El Balón de Bakri como herramienta en el manejo de la hemorragia post parto / THE BAKRI´S BALLOON AS AN IMPORTANT TOOL FOR THE MANAGEMENT OF POST PARTUM HEMORRHAGE

Introducción La hemorragia post parto es una de las complicaciones más graves del puerperio y una de las principales causas de mortalidad materna a nivel mundial. Dentro del esquema del manejo de la misma se encuentra el uso del balón de Bakri para evitar la histerectomía post parto. Objetivo: presentar la experiencia en la utilización del Balón de Bakri en un trabajo colaborativo entre los Servicios de Obstetricia del Hospital Nacional Posadas y de la Madre y el Niño de Formosa Capital entre enero de 2015 a junio de 2016. Método: Estudio transversal y descriptivo que incluyó a 25 pacientes con hemorragia post parto sin respuesta al tratamiento con Ocitócicos y que requirieron colocación del Balón de Bakri. Resultados: El balón de Bakri fue aplicado a 25 mujeres con hemorragia refractaria. La mediana de insuflación del Balón de Bakri fue de 300 (240/ 600 mL). La hemostasia se consiguió en 23 (92 %) de estas mujeres. Dos mujeres debieron ser histerectomizadas por continuar sangrando luego de la colocación del balón. Conclusión: El balón de Bakri es una herramienta eficaz para el manejo de la hemorragia post parto refractaria a carbetocina, evitando la histerectomía en el 92% de los casos.

Postpartum hemorrhage is one of the most serious complications of puerperium and one of the leading causes of maternal mortality worldwide. Within the framework of the management of it is the use of Bakri balloon to prevent puerperal hysterectomy. The aim of this study is to present the experience in the use of Bakri balloon in a collaborative work between the Obstetrics Departments of the Posadas National Hospital and the Madre y el Niño Hospital of Formosa Capital, Argentina, from January 2015 to June 2016. Methods: Cross-sectional descriptive study that included 25 patients with postpartum bleeding with uterine atony refractory to treatment with uterotonics and required Bakri balloon placement. Results: The Bakri ballon was applied to 25 women with refractory bleeding Oxytocics after vaginal delivery. The median Bakri balloon inflation was 300 (240/600 mL). Hemostasis was achieved in 23 (92%) of these women. Two women (8%) had to be undergone hysterectomy for bleeding continue after placement of the ball. Conclusion: The Bakri balloon is an effective tool for the management of post partum hemorrhage refractory to Carbetocin avoiding hysterectomy in 92% of cases.

Can the Induction of Labor with Misoprostol Increase Maternal Blood Loss? / Pode a indução do parto com misoprostol aumentar a perda de sangue materna?

Abstract Purpose To evaluate blood loss during misoprostol-induced vaginal births and during cesarean sections after attempted misoprostol induction. Methods We conducted a prospective observational study in 101 pregnant women indicated for labor induction; pre- and postpartum hemoglobin levels were measured to estimate blood loss during delivery. Labor was induced by administering 25 μg vaginal misoprostol every 6 hours (with a maximum of 6 doses). The control group included 30 patients who spontaneously entered labor, and 30 patients who underwent elective cesarean section. Pre- and postpartum hemoglobin levels were evaluated using the analysis of variance for repeated measurements, showing the effects of time (pre- and postpartum) and of the group (with and withoutmisoprostol administration). Results Therewere significant differences between pre- and postpartum hemoglobin levels (p < 0.0001) with regard to misoprostol-induced vaginal deliveries (1.6 ± 1.4 mg/dL), non-induced vaginal deliveries (1.4 ± 1.0 mg/dL), cesarean sections after attempted misoprostol induction (1.5 ± 1.0 mg/dL), and elective cesarean deliveries (1.8 ± 1.1 mg/dL). However, the differences were proportional between the groups with and without misoprostol administration, for both cesarean (p = 0.6845) and vaginal deliveries (p = 0.2694). Conclusions Labor induction using misoprostol did not affect blood loss during delivery.

Resumo Objetivo Avaliar a perda sanguínea em partos vaginais induzidos com misoprostol, e em cesáreas com tentativa prévia de indução do parto com misoprostol. Métodos Realizou-se estudo prospectivo observacional com 101 gestantes com indicação para indução do trabalho de parto, as quais foram avaliadas pela dosagem de hemoglobina pré e pós-parto para estimativa da perda sanguínea no parto. Procedeu-se à indução do trabalho de parto com misoprostol 25 μg, via vaginal, a cada 6 horas, em um número máximo de 6 doses. O grupo controle foi composto por 30 pacientes que entraram emtrabalho de parto espontaneamente, e por 30 pacientes que se submeteram a cesárea eletiva. O estudo da hemoglobina, antes e depois do parto, foi avaliado por ANOVA paramedidas repetidas, no qual foi verificado o efeito do tempo (pré e pós-parto) e o efeito do grupo (com e sem uso do misoprostol). Resultados Existem diferenças significativas entre os níveis de hemoglobina pré e pós-parto (p < 0,0001) nos partos vaginais induzidos pelo misoprostol (1,6 ± 1,4 mg/ dL), nos partos vaginais não induzidos (1,4 ± 1,0 mg/dL), nas cesáreas com tentativa prévia de indução (1,5 ± 1,0mg/dL), e nas cesáreas eletivas (1,8 ± 1,1mg/dL). Porém, as diferenças foram proporcionais em ambos os grupos, ou seja, ocorreu diferença tanto no grupo que fez uso do misoprostol quanto no grupo que não fez uso do medicamento, tanto na cesárea (p = 0,6845) quanto no parto vaginal (p = 0,2694). Conclusões A indução do parto com misoprostol não alterou a perda sanguínea durante o parto.

Postpartum hemorrhage: an experience at tertiary care hospital

To determine the frequency, causes and various treatment methods used in for postpartum hemorrhage [PPH] our setup. Descriptive study. This study was conducted in the Department of Obstetrics and Gynecology Unit 1, Liaquat University of Medical and Health Sciences Hyderabad, from June 2007 to April 2008. All women admitted with or developed PPH in hospital after delivery or cesarean section were included. Patients with history of bleeding disorders and those on heparin/warfarin were excluded. Results were analyzed through computer software program SPSS version 11 and percentages were used to describe the data. Total number of obstetric admissions during the study period was 1231. Out of these 118 [9.5%] patients developed PPH. Out of these 118 patients, 98[83%] patients had primary PPH while 20[16.9%] patients had secondary PPH. Seventy five [63.5%] patients were unbooked while 43[36.4%] were booked. Regarding causes of PPH, most common cause was uterine atony in 76[64.4%] cases, followed by perineal and vaginal tears in 41[34.7%] patients and prolonged labor in 29[24.5%]. Uterine massage was done in 76[64.4%] patients, B-Lynch sutures were applied in 6[5%] cases and hysterectomy done in 4[3.3%] patients. Majority of patients developed primary PPH and the commonest cause was uterine atony. PPH was commonly seen in unbooked patients, induced/ augmented labor and grand multiparous women

Influence of time at which oxytocin is administered during labor on uterine activity and perinatal death in pigs

Oxytocin is extensively used to induce or augment uterine contractions, especially to facilitate the third stage of labor in humans. Administration of oxytocin to parturient sows reduces duration of labor whereas mortality of the offspring may remain unchanged. This study aimed to evaluate whether time of administration of oxytocin during parturition may alter the uterine response and fetal outcomes. Two hundred parturient sows were randomly assigned to intramuscularly receive either saline solution (control group) or oxytocin 0.083 IU/kg immediately after the delivery of the 1st, 4th or 8th piglet (groups O-1, 0-4 and 0-8, respectively). Uterine effects and fetal outcomes were registered in all groups. The duration of labor was 20-40 min shorter (P < 0.0001) and time interval between babies was reduced by 3-5 min (P < 0.0001) in the three groups receiving oxytocin. The duration and intensity of contractions, meconium-stained piglets and intrapartum deaths decreased as time at which oxytocin administered during labor was increased. In group 0-8, we observed approximately 70 percent less meconium-stained piglets and intrapartum deaths than in the control group. In conclusion, oxytocin administered at early phases of parturition to sows may increase duration and intensity of uterine contractions as well as adverse fetal outcomes.

Incidencia de rotura uterina en el Hospital Dr. Patrocinio Peñuela Ruíz 1982-2003 / Incidence of uterine rupture at the Hospital Dr. Patrocinio Peñuela Ruíz 1982-2003

El presente es un estudio retrospectivo y longitudinal realizado en el Hospital Patrocinio Peñuela Ruíz, San Cristóbal, Estado Táchira, basado en la revisión de las historias clínicas entre los años 1982-2003 con diagnóstico de Rotura Uterina. Encontrándose una Tasa de 0.22 por 1000 partos (1 de 4512 partos). El 50 por ciento pertenecia al grupo 1 a 4 paras. La edad gestacional predominante fue 37-41 semanas 83.33 por ciento. El 66.66 por ciento de los casos tenían útero indemne, el factor determinante más frecuente fue el uso de Oxitócico (66.66 por ciento), el 50 por ciento de las rupturas fueron espontáneas, la Histeretomía fue usada en un 50 por ciento, el diagnóstico intraoperatorio fue del 83.33 por ciento, la mortalidad fetal fue del 33.33 por ciento

A retrospective review of pregnancy outcome after misoprostol (prostaglandin E1) induction of labour

This retrospective study looked at the outcome of using 50-100 micrograms misoprostol once daily to induce labour compared to the outcome of the overall patient population delivered during the same period (1994-1996). During that period 11,255 patients were delivered and 1037 (9.2) were induced with misoprostol. Results showed a significantly lower mean Caesarean section rate: 9.3 for the misoprostol group versus 13.3 for the overall population (p = 0.002, Odds Ratio (OR) 0.67, 95 CI 0.53, 0.83). The abruption rates were not significantly different: 0.8 for misoprostol versus 0.4 (p = 0.09, OR 1.86, 95 CI 0.81, 4.09). There was more postpartum haemorrhage in the misoprostol group: 5.6 versus 3.5 (p = 0.0006, OR 1.63, 95 CI 1.22, 2.19); a higher incidence of Apgar scores less than 6 at one minute 10.2 versus 7.9 (p = 0.0093, OR 1.33, CI 1.06, 1.65) but not at five minutes 2.9 versus 2.4 (p = 0.674, OR 1.09, CI 0.73, 1.61) and a higher perinatal mortality rate 55/1000 versus 16.3/1000 (p = 0.00, OR 3.5, 95 CI 2.55, 4.80). The rate remained higher but not significantly so when a correction was made to eliminate the high number of intrauterine deaths induced with misoprostol 18/1000 versus 16.3/1000 (p = 0.69, OR 1.11, 95 CI 0.66, 1.84). There were no cases of uterine rupture in either group. In conclusion, there was a significantly lower Caesarean section rate among patients who had once daily misoprostol induction of labour. Close monitoring of the foetus, in patients with misoprostol induction, is needed to detect foetal distress and prophylaxis against postpartum haemorrhage is still mandatory.

Depresión cardiorrespiratoria en ocho recién nacidos cuyas madres ingirieron infusiones de yucuyahui (zoapatle-Montanoa tomentosa) durante el trabajo de parto / Cardiorespiratory depression in eight newborns whose mothers took \"Yucuyahui\" (Zoapatlemontanoa tomentosa) during labor

La yucuyahui (zoapatle-Montanoa tomentosa) es una planta silvestre con propiedades oxitócicas. Tomaron infusiones de esta planta durante el trabajo de parto ocho embarazadas y sus recién nacidos evolucionaron con signos de depresión cardio-respiratoria que requirió de apoyo vital básico o avanzado para su recuperación. La efectividad de estas maniobras se midió de acuerdo al puntaje de Apgar que promediado para el primer minuto fue de 4.5 y se incrementó a los 10 minutos por efecto de las maniobras citadas, a 7.4 (p< 0.05). El tiempo para la recuperación total de los neonatos fue de 11.9 horas (10 minutos - 36 horas). Se encontró una correlación negativa entre el número de infusiones administradas a las madres y la calificación de Apgar al minuto (r=- 0.65), sugiriendo que a mayor número de infusiones menor puntaje y por tanto mayor depresión. La administración simultánea de bebidas alcohólicas a tres de las embarazadas pareció no influir en la gravedad de la depresión; la recuperación de los neonatos expuestos al etanol fue más rápida que en aquellos no expuestos: 2.4 vs. 9.7 horas, p< 0.05. Se desconoce cuál es el mecanismo íntimo de acción de Montanoa tomentosa, se especula que pudiera ser similar al de otros oxitócicos como la oxitocina y los alcaloides del cornezuelo de centeno, con los que guarda semejanzas en sus efectos uterotónicos y sistémicos

Uso de methergin en post parto: investigación / Use of methergin in postpartum

Se hace un estudio del uso del Methergin, medicamento derivado del cornezuelo de zenteno. La sensibilidad del útero a los alcaloides del cornezuelo de zenteno es variable, dependiendo especificamente del grado de madurez y la etepa de gestación.