[Efficacy of elective cerclage in patients with cervical incompetence and associated risk factors]. / Eficacia del cerclaje electivo en pacientes con incompetencia ístmico cervical y factores de riesgo asociados.

Cervical incompetence (CI) is considered as a defect of the cervical estroma that takes to the inability of the uterine neck to retain an intra-uterine pregnancy until the viability of the fetus, with an incidence from 0.05% to 1% of all the pregnancies. This defect in the cervix is due to obstetrics trauma, such as disfunctional and anatomical causes. The failure of cervical cerclage have been reported up to 20%, this study was carried out to determine the baby born and procedure complications. All patients demanding attention at the Gynecology and Obstetrics Hospital of the Medical Center La Raza, with diagnosis of CI were included in this study. Thus, 36 patients were included, with 30.1 +/- 4.2 (M +/- SD) year-old age; the cerclage was performed in the second trimester, in order to extend the pregnancy with an average of 18.1 +/- 6.5 weeks until the moment of the interruption of the pregnancy. The 61.1% arrived to the term gestation, in 23 of the cases (63.8%) were born with more than 2500 g of weight, and 24 cases also presented a recurrence among 2 to 5 abortions. The most frequent complication was the threat of preterm childbirth and in patient with antecedents of previous obstetric complications was obtained a relative risk (RR) of 3.8 to present CI, moreover it was also observed at the beginning and the end of the obstetric life the probability of CI has a RR 1.6, with a positive correlation between the gestational age at the application of the cerclage and the continuation of the pregnancy (p < 0.05) after the week 16 of gestation. The cerclage application in the second trimester of pregnancy overcomes the risks of the surgical procedure and does not have adverse effects on the product. The main indicators of success are the cerclage application to smaller gestational age, into the second and third gestation, as well as the presence of the smallest number of complicated obstetric events, therefore great part of the obstetric decision to apply a cerclage should be based on previous obstetric life of each patient.

[Indications and risk factors for emergency obstetric hysterectomy]. / Indicaciones y factores de riesgo para histerectomía obstétrica de urgencia.

Emergency obstetric hysterectomy is a procedure that potentially preserves the life and the postpartum bleeding is the direct cause of its indication, the hemorrhage postpartum happens in 1% of obstetric patients. This study was carried out to identify women with potential risk for this event and to prevent this obstetric problem. The most frequent indications for hysterectomy were identified, as well as the sociodemographic characteristic of the patients. The surgical procedure carried out was extra-fascial technique with type Richardson hysterectomy modified; the surgical pieces went to the pathology service, to obtain the histopathological diagnosis. 43 cases of obstetric hysterectomy, were analyzed; the characteristics of this group showed that bigger percentage of this event was more frequent in 31 to 35 years (39.5%), with pregnancies at term (51.1%) in third pregnancies(27.9%), nulliparas (60.4%), with first cesarean section (39.5%), without previous abortions (79.0%). The most frequent obstetric complications were uterine atony and placenta accreta. The cause for uterine atony could be interstitial edema, as well as myometrial hypertrophy, because such histopathological diagnoses were the most common. Odds ratio showed that a patient with cesarean section has 1.16 more probabilities of suffering hysterectomy than a woman with childbirth. This study describes the histological presence of interstitial edema and myometrial hypertrophy as possible causes of uterine atony in the histological study of surgical specimen. This could be related to no response of myometrial to the uterus-tonic effect of oxytocin. Obstetric uterine dysfunction has multifactorial cause. Patients with the characteristics described in this study should be considered as high risk.