RESUMEN
The objective were to identify the success factors of bilateral hypogastric arteries ligation and to assess its role in surgical treatment of postpartum hemorrhages. We conducted a retrospective study of all the cases of postpartum hemorrhage requiring surgical treatment between January 2008 and December 2011. The study included 88 patients (0,47% of all births). Uterine atony was the most common etiology (64,8 % of patients). Bilateral ligation of the hypogastric arteries was performed in 81.8% of patients. When surgery was the first choice treatment, its success rate was 66%. This rate was variable depending on the etiology of hemorrhage, the presence or the absence of hemostasis disorders and the time between diagnosis and surgical treatment. In case of uterine atony, the association with a second conservative technique, when the first was inadequate, helped stop the bleeding in 98% of cases. Ligation of hypogastric arteries is an effective surgical technique for the treatment of postpartum hemorrhage. Its success rate has increased thanks to early implementation and to the association with other conservative techniques.
Asunto(s)
Arteria Ilíaca/cirugía , Hemorragia Posparto/cirugía , Inercia Uterina , Adolescente , Adulto , Femenino , Humanos , Ligadura , Hemorragia Posparto/etiología , Embarazo , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Endometriosis/complicaciones , Enfermedades de las Trompas Uterinas/complicaciones , Histerosalpingografía , Infertilidad Femenina/diagnóstico , Laparoscopía , Adulto , Pruebas de Obstrucción de las Trompas Uterinas , Femenino , Humanos , Histerosalpingografía/métodos , Infertilidad Femenina/epidemiología , Infertilidad Femenina/etiología , Infertilidad Femenina/terapia , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Túnez/epidemiologíaAsunto(s)
Hematoma/terapia , Técnicas Hemostáticas , Hemorragia Posparto/terapia , Trastornos Puerperales/terapia , Enfermedades de la Vulva/terapia , Adulto , Episiotomía/efectos adversos , Femenino , Hematoma/etiología , Hematoma/patología , Humanos , Recién Nacido , Masculino , Perineo/patología , Hemorragia Posparto/diagnóstico , Hemorragia Posparto/patología , Embarazo , Trastornos Puerperales/etiología , Trastornos Puerperales/patología , Enfermedades de la Vulva/etiología , Enfermedades de la Vulva/patologíaAsunto(s)
Artritis Infecciosa/diagnóstico , Sínfisis Pubiana , Trastornos Puerperales/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Adulto , Antiinflamatorios no Esteroideos/administración & dosificación , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Artritis Infecciosa/patología , Cefalosporinas/administración & dosificación , Diagnóstico Diferencial , Femenino , Fosfomicina/administración & dosificación , Humanos , Embarazo , Sínfisis Pubiana/microbiología , Sínfisis Pubiana/patología , Trastornos Puerperales/tratamiento farmacológico , Trastornos Puerperales/microbiología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/tratamiento farmacológicoRESUMEN
STUDY OBJECTIVE: The New Orleans Criteria and the Canadian CT Head Rule have been developed to decrease the number of normal computed tomography (CT) results in mild head injury. We compare the performance of both decision rules for identifying patients with intracranial traumatic lesions and those who require an urgent neurosurgical intervention after mild head injury. METHODS: This was an observational cohort study performed between 2008 and 2011 on patients with mild head injury who were aged 10 years or older. We collected prospectively clinical head CT scan findings and outcome. Primary outcome was need for neurosurgical intervention, defined as either death or craniotomy, or the need of intubation within 15 days of the traumatic event. Secondary outcome was the presence of traumatic lesions on head CT scan. New Orleans Criteria and Canadian CT Head Rule decision rules were compared by using sensitivity specifications and positive and negative predictive value. RESULTS: We enrolled 1,582 patients. Neurosurgical intervention was performed in 34 patients (2.1%) and positive CT findings were demonstrated in 218 patients (13.8%). Sensitivity and specificity for need for neurosurgical intervention were 100% (95% confidence interval [CI] 90% to 100%) and 60% (95% CI 44% to 76%) for the Canadian CT Head Rule and 82% (95% CI 69% to 95%) and 26% (95% CI 24% to 28%) for the New Orleans Criteria. Negative predictive values for the above-mentioned clinical decision rules were 100% and 99% and positive values were 5% and 2%, respectively, for the Canadian CT Head Rule and New Orleans Criteria. Sensitivity and specificity for clinical significant head CT findings were 95% (95% CI 92% to 98%) and 65% (95% CI 62% to 68%) for the Canadian CT Head Rule and 86% (95% CI 81% to 91%) and 28% (95% CI 26% to 30%) for the New Orleans Criteria. A similar trend of results was found in the subgroup of patients with a Glasgow Coma Scale score of 15. CONCLUSION: For patients with mild head injury, the Canadian CT Head Rule had higher sensitivity than the New Orleans Criteria, with higher negative predictive value. The question of whether the use of the Canadian CT Head Rule would have a greater influence on head CT scan reduction requires confirmation in real clinical practice.