ABSTRACT
Resumen ANTECEDENTES: la ruptura esplénica es una complicación muy rara del embarazo y del puerperio, con una mortalidad materna y fetal extremadamente alta. La mortalidad materna alcanza alrededor de 75% y la fetal incluso 95%, complicándose más frecuentemente durante el tercer trimestre (69%) y pocas veces en el puerperio. CASO CLÍNICO: paciente de 37 años de edad, con embarazo de 31.1 semanas enviada a nuestro hospital por preeclampsia, con datos de severidad, con alteraciones bioquímicas y difícil control de la tensión arterial. En el posoperatorio inmediato tuvo un cuadro de dolor abdominal agudo, con líquido libre en el ultrasonido abdominal por lo que se le efectuó una laparotomía de urgencia, con hallazgo de una lesión de 3 cm, aproximadamente, en el polo inferior e hilio esplénico; se realizó esplenectomía de urgencia. El periodo posoperatorio cursó sin incidentes y la paciente fue dada de alta a los 8 días después de la cirugía. CONCLUSIONES: el diagnóstico y tratamiento oportuno de la ruptura esplénica en el puerperio asociada con preeclampsia previene la muerte materna por esta causa.
Abstract BACKGROUND: Splenic rupture is a very rare complication of pregnancy and puerperium, with extremely high maternal and fetal mortality. Maternal mortality reaches about 75% and fetal mortality up to 95%, complicating more frequently during the third trimester (69%) and rarely in the puerperium CLINICAL CASE: We present the case of a 37-year-old female patient with a 31.1-week pregnancy who was referred to our hospital for preeclampsia with severity data with biochemical alterations and difficult control of blood pressure figures. In the immediate postoperative period, the patient develops acute abdominal pain with free fluid in the abdominal ultrasound. This procedure is followed by an emergency laparotomy, with a lesion of approximately 3 cm in the lower pole and splenic hilum performing emergency splenectomy. The postoperative period was uneventful and the patient was discharged 8 days after surgery. CONCLUSIONS: The diagnosis and timely management of splenic rupture in the puerperium associated with Preeclampsia prevents maternal death.
ABSTRACT
Background: Placenta accreta (abnormal insertion of the placenta or part of the myometrium ) endangers the lives of pregnant women. It is a public health problem because it can be complicated by obstetric hemorrhage , the latter being the main cause of maternal death worldwide. Objetive: To estimate the blood loss and the use of blood products in patients who underwent cesarean hysterectomy for placenta accreta. Material and methods: A descriptive study was conducted in HGO UMAE CMNO IMSS in patients who underwent cesarean hysterectomy for placenta accreta in a period of 4 years. Results: 106 cases of placenta accreta were studied, 23% had a massive bleeding of > 3000 cc. Packed red blood cells were transfused in 68% of events, fresh frozen plasma in platelet concentrates 29% and 6%. The history of uterine curettage was observed in 64 % and cesarean section 1 or 2 occasions in 76 % of cases. Conclusion: An early detection of placenta accreta in patients with risk factors to avoid emergency surgery is desired. Being prepared with blood products and appropriate use is a cornerstone in the management of this condition. The average blood loss was determined in cases of accreta in cesarean hysterectomy was 2523 milliliters.
