ABSTRACT
Objetivo: revisión de la casuística de nuestro centro desde la introducción de la radiología intervencionista en el manejo de la hemorragia postparto hace 6 años. Sujetos y métodos: estudio retrospectivo entre 2009 y 2014 en el que se recogen los datos de 18 pacientes. Resultados: la tasa de éxitos en nuestra serie fue del 88,24% y la tasa global de histerectomía tras embolización fue del 11,76%. Conclusiones: la hemorragia postparto complica el 5-15% de los partos y es la causa aislada más importante de mortalidad materna. Existen protocolos individualizados de manejo según el centro, siendo la radiología intervencionista un tratamiento de segunda línea, alternativo a la histerectomía. En nuestro hospital se ha evidenciado una influencia positiva en la disminución de la histerectomía obstétrica. Las complicaciones, aunque infrecuentes, no son despreciables y se precisan estudios a largo plazo que evalúen su impacto en la fertilidad y gestaciones posteriores (AU)
Purpose: To review the patients who presented to our hospital with postpartum haemorrhage and were treated with interventional radiology procedures since the introduction of this technique 6 years ago. Subjects and methods: We collected data from all postpartum haemorrhages treated with arterial embolization at our hospital (n = 18) between 2009 and 2014. Results: Our success rate was 88.24% and the overall rate of obstetric hysterectomy after embolization was 11.76%. Conclusions: Approximately 5-15% of deliveries are complicated by postpartum haemorrhage, which is the most important isolated cause of maternal mortality. There are specific protocols in each centre, interventional radiology being an alternative treatment to hysterectomy. The number of emergency hysterectomies decreased in our hospital after the introduction of the technique. Although infrequent, the complications of this technique are not negligible, and long-term studies are needed to evaluate fertility and the obstetric impact in these patients (AU)
Subject(s)
Humans , Female , Adult , Postpartum Hemorrhage/surgery , Postpartum Hemorrhage , Radiography, Interventional/methods , Radiography, Interventional , Radiology, Interventional/trends , Uterine Artery Embolization/methods , Embolization, Therapeutic/adverse effects , Retrospective Studies , Hysterectomy/methods , Fluoroscopy , Femoral Artery , Oxytocin/therapeutic useABSTRACT
OBJECTIVE: External validation of the IOTA group's three-step diagnostic model (Strategy 1) and comparison with assessment by an expert sonographer (Strategy 2). STUDY DESIGN: Prospective study in patients with persistent adnexal masses, in which an inexperienced sonographer performed transvaginal ultrasound applying simple descriptors (SD) and rules (SR) for classifying as benign or malignant. Any non-classifiable mass was then submitted to an expert examiner for subjective assessment (SA). RESULTS: Eighty-one patients (mean age, 43; 27.2% postmenopausal) were included in this prospective study. Surgery was performed for 30 (8 malignant and 22 benign) masses; 51 masses were considered as benign and managed expectantly (they were assumed to be benign for statistical purposes). Diagnostic performance for Strategy 1 (SD+SR+SA) was sensitivity (SN): 87.5% (7/8, 95% CI, 47.3-99.7%) and specificity (SP): 100% (73/73, 95% CI, 95.1-100%). For Strategy 2 (SA only) it was SN 87.5% (7/8, 95% CI, 47.3-99.7%), SP 98.6% (72/73, 95% CI, 92.6-100%). CONCLUSIONS: The three-step diagnostic strategy designed by the IOTA group for adnexal masses has a diagnostic performance comparable to that of subjective expert assessment and could be used as a triage method by nonexpert sonographers.
Subject(s)
Abscess/diagnostic imaging , Adenocarcinoma, Clear Cell/diagnostic imaging , Carcinoma, Endometrioid/diagnostic imaging , Endometriosis/diagnostic imaging , Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging , Ovarian Cysts/diagnostic imaging , Ovarian Neoplasms/diagnostic imaging , Teratoma/diagnostic imaging , Abscess/diagnosis , Abscess/surgery , Adenocarcinoma, Clear Cell/diagnosis , Adenocarcinoma, Clear Cell/surgery , Adolescent , Adult , Aged , Carcinoma, Endometrioid/diagnosis , Carcinoma, Endometrioid/surgery , Cohort Studies , Cystadenofibroma/diagnosis , Cystadenofibroma/diagnostic imaging , Cystadenofibroma/surgery , Cystadenoma, Mucinous/diagnosis , Cystadenoma, Mucinous/diagnostic imaging , Cystadenoma, Mucinous/surgery , Cystadenoma, Serous/diagnosis , Cystadenoma, Serous/diagnostic imaging , Cystadenoma, Serous/surgery , Endometriosis/diagnosis , Endometriosis/surgery , Female , Humans , Middle Aged , Neoplasms, Cystic, Mucinous, and Serous/diagnosis , Neoplasms, Cystic, Mucinous, and Serous/surgery , Ovarian Cysts/diagnosis , Ovarian Cysts/surgery , Ovarian Diseases/diagnosis , Ovarian Diseases/diagnostic imaging , Ovarian Diseases/surgery , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/surgery , Prospective Studies , Sensitivity and Specificity , Teratoma/diagnosis , Teratoma/surgery , Ultrasonography , Young AdultABSTRACT
No disponible
