista; 100, el encabezado; 96,1, desde el primer momento en la lista; 95,5, el segundo momento; y 98,9, el tercer momento. Así, el índice de validez de contenido de todas las secciones de verificación presentes en los tres momentos quirúrgicos fue de 97,1, lo que demuestra que la lista presenta relevancia, concisión, precisión, claridad y pertinencia en los ítems presentes en las secciones de verificación. El valor de Alfa de Cronbach en la lista fue de 95,57% (cuasi perfecto) y el valor de Kapiss de Fleiss fue de 0,29 (concordancia media). Los resultados de la validación del contenido de la lista mostraron ítems que obtuvieron consenso entre los especialistas, además de recomendaciones acerca de la inclusión en la lista de ítems generales y otros específicos en el área obstétrica, cuyo análisis de relevancia se realizó en comparación con la literatura científica. Luego de esta etapa, se creó la versión final de la lista. Se espera que esta lista pueda ser utilizada por las unidades de salud como un instrumento que fortalezca una cultura de seguridad en el entorno quirúrgico, ayudando a los equipos quirúrgicos a brindar atención a pacientes obstétricas de manera segura.

A meta-analysis of the effectiveness and safety of acupuncture intervention in gastrointestinal function after gynecilogical and obstetrical operations / 国际中医中药杂志

Objective To systematically evaluate the effectiveness and safety of acupuncture intervention in gastrointestinal function after gynecilogical and obstetrical operations. Methods Databases of SinoMed (1997-2017), VIP (1997-2017), Wanfang (1997-2017), CNKI (2007-2017), PubMed (1997-2017) and Cochrane Library (2017 fourth) were searched by computers (supplemented by manual searching). The randomized controlled trials were included on the gastrointestinal function recovery after acupuncture intervention in gynecilogical and obstetrical operations. The data were extracted independently and cross-checked by two evaluators. Then the quality was evaluated according to the Cochrane system assessor manual 4.2.8, and RevMan 5.3 software was used for meta-analysis. Results A total of 1192 patients were included in 14 randomized controlled trials. Meta-analysis showed that the effective rate [OR=6.09, 95％ CI (2.91, 12.75), P<0.01], the time to first passage of feces [MD=-14.72,95％ CI(-16.00, -13.44),P<0.01], the time to first bowel motion [MD=-8.81, 95％ CI (-10.34, -7.28), P<0.01] and the time to first flatus [MD=-11.84, 95％ CI (-15.31, -8.36), P<0.01] in the acupuncture group were higher than those in control group. Conclusions Acupuncture intervention in gynecilogical and obstetrical operations was safe and effective for gastrointestinal function recovery of patients. However, the above conclusions are required to have further validation with more highly qualified randomized controlled trials for the limited number of literature and the low quality of some studies.

Episiotomy and its relationship to various clinical variables that influence its performance / Episiotomia e sua relação com diferentes variáveis cínicas que influenciam sua realização / La episiotomía y su relación con distintas variables clínicas que influyen en su realización

Objective: to understand the episiotomy rate and its relationship with various clinical variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.

Objetivo: conhecer a taxa de episiotomia e sua relação com diferentes variáveis clínica. Método: e Estudo descritivo, transversal e analítico de 12.093 partos em um hospital terciário. Variáveis: paridade, idade gestacional, início do parto, uso de analgesia epidural, uso de oxitocina, posição durante expulsão do feto, peso do neonato e finalização do parto. A análise foi feita com o SPSS 19.0. Resultados: a porcentagem global de episiotomias foi de 50%. As variáveis clínicas que apresentaram uma associação significativa foram: primiparidade (RR=2,98), idade gestacional > 41 semanas (RR=1,2), início do parto estimulado ou induzido (RR=1,33), uso de analgesia epidural (RR=1,95), uso de ocitocina (RR=1,58), posição de litotomia durante a expulsão fetal (RR=6,4) e instrumentação (RR=1,84). Por outro lado, idade materna ≥ 35 anos (RR=0.85) e peso do neonato < 2500 g (RR=0,8) estão associados a uma menor incidência de episiotomia. Conclusões: a episiotomia depende de intervenções obstétricas feitas durante o parto. Se desejarmos reduzir a taxa de episiotomia, será necessário manter em mente esses fatores de risco para estabelecer políticas para reduzir esse procedimento.

Objetivo: conocer la tasa de episiotomía y su relación con distintas variables clínicas. Método: estudio descriptivo, transversal y analítico, de 12.093 partos en un hospital de tercer nivel. Las variables fueron: paridad, edad gestacional, inicio del parto, uso de analgesia epidural, uso de oxitocina, posición durante la expulsión fetal, peso del recién nacido y finalización del parto. El análisis se realizó con el programa estadístico SPSS 19.0. Resultados: el porcentaje global de episiotomías fue de 50%. Las variables clínicas que presentaron una asociación significativa fueron: primiparidad (RR=2,98), edad gestacional > 41 semanas (RR=1,2), inicio del parto estimulado o inducido (RR= 1,33), uso de analgesia epidural (RR=1,95), uso de oxitocina (RR=1,58), posición de litotomía durante la expulsión fetal (RR=6,4) e instrumentación (RR=1,84). Por otra parte, la edad materna fue ≥35 años (RR=0,85) y el peso del recién nacido < 2500g. (RR=0,8), se asociaron con una menor incidencia de episiotomía. Conclusiones: la episiotomía estuvo condicionada por las intervenciones obstétricas que se realizaron durante el desarrollo del parto. Si deseamos reducir la tasa de episiotomía será necesario tener en cuenta los factores de riesgo para establecer políticas de reducción de este procedimiento.

Eficacia y seguridad del taponamiento uterino para control de hemorragia y disminución de histerectomía obstétrica: cohorte histórica en Nuevo León, México, 2013 / Efficacy and safety of uterine tamponade to control bleeding and reduce obstetric hysterectomy: historic cohort in Nuevo León, México, 2013

Objetivo: realizar una aproximación a la eficacia y seguridad del taponamiento uterino para el control de la hemorragia obstétrica y reducir la necesidad de histerectomía obstétrica.Materiales y métodos: cohorte histórica de mujeres mayores de edad con diagnóstico de hemorragia obstétrica secundaria a atonía que no respondían a manejo inicial, con sangrado del lecho placentario secundario a placentación anormal o secundaria a aborto incompleto, a las cuales se les realizó taponamiento uterino, en la Unidad Médica de Alta Especialidad No. 23 de Ginecología y Obstetricia de la ciudad de Monterrey, hospital de concentración de tercer nivel de atención, ubicado en el estado de Nuevo León (México), de enero a diciembre de 2013. A partir del expediente clínico se registraron las características sociodemográficas y clínicas basales, los datos de laboratorio previo al evento obstétrico y posterior al taponamiento, así como el tiempo de taponamiento en horas, cantidad de insuflación del balón uterino, indicación para el procedimiento, cantidad de sangrado estimado durante el evento obstétrico y posterior a la colocación del balón, control de la hemorragia y necesidad de histerectomía. Se utilizó estadística descriptiva, medidas de dispersión y de tendencia central.Resultados: se incluyeron 161 pacientes con diagnóstico de hemorragia obstétrica, 147 posterior a parto o cesárea y 14 posterior al aborto, entre 16 y 42 años de edad. Se documentó un resultado satisfactorio en más del 95 % posterior al parto o la cesárea, y en más del 93 % posaborto. La permanencia del taponamiento para ambos casos tuvo una media de 20 horas.Conclusiones: este estudio soporta el uso de taponamiento uterino como medida terapéutica eficaz y segura para controlar la hemorragia y evitar una laparotomía o histerectomía, con una disminución de la morbilidad.

Objective: Examine the efficacy and safety of uterine tamponade for controlling obstetric bleeding and reducing the need for obstetric hysterectomy.Materials and methods: Historic cohort of adult women diagnosed with obstetric bleeding secondary to uterine atony that did not respond to the initial management, with bleeding of the placental bed secondary to abnormal placentation or to incomplete abortion, subjected to uterine tamponade at the Highly Specialized Gynaecology and Obstetrics Medical Unit No. 23, a Level III Hospital in the city of Monterrey, state of Nuevo Leon, Mexico, between January and December 2013. Information about social, demographic and baseline clinical characteristics, laboratory values before the obstetric event and after the tamponade procedure, as well as the inflation volume of the balloon, the indication of the procedure, the estimated amount of bleeding during the event and after placement of the tamponade balloon, control of bleeding, and need for hysterectomy, was derived from the clinical record. Descriptive statistics, scatter measurements, and central trends were used.Results: Overall, 161 patients between the ages of 16 and 42 years, with a diagnosis of obstetric haemorrhage were included, 147 following delivery or caesarean section, and 14 following miscarriage. A satisfactory result was documented in more than 95 % of cases after delivery or caesarean section, and in more than 93 % post abortion cases. The mean tamponade time for both groups was 20 hours.Conclusions: This study supports the use of uterine tamponade as an effective and safe therapeutic measure to control bleeding and avoid laparotomy or hysterectomy, and to reduce morbidity.

Validação de questionário para avaliar a vivência e autoconfiança nas emergências na assistência ao parto vaginal / Validation of a questionnaire to evaluate the experience and self-confidence on emergency assistance in vaginal delivery

OBJETIVO: Validar questionário para conhecer e descrever a percepção dos médicos especialistas em ginecologia e obstetrícia quanto à vivência e autoconfiança no atendimento de emergências no parto vaginal. MÉTODOS: Estudo prospectivo de validação de instrumento constituído por afirmativas sobre atendimento nas emergências: parto pélvico (n=23), distocia de ombros (n=20), hemorragia pós-parto (n=24), parto fórcipe (n=32) e vácuo extrator (n=5). Os participantes opinaram sobre cada item segundo escala de Likert (0=discordo plenamente, 1=discordo parcialmente, 2=indiferente, 3=concordo parcialmente e 4=concordo plenamente). O questionário foi aplicado a 12 especialistas em ginecologia e obstetrícia esperando-se encontrar nível de compreensão superior a 80%. Uma escala de cinco pontos foi empregada para avaliar a compreensão de cada questão (de 0=não entendi nada a 5=entendi perfeitamente e não tenho dúvidas). Valores acima de 4 foram considerados indicadores de compreensão suficiente. O instrumento utilizado foi especialmente elaborado para atender às especificidades demandadas. A análise da confiabilidade interna foi pelo coeficiente alfa de Cronbach. Para a validação externa foram calculadas a proporção de itens com plena compreensão, por cada grupo. Para fins de investigação, o alfa deve ser maior do que 0,7. RESULTADOS: Os participantes apresentavam média de idade de 33,3 anos, com desvio padrão (DP) de 5,0 anos, e tempo de formado médio de 5,8 anos (DP=1,3anos). Todos eram especialistas com residência médica em Ginecologia e Obstetrícia. A média da proporção de participantes que compreenderam plenamente os itens de cada emergência estudada foi: parto pélvico 97,3%, distocia de ombros 96,7%, hemorragia ...

PURPOSE: To validate a questionnaire to be applied in order to learn and describe the perceptions of specialists in obstetrics and gynecology about their experience and self-confidence in the emergency care for vaginal delivery. METHODS: This was a prospective study for the validation of an instrument that contains statements about emergency obstetrical care: breech delivery (n=23), shoulder dystocia (n=20), postpartum haemorrhage (n=24), forceps delivery (n=32), and vacuum extractor (n=5). Participants gave their opinions on each item by applying the Likert scale (0=strongly disagree, 1=partially disagree, 2=indifferent, 3=partially agree and 4=strongly agree). The questionnaire was applied to 12 specialists in obstetrics and gynecology and it was expected to be found a level of comprehension exceeding 80%. A five-point scale was used to assess the understanding of each question (from 0=did not understand anything to 5=understood perfectly and I have no doubt). A score above 4 was considered to indicate sufficient understanding. The instrument used was specially designed to suit the specific demands. The analysis of internal reliability was done using the Cronbach alpha coefficient. For external validation, we calculated the proportion of items with full understanding for each subscale. For research purposes, the alpha should be greater than 0.7. RESULTS: Participants had a mean age of 33.3 years, with 5.0 standard deviation (SD), and an average interval time since graduation from medical school of 5.8 years (SD=1.3 years). All were specialists with residency in obstetrics and gynecology. The mean proportion of participants who fully understood the items in each emergency was 97.3% for breech delivery, 96.7% for shoulder dystocia, 99.7% for postpartum hemorrhage, 97.4% for forceps delivery, and 98.3% for the use of a vacuum extractor. The results of Cronbach's alpha for the items in each emergency studied were: 0.85 for breech delivery, ...

Management of gliomas during pregnancy / 中华围产医学杂志

Objective To explore the management of gliomas in pregnant women.Methods We retrospectively analyzed the clinical data in 11 pregnant women with gliomas treated at Xuanwu Hospital of Capital Medical University between January 1989 and December 2012.Results All the patients were first diagnosed with gliomas during pregnancy,including two cases during early pregnancy,four cases during midpregnancy,and five cases during late pregnancy.The main clinical manifestations were dizziness,headache,nausea and vomiting due to intracranial hypertension,accompanied by epilepsy and blurred vision,hearing and speech disorder and other neurological dysfunctions.Among the 11 patients,one received no obstetric treatment,five underwent cesarean section,three had metaphase induced labor,one had induced abortion,and one had spontaneous abortion.Five neonates appeared normal without malformation:four survived,and one with severe asphyxia died.Ten patients underwent neurosurgery,four of them were diagnosed with low-grade gliomas and six were diagnosed with high-grade glioma by pathology.Seven patients received craniotomy after termination of pregnancy,two underwent craniotomy before termination of pregnancy,and one received emergency craniotomy immediately after admission without obstetric treatment because of her critical conditions.Of the ten patients treated with craniotomy,one died after a coma for 50 days,one was lost to follow-up,six received radiotherapy plus chemotherapy,one received chemotherapy alone,and one received neither radiotherapy nor chemotherapy.Among the 11 patients,one patient who underwent cesarean section without craniotomy was lost to follow-up,one patient with low-grade glioma died 50 days after operation,one treated with craniotomy was lost to follow-up,and eight were followed up for four months to three years,among which four survived and four with high-grade glioma died within one year after operation.Conclusion The overall prognosis of glioma patients during pregnancy is poor.It is important to take into account the tumor status of the pregnant women,gestational age,fetal maturity and patient's desire for tocolysis,and weigh the pros and cons,and timely terminate pregnancy and perform neurosurgery.

Logistic regression analysis of related risk factors of obstetric emergency hysterectomy / 中国基层医药

Objective To investigate the incidence rate and risk factors of obstetric emergency hysterectomy.Methods The clinical data of childbirth puerpera in Shangqiu four municipal hospitals were retrospectively analyzed,80 patients underwent routine obstetric emergency hysterectomy were selected as hysterectomy group,56 postpartum hemorrhage patients without uterus excision were randomly selected as control group.The related risk factors of obstetric emergency were analyzed.Results (1) The total delivery number was 65 259 cases,cesarean rate was 47.46％ (30 972/65 259),postpartum hemorrhage rate was 4.61％ (1 429/30 972),and uterus removal rate of cesarean section was 0.18％ (56/30 972),vaginal delivery postpartum hemorrhage rate was 3.28％ (1 124/34 287),in the courtyard the vaginal delivery emergency uterus removal rate was 0.03％ (12/34 287).The postpartum hemorrhage rate and obstetrics emergency uterus removal rate were higher than vaginal delivery,the differences were statistically significant (x2 =77.22,33.24,all P ＜ 0.05).(2) The results of the single factor analysis showed that,placenta previa and implant,placental abruption,merge multiple or huge uterine fibroids,uterine rupture,blood coagnlation dysfunction,armount of bleeding ＞ 2 000ml,vanda operation with oxytocin rate between the two groups,there were significant differences(P ＜ 0.01).(3) The results of unconditional multi-factor Logistic regression analysis showed that,placental abruption,uterine rupture,merge multiple or huge uterine fibroids,blood coagulation dysfunction,amount of bleeding ＞ 2 000ml were independent risk factors which lead to obstetric emergency hysterectomy.Vanda operation with oxytocin and hysterectomy had negative correlation.Conclusions Obstetric emergency hysterectomy was related with a variety of factors.Strengthen the perinatal health care,and actively prevent emergency hysterectomy can reduce the dangerous factors of uterus removal rate and has important significance.

Clinical value of anti-adhesion agents used in laparotomy in obstetrics and gynecology / 中华妇产科杂志

Objective To investigate clinical value of anti-adhesion agent:chitosan in preventing adhesions followed by laparotomy surgery in obstetrics and gynecology.MethodsFrom Jan.2006 to Dec.2009,770 patients underwent laparotomy surgery at Department of Obstetrics and Gynecology in the Second Affiliated Hospital of Harbin Medical University.One hundred and twenty-five patients underwent secondary surgery due to disease recurrence or cesarean section,the previous surgery were 18 cases with myomectomy,20 cases with endometriosis surgery,5 cases with resection of pelvic abscess,20 cases with ectopic pregnancy surgery,27 cases with benign adnexal neoplasm resection,9 cases with cyto-reductive surgery in ovarian cancer,26 cases with variable infertility surgery.Those 125 patients were managed by different agents washing before abdomen closure,which were assigned into two groups,including 59 cases washed by saline in control group and 66 cases washed by chitosan in study group.The abdomen adhesion in secondary surgery was evaluated by adhesion classification system.Results In study group,37 patients without adhesions,20 patients with degree Ⅰ adhesion,6 patients with degree Ⅱ adhesion,3 patients with degree Ⅲ adhesion,and no patients with degree Ⅳ adhesion were observed.While in control group,there were 11 patients without adhesions,23 patients with degree Ⅱ adhesion,14 patients with degree Ⅱ adhesion,8 patients with degree Ⅲ adhesion,and 3 patients with degree Ⅳ adhesion.The distribution of adhesion reached statistical significance between the two groups (x2 =20.9999,P =0.0003 ).Twenty-six patients in previous surgeries due to infertility included 17 cases in control group and 9 cases in study group.They all were managed by cesarean section in secondary surgery,it was found that 15 cases without adhesion and 2 cases with degree Ⅰ adhesion were in study group and 2 cases without adhesion and 7 cases with degree Ⅰ adhesion were in control group.It reached statistical difference ( P =0.0016 ).ConclusionAnti-adhesion agent could prevent adhesion followed by surgery in obstetrics and gynecology effectively.

CLINICAL ANALYSIS OF 12 CASES OF DISSEMINATED INTRAVASCULAR COAGULATION IN OBSTETRICS / 解放军医学杂志

To investigate manifestations and treatment of acute disseminated intravascular coagulation (DIC) in obstetrics, the medical records of 12 cases of acute DIC in obstetric patients admitted into our hospital from January 1993 to July 2001 were analyzed retrospectively. The result showed that the major causes of DIC in obstetric patients were amniotic fluid embolism and pregnancy induced hypertension. The main manifestations were bleeding, embolism or impairment of circulation. In all of the 12 patients accurate diagnosis was made, and treatment including elimination of causes, anti shock measures and prompt complement of coagulation factors. Nine patients received heparin early, 8 received antifibrinolytic agents rationally, and in 5 patients hysterectomy was performed. Nine patients were cured, 3 died. The key to decrease mortality of DIC in obstetric patients is to diagnose DIC early, to eliminate the causes promptly, to treat shock actively, and to use heparin and antifibrinolytic agents more rationally.