Sangramento uterino anormal / Bleeding abnormal uterine

O sangramento uterino anormal (SUA) é um distúrbio em que um ou mais dos parâmetros do sangramento uterino normal está alterado: quantidade, duração ou frequência.(1) É também definido como perda menstrual excessiva, com repercussões físicas, emocionais, sociais e materiais na qualidade de vida da mulher, que podem ocorrer isoladamente ou em combinação com outros sintomas.(2) O SUA é uma condição comum que afeta até 40% das mulheres no mundo, impacta negativamente a qualidade de vida das mulheres, sendo a vida social e os relacionamentos prejudicados em quase dois terços dos casos.(AU)

Correlación clínica, imagenológica e histológica en patología endometrial: experiencia en el hospital Dr. Francisco Antonio Rísquez (2006-2016) / Clinical, imaging and histological correlation in endometrial pathology: experience in the hospital Dr. Francisco Antonio Rísquez (2006-2016)

Para el estudio y diagnóstico de la patología endometrial se cuenta con el ultrasonido transvaginal y la biopsia de endometrio. Objetivo: Determinar la correlación clínica, ultrasonográfica e histológica en patología endometrial, en pacientes tratadas en el Servicio de Cirugía del Hospital Dr. Francisco Antonio Rísquez, entre 2006 y 2016. Métodos: Estudio retrospectivo, transversal. Se incluyeron las pacientes intervenidas quirúrgicamente por patologías uterinas, que contaron con información completa en la historia clínica. Se utilizó estadística descriptiva, sensibilidad, especificidad y coeficiente de correlación. Resultados: El grupo etario más afectado fue el de 41 a 50 años, con 62,73 %, el motivo de consulta más frecuente fue sangrado genital con 52 casos (47,3 %), 52 pacientes (47,3 %) presentaron sangrado menstrual abundante y 40 (36,4 %) refirieron sangrado abundante y prolongado. Ecográficamente, el diagnóstico más frecuente fue leiomiomatosis uterina (87 casos, 79,1 %). La línea endometrial estuvo entre 1,3 y 11,3 mm en 80,9 %; en 54 casos (49,1 %) la biopsia de endometrio reportó secretor sin atipia. No se observó correlación estadística entre la clínica y la biopsia de endometrio (p=0,478 Kappa=0,00). La correlación estadística entre el ultrasonido y la biopsia de endometrio fue casi perfecta (p=0,000 Kappa=0,947) y entre la biopsia preoperatoria y la definitiva fue moderada (p=0,000 Kappa 0,542). La sensibilidad del ultrasonido es de 100 % y especificidad de 90,91 %. Conclusiones: La sensibilidad y especificidad del ultrasonido respecto a la biopsia de endometrio fue elevada. La frecuencia de patología endometrial en la biopsia endometrial fue baja(AU)

For the study and diagnosis of endometrial pathology it has with transvaginal ultrasound and endometrial biopsy. Objective: To determine the correlation of clinical, ultrasound and histological endometrial pathology in patients treated in the service of surgery of the Hospital Dr. Francisco Antonio Rísquez, between 2006 and 2016. Methods: Retrospective, cross-sectional study. Included patients surgically treated by uterine pathologies, which counted with complete information in the medical record. We used descriptive statistics, sensitivity, specificity, and correlation coefficient. Results: The most affected age group was that of 41 to 50 years, in 62,73%, the reason for more frequent consultation was bleeding genital with 52 cases (47.3%), 52 patients (47.3%) they had heavy menstrual bleeding and 40 (36.4%) abundant and prolonged bleeding was referred. Ecograficamente, the most frequent diagnosis was uterine leiomyomatosis (87 cases, 794.1%). The endometrial line was between 1.3 and 11.3 mm 80.9%; in 54 cases (49.1%) the endometrial biopsy reported secretory without atypia. No statistical correlation between the clinic and the endometrial biopsy was observed (p = 0, 478 Kappa = 0, 00). The statistical correlation between ultrasound and endometrial biopsy was almost perfect (p = 0, 000 Kappa = 0, 947) and between preoperative biopsy and the final was moderate (p = 0, 0000,542 Kappa). The sensitivity of ultrasound is 100% and specificity of 90.91%. Conclusions: The sensitivity and specificity of ultrasound for endometrial biopsy was high. The frequency of endometrial pathology in endometrial biopsy was low(AU)

Ablação endometrial: para qual paciente indicar? / Endometrial ablation: for whom is indicated?

O sangramento uterino anormal tem, como primeira linha de tratamento, o uso de medicação. Na sua falha ou impossibilidade de utilização, indica-se a histerectomia ou a ablação endometrial. A adequada seleção da paciente para realizar esse último método é essencial para minimizar os riscos de falhas e eventos adversos. Assim, esse estudo objetiva buscar evidências sobre as características das pacientes com maior chance de sucesso na ablação e avaliar se há diferença no resultado com o uso da primeira ou da segunda geração. Buscou-se artigos na base de dados Medline com os termos endométrio e ablação associados ao sangramento menstrual aumentado e sangramento uterino anormal. Foram selecionados 19 artigos dos últimos quatro anos. Comparando-se os dois métodos cirúrgicos, a ablação endometrial tem enorme vantagem perante à histerectomia, tendo menores riscos de complicações, menor custo e por ser de rápida realização. O prévio reconhecimento dos fatores, como adenomiose, laqueadura tubária, anormalidade uterina e dismenorreia, entre outros, pode reduzir a chance de falha da ablação endometrial, além de se sugerir a melhor técnica a ser aplicada. Assim, o alcance do sucesso no tratamento junto à melhora da qualidade de vida da paciente deve ser feito de modo individualizado.(AU)

The first line of treatment for abnormal uterine bleeding is medicine. If it fails or if the patient cannot use it, it is indicated hysterectomy or endometrial ablation. In order to minimize the risk of failure or adverse effects, it is recommended that patients should be selected with criteria for endometrial ablation. Therefore, this study aims to look for evidence of characteristics that could enhance the chances of success for endometrial ablation and observe if there is a difference in results when using either the first or the second generation. Nineteen articles published between 2013-2016 were selected from the Medline base ­ the terms endometrial, ablation, heavy menstrual bleeding and abnormal uterine bleeding were used as key words. Endometrial ablation has advantage over hysterectomy because it shows fewer risks for complications and has lower costs, besides being faster. Previous recognition of factors like adenomyosis, tubal sterilization, uterine abnormality and dysmenorrhea can reduce the chances of failure of endometrial ablation. Moreover, the best technique is suggested to be applied. Thus, the achievement of success in the treatment and improvement in the patient's quality of life should be individualized.(AU)

Caracterización clínico-epidemiológica de la morbilidad materna extremadamente grave en Villa Clara (2012) / Clinical-epidemiological characterization of extremely serious maternal morbidity in Villa Clara (2012)

Introducción: el análisis de la morbilidad materna extremadamente grave puede tener una interpretación significativa en su estudio desde una nueva visión epidemiológica para nuestro contexto, constituye un indicador de la calidad de los cuidados maternos, de sensibilidad social extraordinaria, que interviene en la toma de decisiones con una base científica para el fortalecimiento de la atención médica. Objetivos: caracterizar la morbilidad materna extremadamente grave en la provincia Villa Clara (2012). Métodos: se realizó un estudio transversal de todas las pacientes diagnosticadas con morbilidad materna extremadamente grave en los hospitales con servicios ginecológicos y obstétricos de la provincia. Se utilizó como fuente de información la historia clínica de la atención prenatal y hospitalaria. Resultados: el mayor porcentaje de casos con morbilidad materna extrema después del parto (fundamentalmente por cesárea) se diagnosticó en el Hospital Mariana Grajales. La edad promedio fue de 28 años. Se identificaron riesgos maternos en el 82,1 por ciento de las pacientes; fueron más frecuentes los trastornos hipertensivos, la infección vaginal, la anemia y la edad extrema. Las causas relacionadas con el manejo instaurado fueron las de mayor ocurrencia. La hemorragia obstétrica fue la principal causa de ingresos en la unidad de cuidados intensivos y del proceder quirúrgico adicional. Conclusiones: la hemorragia obstétrica y los trastornos hipertensivos constituyeron las principales causas de morbilidad materna extremadamente grave, que indujeron la mayoría de los ingresos en la unidad de cuidados intensivos y el tratamiento quirúrgico y transfusional(AU)

Introduction: analysis of extremely serious maternal morbidity may have a significant interpretation when approached from a new epidemiological standpoint in our context, for it is an indicator of extraordinary social sensitivity of the quality of maternal care which contributes to decision making based on scientific grounds for the strengthening of healthcare. Objectives: characterize extremely serious maternal morbidity in Villa Clara in the year 2012. Methods: a cross-sectional study was conducted with all the patients diagnosed with extremely serious maternal morbidity in hospitals with obstetrics and gynecology services in the province. Classification criteria were applied. Prenatal and hospital medical records were used as data sources. Results: the highest percentage of cases with extreme maternal morbidity was found in Mariana Grajales Hospital. These were diagnosed after delivery, mostly when caesarean sections were performed. Average age was 28 years. Maternal risks were identified in 82.1 percent of the patients. the most common were hypertensive disorders, vaginal infection, anemia and extreme age. The most frequent causes were related to the management performed. Obstetric hemorrhage was the main cause of hospital admission in the intensive care unit and of additional surgery. Conclusions: obstetric hemorrhage and hypertensive disorders are the main causes of extremely serious maternal morbidity, leading to most admissions in the intensive care unit and to surgical and transfusional treatment(AU)

Ablación endometrial histeroscópica como tratamiento definitivo para el sangrado uterino anormal / Hysteroscopic endometrial ablation for abnormal uterine bleeding

Introducción: El sangrado uterino anormal (SUA) afecta a un 19% de las mujeres. Su tratamiento definitivo consiste en la histerectomía, sin embargo la ablación endometrial histeroscópica surge como un tratamiento menos invasivo, menos riesgoso y más rápido. Objetivo: Evaluar la efectividad de la ablación endometrial histeroscópica como tratamiento definitivo para el SUA. Método: Estudio de cohorte retrospectivo obtenido de base de datos de protocolos operatorios específicos del total de histeroscopías quirúrgicas realizadas en el Servicio de Ginecología del Hospital Naval Almirante Nef de Viña del Mar, entre enero de 2002 y diciembre de 2010. Resultados: De las 507 histeroscopías quirúrgicas realizadas, 230 fueron por SUA. Del total de pacientes sometidas a ablación endometrial histeroscópica, 27 (11,7 por ciento) necesitaron un segundo procedimiento, de las cuales sólo 15 (6,5 por ciento) fueron por persistencia de SUA. No se encontró asociación entre la necesidad de un segundo procedimiento por SUA con características propias de la paciente ni del procedimiento quirúrgico. Conclusión: La ablación endometrial histeroscópica es una opción terapéutica efectiva y segura para el tratamiento del SUA, con baja necesidad de segundo procedimiento por persistencia de éste y bajo riesgo de complicaciones. La necesidad de un segundo procedimiento por SUA no se asocia con características propias de la paciente ni del procedimiento quirúrgico.

Introduction: Abnormal uterine bleeding (AUB) affects 19% of women. Definitive treatment is hysterectomy, however hysteroscopic endometrial ablation is emerging as a less invasive, less risky and faster treatment. Objective: To evaluate the effectiveness of hysteroscopic endometrial ablation as definitive treatment for AUB. Method: Retrospective cohort study database obtained from specific surgical protocols of all surgical hysteroscopies performed in the Gynecology Department of Hospital Naval Almirante Nef de Vina del Mar, between January 2002 and December 2010. Results: Of the 507 surgical hysteroscopies performed, 230 were because of AUB. Of all patients undergoing hysteroscopic endometrial ablation, 27 (11.7 percent) required a second procedure, of which only 15 (6.5 percent) were due to persistence of AUB. No association was found between the need for a second procedure because of AUB with patient characteristics or the surgical procedure itself. Conclusion: Hysteroscopic endometrial ablation is a safe and effective therapeutic option for AUB treatment, with a low need for a second procedure due to its persistence and with low risk of complications. The need of a second procedure because of AUB is not associated with patient characteristics or the surgical procedure itself.

Ablação histeroscópica do endométrio: resultados após seguimento clínico de 5 anos / Results of hysteroscopic endometrial ablation after five-year follow-up

OBJETIVO: Avaliar os resultados clínicos, após seguimento mínimo de 5 anos, de pacientes com sangramento uterino anormal de etiologia benigna que realizaram ablação endometrial, analisando a taxa de sucesso do tratamento em relação ao método, compreendida como satisfação da paciente e melhora do sangramento uterino anormal, bem como complicações tardias, fatores associados e recorrência dos sintomas. MÉTODOS: Estudo transversal conduzido após período mínimo de 5 anos de cirurgia em pacientes submetidas ao procedimento entre 1999 e 2004. Foram analisados os seguintes dados: faixa etária quando da realização da cirurgia, complicações imediatas e tardias, e fatores associados. Foi utilizado o modelo de regressão logística com cálculo da respectiva Odds Ratio (OR) para se observarem as possíveis associações existentes entre a taxa de sucesso da cirurgia e as variáveis analisadas. RESULTADOS: Cento e quatorze pacientes foram submetidas à ablação endometrial no período de Março de 1999 a Abril de 2004. O tempo mediano de seguimento foi de 82 meses. O modelo de regressão logística permitiu a predição correta do sucesso da ablação endometrial em 80,6 por cento. A idade relacionou-se diretamente com o sucesso do procedimento (OR=1,2; p=0,003) e a ligadura tubária pregressa mostrou relação inversa com o sucesso da ablação endometrial (OR=0,3; p=0,049). Dentre as pacientes com falha terapêutica, 21 (72,4 por cento) foram tratadas com histerectomia. Em uma das pacientes submetidas à histerectomia foi confirmada a presença de hidro-hematossalpinge ao exame anatomopatológico, caracterizando a síndrome da ligadura tubária pós-ablação. CONCLUSÃO: A ablação endometrial tem se mostrado uma opção de tratamento vantajosa, mantendo altos índices de satisfação das pacientes, mesmo em seguimentos a longo prazo A idade quando da ablação endometrial influenciou no sucesso terapêutico e mais estudos são necessários para avaliar os fatores que poderão futuramente influenciar na indicação do procedimento em casos selecionados.

PURPOSE: To evaluate the clinical outcomes after a minimum period of 5 years of follow-up of patients with abnormal uterine bleeding of benign etiology who underwent endometrial ablation, analyzing the success rate of treatment defined as patient satisfaction and improvement in uterine abnormal bleeding, as well as late complications and factors associated with recurrence of symptoms. METHODS: A cross-sectional survey was conducted after a minimum period of 5 years after surgery in patients who underwent the procedure between 1999 and 2004. We analyzed the following data: age at the time of surgery, immediate and late complications and associated factors. Logistic regression with Odds Ratio (OR) calculation was performed to evaluate possible associations between the success rate of surgery and the analyzed variables. RESULTS: A total of 114 patients underwent endometrial ablation between March 1999 and April 2004. The median follow-up was 82 months. The logistic regression model allowed the correct prediction of the success of endometrial ablation in 80.6 percent of cases. Age was directly related to the success of the procedure (OR=1.2; p=0.003) and previous tubal ligation showed a negative association with the success of endometrial ablation (OR=0.3; p=0.049). Among the patients with treatment failure, 21 (72.4 percent) underwent hysterectomy. In one of the hysterectomy cases, hydro/hematosalpinx was confirmed by the anatomopathological exam, characterizing the postablation-tubal sterilization syndrome. CONCLUSION: Endometrial ablation has proven to be a worthwhile treatment option, maintaining high rates of patient satisfaction, even over long-term follow-up. The age at endometrial ablation influenced the therapeutic success. Further studies are needed to evaluate the factors that may influence the future indication for the procedure in selected cases.

Endometrial ablation in the women's Hospital, HMC, Doha, Qatar: a retrospective cohort

To study the outcome of various methods of endometrial ablation as a treatment of heavy vaginal bleeding, the records and post-operative histories were reviewed of 122 women with a mean age of 47 years who attended the Women's Hospital, Doha, Qatar, between January 2002 and December2005. Post-operative amenorrhea, oligomenorrhea, or a normal flow plus a satisfied patient were considered evidence of success; a need for further medical or surgical intervention was considered failure. Fifty-eight women [47.5%] had Thermachoice Balloon Ablation with a success rate of 83%; 37[30%] had Microwave Endometrial Ablation [MEA] with 71% success; and 27[22%] had Transcervical Resection of Endometrium [TCRE] with 74% success. Apart from the duration of the procedures there were no statistically significant differences in age, parity, pre-operative haemoglobin and platelets, presence of fibroids, pre-operative endometrial preparation by hormones, or final satisfaction level. It is concluded that Balloon Thermal Ablation, MEA and TCRE are equally effective for the treatment of abnormal vaginal bleeding

Role of hysterectomy and its alternatives in benign uterine diseases.

There is a rising trend of hysterectomy rate as too frequently it is being performed now for conditions like symptomatic fibroids and dysfunctional uterine bleeding which can be treated alternatively. Hysterectomy, as with all other major surgeries, is also associated with increased mortality and morbidity risks. Various medical and surgical lines of management, other than hysterectomy, are presently accessible for the above conditions. Availability of safer and newer treatment options is great boon for women with changing attitudes towards child-bearing and uterine conservation.

Comparación entre el sistema intrauterino de liberación de levonorgestrel y la ablación endometrial en el tratamiento de la hemorragia uterina disfuncional / Comparison between the levonorgestrel intrauterine system and endometrial resection in the treatment of dysfunctional uterine bleeding

Objetivo: Comparación entre el sistema intrauterino de liberación de levonorgestrel (SIL-LNG) y las técnicas de ablación endometrial (AR-E) en el tratamiento de la hemorragia uterina disfuncional (HUD). Método: Estudio retrospectivo de 170 pacientes con HUD distribuidas de la siguiente forma: 51 de ellas en el grupo AR-E y 119 en el grupo SIL-LNG. Se estudió el ciclo menstrual, la hemoglobina y el hematocrito, los efectos adversos y la satisfacción de las usuarias. Resultados: En ambos grupos se observó un incremento de los niveles de hemoglobina y hematocrito. El patrón de sangrado más frecuente fue el de amenorrea, hipomenorrea y ciclos normales tras los tratamientos. El grado de satisfacción fue muy elevado en ambos grupos. Conclusión: Ambos tratamientos son efectivos para mejorar la HUD. La paciente debe conocer los beneficios y riesgos de cada uno y elegir el más conveniente.

Objective: To compare the efficacy of levonorgestrel intrauterine system and endometrial resection in the treatment of dysfunctional uterine bleeding. Methods: Retrospective study with 170 women, 51 of them in endometrial resection group and 119 in the levonorgestrel intrauterine system group. Hemoglobin levels, menstrual bleeding patterns, adverse effects and degree of satisfaction were evaluated. Results: Hemoglobin levels increased in both groups. The most frequent bleeding patterns were amenorrhea, hypomenorrhea and normal pattern. The most of the patients in both groups were satisfied with the treatment. Conclusion: Both treatments were effective in reducing dysfunctional uterine bleeding. The woman must know risks and benefits from each one.

Resección endometrial histeroscópica más inserción de DIU-LNG en el sangrado uterino anormal refractario a tratamiento médico / Hysteroscopic endometrial resection plus LNG-IUD insertion in abnormal uterine bleeding refractory to medical treatment

OBJETIVO: Evaluar los resultados del tratamiento del sangrado uterino anormal (SUA) refractario a tratamiento médico, con resección endometrial histeroscópica asociado a la inserción de un sistema intrauterino de liberación de levonorgestrel. MÉTODO: Estudio prospectivo de 24 pacientes con SUA tratadas con resección endometrial histeroscópica seguida de inserción de un dispositivo intrauterino que libera 20 microgramos diarios de levonorgestrel. RESULTADOS: En 23 de las 24 pacientes tratadas se obtuvo un resultado favorable en término de control del SUA, con un período de seguimiento promedio de 18,3 meses. Una paciente requirió histerectomía por persistencia de dolor pélvico. CONCLUSIÓN: Asociar a la resección endometrial histeroscópica la inserción de un sistema intrauterino de liberación de levonorgestrel mejora los resultados de la cirugía conservadora pudiendo evitar la histerectomía en el 95,9% de las mujeres con SUA de causa benigna.

OBJECTIVE: To evaluate hysteroscopic endometrial resection associated to levonorgestrel intrauterine device insertion as a treatment of abnormal uterine bleeding of benign cause. METHOD: 24 patients with abnormal uterine bleeding, were treated with hysteroscopic endometrial resection followed by the insertion of a intrauterine levonorgestrel device. RESULTS: 23 of 24 patients no report symptoms after 18.3 months follow up. One hysterectomy was performed for persistent chronic pelvic pain. CONCLUSIONS: Endometrial ablations with diathermic loop followed by the insertion of intrauterine levonorgestrel device improve the results of the conservative surgeries, avoiding 95.9% of hysterectomies in patients with abnormal uterine bleeding.

Placenta percreta con invasión vesical: reporte de 2 casos / Placenta percreta with urinary bladder involvement: report of two cases

Se presentan dos casos clínicos de placenta percreta. Uno como hallazgo intraoperatorio y otro con diagnóstico antenatal. Se describen los procedimientos diagnósticos, el manejo quirúrgico intra y post operatorio y el seguimiento, así como el enfrentamiento y la reparación de las complicaciones encontradas. Se hace énfasis en la importancia del trabajo en equipo multidisciplinario en estos casos extremadamente graves. Se revisa la literatura y se sugieren algunas recomendaciones para su mejor manejo.

Analysis of maternal complications in caesarean section

This interventional quasi experimental study was carried out at Gynaecology Department, Jinnah Hospital Lahore to determine frequency, indications of emergency and elective caesarean sections and to establish a comparison of maternal complications. During one year period July 2003-june 2004 total birth were 3932.955 women underwent caesarean section which makes the rate of 24.3% in our unit. Out of 955, 713[74.6%] were emergency and 242[25.4%] were elective caesarean sections. Common indications in emergency group were fetal distress [26.21%], repeat section [18.9%], failed progress of labour [14.3%] and malpresention [13%]. In elective group repeat section [48.7%], malpresentation [17.3%], cephalopelvic disproportion [10.8%] antepartum haemorrhage [8.3%] were common indications. 490[93.2%] patients in emergency group required blood transfusions mainly due to anemia and 36[6.8%] patients in elective group were transfused mainly due to placenta previa.54 women faced intraoperative complications.54[93.1%] belong to emergency group and 4[6.89%] belong to elective group. caesarean hysterectomy were done in 6 patients in emergency group. post operative complications were encountered in 162 patients.150[92.6%] were from emergency and 12[7.4%] were from elective group. Infective morbidity constituted the major post operative problem

Histeroscopía quirúrgica: análisis de la experiencia en cirugía uterina endoscópica ambulatoria de 100 pacientes / Surgical hysteroscopy: experience in ambulatory endoscopic uterine surgery in 100 patients

Se analizan 103 histeroscopias quirúrgicas ambulatorias realizadas en un centro de atención ambulatoria. Las pacientes tenían entre 21 y 81 años de edad; el motivo de consulta principal fue el sangrado uterino anormal en un 34 por ciento, y alteracion del examen ecográfico de la cavidad uterina en un 65 por ciento. A todas las pacientes se les realizó resección endoscópica o biopsia amplia con visión directa de la cavidad uterina, usando medio de distensión líquida, con estudio anatomopatológico diferido de todas las muestras. Los principales diagnóstico histológicos fueron pólipos, mioma, e hiperplasia endometrial. Destaca el hallazgo de 2 casos de cáncer endometrio. Todas las pacientes se controlaron a los 7 y 30 días posterior al procedimiento, no existiendo complicaciones mayores en ninguna de ellas. Se plantea la necesidad de adiestramiento y difusión de esta técnica. Así como queda planteada la posibilidad de su realización ambulatoria

Hemostatic suturing technique for uterine bleeding in post-partum hemorrhage

The objective of this study was to assess the efficacy of multiple square suturing technique as a conservative surgical intervention in the management of postpartum hemorrhage. This technique was used in 20 patients with postpartum hemorrhage who did not respond to the conservative management. In 18 cases, bleeding decreased markedly and hysterectomy was avoided. Hemostatic multiple square suturing was an easy, safe conservative surgical technique alternative to hysterectomy for treating uncontrollable postpartum hemorrhage

Ligadura de las arterias iliacas internas en emergencia gíneco-obstétricas: experiencia en 6 casos / Ligature of internal iliac arteries in gynecologic emergencies: report of 6 cases

Se presentan seis casos de ligadura de las arterias ilíacas internas realizadas entre los años 1995 y 1997 en el Servicio de Ginecología y Obstetricia del Hospital San Juan de Dios. El procedimiento fue exitoso en todos los casos y en el 60 por ciento de ellos permitió conservar el útero. No hubo morbimortalidad asociada a la ligadura. En un tercio de los casos se detuvo la hemorragia con la ligadura unilateral, según el sitio de origen del sangramiento. Se recomienda el mejor control post operatorio de estas pacientes, especialmente respecto a futuros embarazos. La ligadura de las arterias ílíacas internas, aparece como la técnica de elección frente a hemorragias severas o persistentes, en pacientes jóvenes, con paridad incompleta, en las cuales se presente preservar la fertilidad

Abdominal hysterectomy: a new approach for young gynaecologists.

Abdominal hysterectomy is performed for various gynaecological conditions. During operative procedures haemorrhage caused by trauma or slipping and retraction of uterine or ovarian artery has been a cause of great concern to gynaecologists specially in absence of adequate blood transfusion facilities. To overcome this problem, a new approach has been developed--ligation of the uterine artery and ovarian artery (in case of salpingo-oophorectomy) before going for conventional hysterectomy procedures. Abdominal hysterectomy was performed in 500 cases during last 7 years. Traumatic injury to left uterine vessels was seen in 2 cases (0.4%). No other injury to ovarian vessels, right uterine vessels, ureter and bladder was observed. Hence it is concluded that ligation of uterine artery, prior to conventional abdominal hysterectomy procedures, is an extremely safe procedure reducing the risk of haemorrhage and thus allowing young gynaecologists to perform this operation with less fear and more confidence.

Estudio comparativo entre la ultrasonohisterografía y el diagnóstico histeroscópico en la evaluación de pacientes con sangrado uterino anormal / Comparative study between the ultrasonohysterography and the hysteroscopia diagnostic in the evaluation of patients wit abnormal uterine bleed

Para determinar que la ultrasonografía (USHG) es un procedimiento tan efectivo como la histeroscopia diagnóstica para descartar patología intracavitaria en pacientes con sangrado uterino anormal, se evaluaron 30 pacientes de la consulta ginecológica del Hospital Universitario de Caracas, con USHG, histeroscopia y toma de biopsia. Comparando la USHG e histeroscopia con las biopsias, la USHG demostró sensibilidad del 96 por ciento y especificidad del 66 por ciento, valores predictivos positivo y negativo de 96 y 66 por ciento. Una sensibilidad del 98 por ciento y especificidad del 78 por ciento reportó la histeroscopia, con valor predictivo del 94 por ciento y negativo del 91 por ciento. El tiempo promedio para realizar la USHG fué 8,4 minutos y 10,7 minutos para la histeroscopia. El 83,3 por ciento de las pacientes toleraron excelente o bien la USHG y el 79,9 por ciento la histeroscopia. Los resultados demuestran que ambos procedimientos son comparables, lo que hace a la USHG una técnica de pesquisa promedio en la evaluación de pacientes que puedan beneficiarse de otros métodos diagnósticos y terapéuticos más sofisticados

Histerectomias abdominais: análise de 1766 cirurgias / Abdominal hysterectomies: analysis of 1766 cases

Os autores analisaram 1766 histerectomias abdominais realizadas na Clínica Ginecológica do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina da U.F.M.G, no período de 1940 a 1987. A miomatose uterina foi a principal indicaçao da cirurgia, a qual ocorreu com maior freqüência em mulheres na faixa etária entre 40 e 49 anos e nas nulíparas. As complicaçoes no pós-operatório imediato ocorreram em 3,2 por cento das histerectomias realizadas, destacando-se a infecçao da cicatriz cirúrgica.