Complicaciones maternas de la cesárea en gestantes a término en periodo expulsivo en un hospital general de Lima, Perú / Maternal complications of cesarean sections performed in the expulsive period of labor in a general hospital in Lima, Peru

RESUMEN

Objetivo: Describir las complicaciones maternas de la cesárea en gestantes a término en periodo expulsivo en un hospital general. Material y métodos: Estudio descriptivo, observacional, retrospectivo, tipo serie de casos, realizado en el Hospital Nacional Cayetano Heredia entre el 1 de enero de 2011 hasta el 31 diciembre de 2012. Se incluyeron 67 gestantes a término operadas en periodo expulsivo. Se revisaron las historias clínicas de las pacientes, se registraron las características clínicas y las complicaciones maternas. Resultados: En el periodo de estudio se realizaron 4 218 cesáreas, siendo el 1,84% hechas en periodo expulsivo. En general, 59/ 67 (88,1%) presentaron algún tipo de complicación. Se observaron 8 casos de hipotonía uterina (11,9%) y 2 (2,9%) de atonía. En 5 (7,4%) pacientes ocurrieron desgarros de segmento adyacente a la histerotomía, siendo 2 de ellos asociados a compromiso de cuerpo uterino y vagina, y 4 (5,9%) casos a laceración de arteria uterina, uno fue bilateral. No se produjeron lesiones en tracto urinario ni digestivo y tampoco hubo necesidad de reintervención quirúrgica. Cuatro pacientes presentaron hemorragia puerperal, dos asociados a hipotonía uterina post cesárea. En 56 (83,5%) casos ocurrió anemia post operatoria. Hubo 1 (1,5%) caso de endometritis, 3 (4,5%) infecciones de herida operatoria. Conclusiones: La cesárea realizada en período expulsivo ocasiona complicaciones frecuentes, algunas muy severas. (AU)

ABSTRACT

Objective: To determine the maternal complications of cesarean sections performed in the expulsive period of labor in a general hospital. Methods: Case series performed at Hospital Nacional Cayetano Heredia from January 1st, 2011 to December 31st, 2012. Sixty-seven pregnants in whom a cesarean section was performed during the expulsive period of labor were included. Clinical charts were reviewed to gather clinical information. Results: A total of 4218 cesarean sections were performed during the study period, 1.84% were performed during the expulsive period of labor. Overall, 88.1% (59/67) had any kind of complication. Eight cases of uterine hypotonia (11.9%) were observed, and 2 of uterine atonia (2.9%). Detachment of the segment close to the uterine incision was observed in 5 patients (7.4%), in two cases affection of the vagina and uterus was observed, and 4 cases (5.9%) of laceration of the uterine artery, one with bilateral laceration, were observed. No urinary tract or digestive tract lesions were observed; there was also no need to perform re-interventions. Four patients presented puerperal hemorrhage; two were associated with uterine hypotonia. Post-operative anemia was observed in 56 patients (83.5%). There was one case (1.5%) of endometritis and 3 (4.5%) of wound infections. Conclusions: Cesarean sections performed in the expulsive period of labor are associated with frequent complications; some of them are very severe. (AU)