Inversión uterina puerperal: experiencia en nuestro centro / Puerperal uterine inversion: a single-center experience

RESUMEN

Objetivo. Evaluar la incidencia, la evolución y el riesgo de recurrencia en casos de inversión uterina puerperal en nuestro centro. Material y métodos. Estudio retrospectivo. Veintidós casos de inversión uterina puerperal entre enero del 1993 y diciembre del 2013. Se analizan los diferentes riesgos. Resultados. Pacientes edad media 28 años (18-41); 19 nulíparas (86%); 4 pacientes presentaban cirugía uterina anterior (18%). Trabajo de parto 6 finalizaron la gestación mediante cesárea (27%), y 16 (73%) vía vaginal. Peso medio de los recién nacidos 3.111 g (2.130-3.950); 8 casos de retención de placenta (36,4%) y 3 atonías uterinas (13,6%). Tipo inversión 100% aguda. Complicaciones y manejo hemorragia severa en 7 pacientes; 20 casos (91%) se resolvieron mediante maniobra de Johnson; 2 histerectomías (9%). No hubo muertes ni recurrencias. Conclusiones. La nuliparidad y la retención de placenta fueron factores de riesgo importantes en nuestro estudio. La precocidad en el diagnóstico y el tratamiento es de vital importancia. La cirugía debe ser la última opción (AU)

ABSTRACT

Objective. To assess the incidence, outcomes, and risk of recurrence of puerperal uterine inversion in our hospital. Material and methods. A retrospective study was carried out in 22 cases of puerperal uterine inversion from January 1993 to December 2013 in our hospital. We analyzed different risk factors. Results. The mean age of the patients was 28 years (18-41). Nineteen (86%) were nulliparous. Four (18%) had undergone previous uterine surgery. Delivery was through cesarean section in 6 patients (27%) and through the vaginal route in 16 (73%). The mean birthweight was 3111 grams (2130-3950). Retained placenta occurred in 8 patients (36.4%) and uterine atony in 3 (13.6%). Uterine inversion was acute in all patients. Complications and management consisted of severe hemorrhage in 7 patients, 20 cases (91%) were resolved by the Johnson procedure, and 22 hysterectomies (9%) were performed. There were no deaths and no recurrences. Conclusions. In our study, important risk factors were nulliparity and placenta accreta. Early diagnosis and treatment are of the utmost importance. Surgery should be the last option (AU)