RESUMO
Postpartum hemorrhage is one of the leading causes of maternal mortality worldwide. Uterine atony is the main cause, representing up to 90% of cases, and is a risk factor for uterine inversion. Morbidity and mortality occur in 41% of uterine inversion cases, including massive obstetric hemorrhage. Massive obstetric hemorrhage is a medical emergency that puts life and reproductive function at risk, and therefore, its treatment must be timely and immediate. If there is no favorable response with the initial measures, surgical intervention proceeds. When choosing the surgical procedure, priority should be given to the technique with the easiest access and which is the least invasive, the safest, and in which the surgeon has more experience. We present a case report with our technique of bilateral ligation of the anterior trunk of the hypogastric artery, after a uterine compression suture failed, with excellent results and preserved fertility in an adolescent patient. We describe the technique and the result. The response time of the uterus with normal tone was 5 minutes, and postligation bleeding was only 50 mL after the patient had bled 1200 mL without complications; thus, it is an adequate and cost-effective technique. The bilateral ligation of the anterior trunk of the hypogastric artery technique in the case of postpartum hemorrhage is an effective, safe, and fertility-preserving surgical procedure that constitutes an alternative to emergency obstetrical hysterectomy when other, less invasive methods have failed.
RESUMO
Resumen: OBJETIVO: Describir el incremento en la frecuencia del cáncer de endometrio en un hospital de tercer nivel en las últimas décadas y su asociación con el sobrepeso y la obesidad. MATERIALES Y MÉTODOS: Estudio retrospectivo, comparativo y observacional efectuado con base en la información de los expedientes de pacientes con diagnóstico de cáncer de endometrio atendidas en el servicio de Oncología del Hospital General de México (2000-2017). Los datos se compararon con un estudio previo de 1966-1993. RESULTADOS: Del 2000 al 2017 se registraron 785 pacientes y en el periodo global de 44 años, incluidos en el estudio, 1045 enfermas. En el lapso de 27 años se registraron 260 pacientes, y en el de 17 años: 785 enfermas; es decir, un incremento de 200% en la frecuencia de esta enfermedad. CONCLUSIONES: En esta serie los porcentajes de sobrepeso y obesidad se elevaron de 46 a 72.5%. El cáncer de endometrio en mujeres menores de 48 años aumentó de 19 a 28%. El 30.5% de las pacientes en etapas tempranas de cáncer de endometrio tuvieron factores de riesgo de recurrencia tumoral y 42% de la serie global cursó con neoplasias avanzadas, lo que está demostrado afecta su pronóstico.
Abstract: OBJECTIVE: To describe the increase shown in the frequency of endometrial cancer in a tertiary hospital in the last decades and its association with overweight and obesity. MATERIALS AND METHODS: Retrospective, comparative and observational study based on information from the files of patients with a diagnosis of endometrial cancer attended at the Oncology Service of the General Hospital of Mexico (2000-2017). Data were compared with a previous study from 1966-1993. RESULTS: From 2000 to 2017, 785 patients were registered and in the global period of 44 years, 1045 patients were included in the study. In the 27-year period, 260 patients were registered, and in the 17-year period, 785 patients were registered; that is, a 200% increase in the frequency of this disease. CONCLUSIONS: In this series the percentages of overweight and obesity rose from 46 to 72.5%. Endometrial cancer in women under 48 years of age increased from 19 to 28%. 30.5% of patients in early stages of endometrial cancer had risk factors for tumor recurrence and 42% of the overall series had advanced neoplasms, which is shown to affect their prognosis.
