Impacto de la hemorragia obstétrica mayor en la morbilidad materna extremadamente grave / Impact of major obstetric hemorrhage in extremely severe maternal morbidity

Introducción: la hemorragia es la complicación más significativa durante el embarazo, fundamentalmente del tercer y cuarto periodo del parto. Objetivos: caracterizar a las gestantes con hemorragia obstétrica mayor como causa de morbilidad materna extremadamente grave. Métodos: se realizó un estudio de desarrollo, transversal, observacional en el Hospital Ginecobstétrico Docente Mariana Grajales de Villa Clara desde enero de 2012 hasta diciembre de 2014. La población está constituida por 46 mujeres que tuvieron una hemorragia obstétrica mayor. Los datos se obtuvieron de la revisión documental del registro de partos e historias clínicas. Para el análisis estadístico se utilizó la prueba de chi cuadrado para identificar la relación entre variables. Se aplicó la prueba no paramétrica del Test de la mediana para buscar diferencias en los grupos según la causa de hemorragia. Resultados: predominan las pacientes que ya han tenido un parto o más con 78,3 por ciento y la atonía uterina como causa fundamental de hemorragia con 45,7 por ciento. Ocurrió la hemorragia después del parto en 71,7 por ciento. Conclusiones: la hemorragia obstétrica mayor se presenta con más frecuencia en las edades entre 20 y 35 años, y de ellas, las que han tenido un parto o más en su historia obstétrica. La atonía uterina sigue siendo la primera causa de hemorragia obstétrica mayor, y el puerperio el momento más crítico para la morbilidad materna extremadamente grave por hemorragia(AU)

Introduction: Hemorrhage is the most significant complication during pregnancy, mainly in the third and fourth stage of labor. Objectives: To characterize the pregnant women with major obstetric hemorrhage as a cause of extremely severe maternal morbidity. Methods: Observational, cross-sectional and developing study performed in ¨Mariana Grajales¨ teaching gynecobstetric hospital in Villa Clara from January 2012 to December 2014. The study population was made up of 46 women who had major obstetric hemorrhage. Data were taken from review of documents from the delivery register and medical histories. For the statistical analysis, Chi square test was used to identify association among variables. The non-parametric test of the median´s test was applied to find differences among the groups by cause of hemorrhage. Results: Predominance of patients with one or more deliveries with 78.3 percent and uterus atony as an essential cause of hemorrhage with 45.7 percent of cases. Postpartum hemorrhage occurred in 71.7 percent of the group. Conclusions: Major obstetric hemorrhage occurs more frequently at ages of 20 to 35 years and in women with one or more deliveries in their obstetric history. Uterus atony remains the first cause of major obstetric hemorrhage and the puerperium is the most critical time for extremely severe maternal morbidity from hemorrhage(AU)

audit of primary post partum haemorrhage

Postpartum haemorrhage [PPH] is one of the leading causes of maternal morbidity and mortality .Its causes and risk factors are important for its prevention and management. Poor, unhealthy, high parity women delivering away from health facility are usual victims. The purpose of this study is to determine causes of PPH, risk factors, preventable factors and to assess treatment measures adopted. This retrospective study is carried out in Gynaecology 'B' unit of Ayub Teaching Hospital Abbottabad. All patients admitted with PPH or developed PPH within hospital from 1st Jan-31st Dec 2006 are included. Exclusion criteria were patients with bleeding disorders and on anticoagulants. Records of admissions, deliveries, caesareans, major and minor procedures and history charts were thoroughly evaluated for details. Details included age, parity, socioeconomic status, transportation facility, distance from hospital, onset of labours, birth attendant skilled/unskilled, evaluation of risk factors, duration of labour and mode of delivery. Patient's general health, anaemia, shock, abdominal and pelvic examination and laboratory findings were also taken in to account. Treatment measures including medical, surgical, blood transfusions were evaluated. Results: The most important cause was uterine atony, 96 [70.5%] and traumatic lesions of genital tract, 40 [29.4%]. Factors causing uterine atony were augmented labour 20 [20.9%], prolonged labour 21 [21.9%], retained placental tissues, 11 [12.5%], retained placenta, 11 [11.4%] Couvelliar uterus, 10 [10.4%], placenta preavia, 8 [8.3%], placenta increta, 7 [7.3%], chorioamnionitis 5 [5.2%], and multiple pregnancy, 2 [2.1%]. Risk factors, grand multiparity 70 [51.5%], antepartum haemorrhage 12 [8.9%], instrumental delivery 10[7.3%], previous PPH, 6 [4.5%], choreoamnionitis, 5 [3.6%], multiple pregnancy, 2 [1.5%], no risk factor, 21 [15.4%]. Socioeconomic status was poor [75] and lower middle class [61]. Induced labour, 33 [24.3%], augmented labour 62 [45.5%].Uterotonics used for prophylaxis in 30 [22%], for treatment of PPH, 106 [78%]. Patients delivered by traditional birth attendants 70 [51.4%], lady health workers 40 [29.4%] and doctors 26 [19.2%]. Uterine massage performed in 30 [22%], minor surgical procedures 33 [24.3%], manual removal of retained placenta, 11 [8%], hysterectomy, 50 [36.7%], and compression sutures were applied in 3 [2.2%]. Maternal deaths due to PPH were 6 [40%]. PPH can be prevented by avoiding unnecessary inductions/augmentations of labour, risk factors assessment and active management of 3rd stage of labour. It needs critical judgment, early referral and early resuscitation by birth attendant. There is room for temponade and compression sutures. Hysterectomy should be the last option

Atonía uterina e histerectomía de emergencia en el postparto tardío. Presentación de un caso

Se presenta el caso de una paciente multípara de 34 años de edad, quien ingresó al servicio de urgencias obstétricas con un cuadro clínico de shock hipovolémico grave secundario a una atonía uterina en el décimo primer día del puerperio. Se practicaron maniobras de revisión y masaje uterino, y aplicación parenteral de oxitócicos y methergina, sin lograrse obtenerse respuesta de la contracción uterina. La gravedad de la situación hemodinámica determinó la necesidad de practicar una histerectomía de urgencias. En este caso se destaca lo tardío de la presentación de la atonía postparto, complicación clásicamente considerada dentro de las primeras horas del período puerperal. Es importante además la posibilidad de una relación etiológica entre lo acontecido a esta paciente con la presentación de una circunstancia generadora de un gran estrés emocional-la muerte accidental del esposo- posiblemente con mediación de mecanismos neuroendocrinos que expliquen la relajación uterina súbita

Uterine ballonning: an unusual hysterosalpingraphic finding in cases of infertility

On interpertation of the hysterosalpingograhic studies for cases of infertility three types of uteine ballonning were observed. These functional uterine lesions include; the diffuse regular, diffuse irregular and comual types. A trial therapy with methergine tabelts daily during the five fertile days around the mid-cycle resulted in three pregnancies, an observation which suggests the hypotoncity of uterus resulting in such ballonning