Sutura de B-Lynch en hemorragia postparto por inercia uterina: experiencia Hospital Dr. Luis Tisné Brousse 2013-2016 / B-Lynch suture in postpartum hemorrhage due to uterine inertia: Hospital Experience Dr. Luis Tisné Brousse 2013-2016

INTRODUCCIÓN Y OBJETIVOS: La Hemorragia Postparto (HPP) es uno de los grandes desafíos para el equipo multidisciplinario y sigue siendo una de las principales causas de muerte materna en el mundo, pese a los adelantos en su manejo. Se define como la hemorragia que produce compromise hemodinámico de la paciente e involucra entre el 1 al 5% de todos los partos. Dentro de las técnicas quirúrgicas conservadoras, existen las suturas compresivas, tales como la sutura de B-Lynch. Nuestro objetivo es determinar la efectividad de la sutura de B-Lynch como manejo quirúrgico conservador de hemorragia postparto por inercia uterina, a través de la necesidad de reintervención o de recurrir a la histerectomía obstétrica como manejo quirúrgico final. MÉTODOS: Estudio retrospectivo observacional, a través de revisión de fichas clínicas de pacientes sometidas a técnica B-Lynch entre enero de 2013 y diciembre de 2016, en el Servicio de Ginecología y Obstetricia del Hospital Dr. Luis Tisné Brousse. RESULTADOS: En 48 pacientes, la efectividad de la sutura de B-Lynch como técnica única o asociada a ligadura arterias uterinas o hipogástricas fue de 91,7%. Requirieron reintervención 8,3%, no se reportaron muertes fetales ni maternas y se obtuvo sólo un recién nacido con Apgar inferior a 7 a los 5 minutos. CONCLUSIONES: La sutura de B-Lynch es una técnica segura, de rápido acceso y con Buenos resultados, por lo que recomendamos su uso en la HPP por inercia uterina que no responde a manejo médico y con deseos de preservación uterina.

INTRODUCTION AND OBJECTIVES: Postpartum haemorrhage (HPP) is one of the major challenges for the multidisciplinary team and remains one of the leading causes of maternal death in the world despite advances in its management. It is defined as hemorrhage that produces hemodynamic compromise of the patient and involves between 1 and 5% of all deliveries. Within conservative surgical techniques, there are compressive sutures, such as the B-Lynch suture. Our goal is to determine the effectiveness of B-Lynch suture as a conservative surgical management of postpartum hemorrhage by uterine inertia, through the need for reoperation or to resort to obstetric hysterectomy as final surgical management. METHODS: Retrospective observational study, through review of clinical files of patients submitted to B-Lynch technique between January 2013 and December 2016, at the Gynecology and Obstetrics Service of the Dr. Luis Tisné Brousse Hospital. RESULTS: In 48 patients, the effectiveness of the B-Lynch suture as a single technique or associated with ligature uterine or hypogastric arteries was 91.7%. 8.3% were reoperated, fetal or maternal deaths were not reported, and only one Apgar score was less than 7 at 5 minutes. CONCLUSIONS: The B-Lynch suture is a safe technique, of fast access and good results, so we recommend its use in PPH by uterine inertia that does not respond to medical management and with desires of uterine preservation.

[Ligation of internal iliac arteries for sever hemorrhage in obstetric]

To assess the efficiency of arteries ligation in intractable obstetrical hemorrhage. Prospective study which concerned 53 patients who underwent internal iliac arteries ligation for persistent and severe obstetrical hemorrhage from January 2007 to June 2010. The average age of patients was 29.3 years. The mean parity was 2.2. Main etiology of hemorrhage were: uterine atony [62.2%], abruptio placentae [15.1%]. Coagulation disorders and hypovolemic shock were observed respectively in 20.7% and 37.7%. Blood transfusion was performed in all cases. Internal iliac arteries ligation allowed hemorrhage control in 90.5% of cases. In five cases a hysterectomy was necessary to control bleeding.. No peroperative complication were observed. Internal iliac arteries ligation is a prerequisite treatment of severe postpartum hemorrhage. It is a good alternative to arterial embolization

Use of bilateral internal iliac artery ligation for controlling severe obstetric haemorrhage

To study the role of bilateral internal iliac artery ligation [BIAL] in arresting intractable postpartum haemorrhage. This study of case series was conducted in Civil Hospital, Karachi, Pakistan from July 2008 to December 2009 over a period of one and half years during which all the patients who needed BIAL for control of severe obstetric haemorrhage were included and their detailed characteristics were recorded on a proforma. Main outcome measure was the effectiveness to control haemorrhage, which was assessed by the per-operative assessment of arrest of intraperitoneal or vaginal bleeding and need of additional hysterectomy. During this period total eight patients underwent BIAL, three for PPH due to atony, two for placenta praevia and one each for placenta increta, ruptured uterus and coagulopathy. Three patients needed hysterectomy, out of which one followed BIAL because of failure to control bleeding [failure rate 16.66%]. While two other patients underwent hysterectomy before BIAL. Failure to control bleeding was evident immediately and no patient needed re-laparotomy. Two women developed wound infection one maternal death occurred due to coagulopathy and its complications. None of the patient had iliac vein injury or any ischaemic complications during inpatient stay. We conclude that BIAL is a safe and effective procedure for treating life threatening obstetric haemorrhage with preservation of future reproductive capacity

Histerectomía posparto: experiencia de Clínica Las Condes / Postpartum hysterectomy: Clínica Las Condes experience

Objetivo: Analizar la experiencia clínica de pacientes sometidas a histerectomía posparto (HPP). Método: Estudio retrospectivo de la HPP efectuadas en Clínica Las Condes entre enero de 2000 y diciembre de 2009. Resultados: Hubo 15.356 partos con 34 casos de HPP (incidencia de 2,2 histerectomías/1000 partos). La edad materna promedio fue de 36 años; 97 por ciento eran multíparas. La edad gestacional promedio al parto fue 36,1 semanas (rango: 27-40). Causas principales: acretismo placentario (61,8 por ciento), inercia uterina (20,6 por ciento) y rotura uterina (8,8 por ciento). En el 29,4 por ciento se realizó además la ligadura de arterias hipogástricas. Histerectomía total en el 85,3 por ciento. El 91,2 por ciento presentó complicaciones, la más frecuente correspondió a lesión vesical asociada a acretismo placentario (26,5 por ciento). En el postoperatorio inmediato hubo 29 casos de anemia, 10 casos de coagulación intravascular diseminada, 2 casos de hemoperitoneo (reoperadas) y 2 pacientes con choque hipovolémico. Hubo 1 caso de trombosis pelviana, 1 caso de trombosis de vena ovárica y 1 caso de fasceitis necrotizante. Tardíamente hubo 3 casos de depresión, 1 tromboembolismo pulmonar, 1 fístula vésico-vaginal y 1 proceso inflamatorio pelviano. No hubo muertes maternas. Transfusión de sangre y/o hemoderivados en 76,5 por ciento. Hubo 1 mortinato y 2 mortineonatos con un 8,5 por ciento (3/35) de muerte perinatal. Conclusiones: La HPP es una intervención de urgencia que se plantea frente a una hemorragia severa, secundaria a diversas patologías, durante o posterior al parto, asociada frecuentemente con cesárea anterior e inercia uterina.

Objetive: To analyze the clinical experience of peripartum hysterectomy (PH). Method: Retrospective review of women who required PH at Las Condes Clinic since January 2000 to December 2009. Results: In the study period 15,356 patients were delivered with 34 cases of PH (incidence: 2.2/1000 deliveries). The mean age was 36 years old, 97 percent were multiparous. The mean gestational age at delivery was 36.1 weeks (range: 27-40). Causes: placenta accreta (61.8 percent), uterine atony (20.6 percent) and uterine rupture (8.8 percent). In 29.4 percent a bilateral hypogastric ligation was added to the hysterectomy. Total hysterectomy was performed in 85.3 percent of cases. There was at least one complication in 91.2 percent women. The intraopertive bladder injury associated with placenta accreta was the most frequent complication (26.5 percent). Postoperative complications: 29 cases of anemia, 10 cases of disseminated intravascular coagulopathy, 2 hemoperitoneum that required surgical reexploration, 2 cases of hypovolemic shock, 1 case of pelvic thrombosis, 1 case of ovarian vein thrombosis and 1 case of necrotizing fasceitis. Late complications included depression, pulmonary embolism, bladder-vagina fistula and pelvic inflammatory disease. 76.5 percent required transfusion. There were no cases of maternal death with 8.5 percent of perinatal death. Conclusions: PH it is performed in patients with severe bleeding during or after labor and delivery, frequently is associated with serious maternal morbidity. Previous cesarean section with abnormal placental implantation and uterine atony were the most frequent indications.

Emergency peripartum hysterectomy: review of 48 cases

To determine the incidence, indications, complications and associated risk factors with emergency peripartum hysterectomy at El-Sahel Teaching Hospital, Cairo, Egypt. This is a retrospective study of 48 cases of emergency peripartum hysterectomy done from January 2000 to December 2009. 48 Patients of emergency peripartum hysterectomy were identified among 35,576 deliveries and the incidence rate was [0.13%]. Uterine atony 23 [47.9%], uterine rupture 15 [31.3] and placenta previa with accreta 10 [20.8%] were the most common indications of hysterectomy. Of the atony group, 18 bilateral uterine arteries [78%] and 13 bilateral internal iliac arteries ligation [57%] were performed as conservative surgery before proceeding to hysterectomies. In placenta previa with accreta group, the prior cesarean deliveries were higher compared to both atony and uterine rupture groups and that variable was statistically significant. 16 patients [33.2%] were complicated by disseminated intravascular coagulopathy [11/23 patients in atony group [47.8%], 4/15 patients in uterine rupture group [26.7] and one/10 [10%] in placenta previa with accrete group]. Uterine atony group received the highest volume of transfusion [packed red cells and fresh frozen plasma]. Differences in both gestational age [p<0.01], previous cesarean section [p<0.05] and fetal weight [p<0.05] between the three groups were significant. Placenta previa with accreta group had the highest rate of previous cesarean sections [2 +/- 1.4] suggesting a higher incidence of this complication with repeated cesarean sections. Uterine atony is still the main indication of peripartum hysterectomy. Careful prenatal care is needed for women who are at risk of postpartum hemorrhage. Cesarean deliveries of patient with suspected placenta accreta, specifically those performed due to placenta previa in women with a previous uterine scar, should involve specially trained obstetricians. In addition, detailed informed consent about the possibility of emergency peripartum hysterectomy and associated morbidity should be obtained

Sutura de B-Lynch: experiencia en el desarrollo de una nueva técnica quirúrgica / B-Lynch suture for postpartum hemorrhage: a new surgical technique

Antecedentes: La hemorragia postparto (HPP) continúa siendo una de las patologías más prevalentes en la morbimortalidad materna en todo el mundo, especialmente en los países subdesarrollados. Distintos protocolos de manejo y técnicas se han desarrollado en los últimos años para su control. La sutura de B-Lynch surge como una herramienta útil y reproducible. Objetivo: Demostrar los beneficios de la técnica para el control de la HPP. Método: Serie de 5 casos en los que se realizó la sutura de B-Lynch en el Servicio de Obstetricia y Ginecología del Hospital Carlos Van Buren. Se identifican 5 casos en los que se realizó la técnica. Resultados: En los 5 casos se logró exitosamente controlar la HPP y preservar el útero. Una de las pacientes logró un embarazo posterior exitoso. Conclusión: Nuestros resultados permiten afirmar que la técnica de B-Lynch es segura, útil y reproducible en el manejo de la HPP.

Background: The postpartum haemorrhage (PPH) continues to be a prevalent problem affecting maternal morbimortality all over the world, particularly in non-developed countries. Different protocols of management and new techniques have been developed through these last years to control and treat PPH. The B-Lynch suture appears to be a useful and reproductible tool. Objectives: To show the benefits of the technique in the management of PPH. Method: A retrospective review of five cases in which B-Lynch suture was made, with the postoperatory controls and histeroscopics evaluations. Results: In all cases, successfully PPH was controlled and the uterus preserved. In one patient a successfully pregnancy and delivery was achieved. Conclusion: The B-Lynch suture is secure, useful and reproducible technique in the management of PPH.

Peripartum hysterectomy

To find out the frequency, indication and its associated morbidity in our setup. Prospective cross-sectional observational study for the period one year [from June 2003 - May 2004] carried out in the Department of Obs / Gynae, Lahore General Hospital Lahore. During the study there were 26 cases of peripartum hysterectomy, of which 14 case were of caesarean hysterectomy, while 10 cases were following normal vaginal delivery and 2 cases followed by instrumental delivery. Uterine atony was the most common indication for peripartum hysterectomy in 12 cases [46.15%]. Uterine rupture including instrumental delivery tear was 2nd most frequent cause in 4 +2=6[23.07%] of cases. In 19.2% [5] of cases abnormal placentation was the cause. In 2[7.6%] of cases sepsis was the cause leading to secondary PPH followed by hysterectomy. A subtotal hysterectomy was carried out in 10 [38.46%] and total hysterectomy was performed in 16 [61.53%] cases. there were 4 maternal deaths. Urinary tract injuries occurred in 3[11.53%] cases, fever, chest infection and wound infection were common morbidity. Anemia was found in almost every case. Intra and post operative Blood transfusion s were given in all cases. Reloparotomy was done in one patient for continues vaginal bleeding. Despite its morbidity and mortality emergency Obstetric hysterectomy remains an essential life saving tool. Uterine atony, uterine rupture and abnormal placentation were mast common indications, reflecting under utilization of existing antenatal, family planning services. Injudicious use of oxytocin, lack of transportation facilities, poverty and delayed referral all contribute to morbidity and mortality associated with emergency Obstetric hysterectomy

Histerectomía obstétrica / Obstetric hysterectomy

Se analizan 52 casos de histerectomía obstétrica en la maternidad del Hospital Félix Bulnes Cerda ocurridas entre 1983 y 1998, obteniéndose una incidencia de 1 por cada 2283 partos ocurridos en ese período. Sus principales indicaciones son: la inercia uterina, adherencia placentaria anormal y el desprendimiento de placenta normoiserta (D.P.P.N.I.). La histerectomía fue subtotal en la mayoría de los casos (57,7 por ciento). Existe un alto porcentaje de pacientes multíparas con edades sobre los 30 años. Las complicaciones más frecuentes son: lesión de la vía urinaria, fiebre, hematoma y/o hemorragia de la neocúpula. La indicación de histerectomía obstetricia usada como recurso de salvataje debe ser criteriosa evitando causar mayor daño a la paciente, siempre entendiendo que la prevención y la optimización de las medidas coadyuvantes pueden hacer innecesaria la histerectomía

Ligaduras hemostáticas en la inercia uterina postcesárea / Hemostatic sutures in uterine, postcesarea inertia

El presente informe describe una nueva técnica con base en ligaduras hemostáticas sobre el músculo uterino, las cuales se utilizan en los casos de inercia uterina con la finalidad de coadyuvar en la contracción de este órgano después del alumbramiento, estas ligaduras pueden ser utilizadas tanto en la cesárea como en el parto. La indicación precisa es cuando aún después de haber recurrido a métodos habituales como: masaje, comprensión del útero y la metrorragia persiste. Se informan 69 casos en los cuales se aplicaron ligaduras hemostáticas, de los cuales sólo en un caso no se controló la hemorragia y fue necesario practicar histerectomía. En los restantes 68 se logró evitar la histerectomía con el uso de las suturas hemostáticas