Uterine transposition in a patient with vulvar cancer.

Objective: To report the first uterine transposition for fertility preservation in a patient with vulvar cancer.Case: A 26-year-old nulliparous patient with stage IIIB vulvar cancer, which was resected with adequate margins and bilateral inguinofemoral lymphadenectomy.Laparoscopic transposition of the uterus to the upper abdomen, outside of the scope of radiation was performed to preserve fertility and ovarian function. After the end of radiotherapy, the uterus was repositioned into the pelvis.Main Outcome Measure: Uterine and ovarian function preservation. Result: The patient recovered her menstrual cycles spontaneously 1 month after the reimplantation and exhibited normal variation in ovarian hormones.Twelve months after the surgery, the uterus was normal and there was no sign of recurrent disease. Conclusion: Uterine transposition might represent a valid option for fertility preservation in women who require pelvic radiotherapy. However, studies that assess its viability, effectiveness, and safety are required.

Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study.

OBJECTIVE: To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy. METHODS: A multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes. RESULTS: Thirty-three patients were included. Median age was 34 years (range 31-36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA-IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34-36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0-36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease. CONCLUSION: Neoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.

Alternative management for gynecological cancer care during the COVID-2019 pandemic: A Latin American survey.

OBJECTIVE: To determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID-19 pandemic among Latin American gynecological cancer specialists. METHODS: Twelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software. RESULTS: A total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post-cancer treatment follow-up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo-oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively). CONCLUSION: Latin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID-19 pandemic, which may reflect the region's particularities. The COVID-19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.

Autologous transobturator sling as an alternative therapy for stress urinary incontinence.

OBJECTIVE: To evaluate efficacy and outcomes of the autologous transobturator midurethral sling for treatment of stress urinary incontinence (SUI). METHODS: In a prospective cohort study, an autologous transobturator mid-urethral sling was used to treat SUI among women attending a university hospital in Montevideo, Uruguay, from June 2017 to July 2018. In the first phase, autologous tissue of the abdominis rectus fascia was collected. In the second phase, the midurethral sling was placed via the transobturator approach. Outcomes were measured every 3 months by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) Score. Preoperative and postoperative results were compared by Wilcoxon test. RESULTS: Eighteen women with a median age of 51 years were enrolled. The median follow-up was 9 months (range 6-15 months). Overall, 17 women showed symptomatic improvement after the procedure. In a comparison of preoperative versus postoperative ICIQ-FLUTS questionnaires, improvement in the incontinence subscore was observed at 3 (P<0.001), 6 (P<0.001), and 12 (P=0.008) months. No severe complications were observed. CONCLUSION: Use of an autologous transobturator urethral sling was found to be technically feasible and safe for SUI, with good short-term outcomes. Longer follow up and larger series are needed to validate the procedure.

Surgical Management and Prognostic Factors of Vulvovaginal Melanoma.

OBJECTIVE: The aim of the study was to evaluate the surgical management and the role of different prognostic factors on survival outcomes of women affected by genital (i.e., vulvar and vaginal) melanoma. MATERIALS AND METHODS: Data of patients undergoing primary surgical treatment for genital melanoma were evaluated in this retrospective study. Baseline, pathological, and postoperative variables were tested to identify prognostic factors. Five-year disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox proportional hazards models. RESULTS: Overall, 98 patients met the inclusion criteria. Sixty-seven (68%) and 31 (32%) patients in this study population were diagnosed with vulvar and vaginal melanoma, respectively. Median (range) DFS and OS were 12 (1-70) and 22 (1-70) months, respectively. Considering factors influencing DFS, we observed that at multivariate analysis, only vaginal localization (hazard ratio [HR] = 3.72; 95% CI = 1.05-13.2) and number of mitoses (HR = 1.24; 95% CI = 1.11-1.39) proved to be associated with worse DFS. Nodal status was the only independent factor influencing 5-year OS in patients with vulvar (HR = 1.76; 95% CI = 1.22-2.54; p = .002) and vaginal (HR = 3.65; 95% CI = 1.08-12.3; p = .03) melanoma. CONCLUSIONS: Genital melanomas are characterized by a poor prognosis. Number of mitoses and lymph node status are the main factors influencing survival. Surgery is the mainstay of treatment. A correct and prompt diagnosis is paramount.

Normal Pregnancy Is Associated with Changes in Central Hemodynamics and Enhanced Recruitable, but Not Resting, Endothelial Function.

Introduction. Flow-mediated dilation (FMD), low flow-mediated constriction (L-FMC), and reactive hyperemia-related changes in carotid-to-radial pulse wave velocity (ΔPWVcr%) could offer complementary information about both "recruitability" and "resting" endothelial function (EF). Carotid-to-femoral pulse wave velocity (PWVcf) and pulse wave analysis-derived parameters (i.e., AIx@75) are the gold standard methods for noninvasive evaluation of aortic stiffness and central hemodynamics. If healthy pregnancy is associated with both changes in resting and recruitable EF, as well as in several arterial parameters, it remains unknown and/or controversial. Objectives. To simultaneously and noninvasively assess in healthy pregnant (HP) and nonpregnant (NP) women central parameters in conjunction with "basal and recruitable" EF, employing new complementary approaches. Methods. HP (n = 11, 34.2 ± 3.3 weeks of gestation) and age- and cardiovascular risk factors-matched NP (n = 22) were included. Aortic blood pressure (BP), AIx@75, PWVcf, common carotid stiffness, and intima-media thickness, as well as FMD, L-FMC, and ΔPWVcr %, were measured. Results. Aortic BP, stiffness, and AIx@75 were reduced in HP. ΔPWVcr% and FMD were enhanced in HP in comparison to NP. No differences were found in L-FMC between groups. Conclusion. HP is associated with reduced aortic stiffness, central BP, wave reflections, and enhanced recruitable, but not resting, EF.

Preeclampsia Is Associated with Increased Central Aortic Pressure, Elastic Arteries Stiffness and Wave Reflections, and Resting and Recruitable Endothelial Dysfunction.

Introduction. An altered endothelial function (EF) could be associated with preeclampsia (PE). However, more specific and complementary analyses are required to confirm this topic. Flow-mediated dilation (FMD), low-flow-mediated constriction (L-FMC), and hyperemic-related changes in carotid-radial pulse wave velocity (PWVcr) offer complementary information about "recruitability" of EF. Objectives. To evaluate, in healthy and hypertensive pregnant women (with and without PE), central arterial parameters in conjunction with "basal and recruitable" EF. Methods. Nonhypertensive (HP) and hypertensive pregnant women (gestational hypertension, GH; preeclampsia, PE) were included. Aortic blood pressure (BP), wave reflection parameters (AIx@75), aortic pulse wave velocity (PWVcf) and PWVcr, and brachial and common carotid stiffness and intima-media thickness were measured. Brachial FMD and L-FMC and hyperemic-related change in PWVcr were measured. Results. Aortic BP and AIx@75 were elevated in PE. PE showed stiffer elastic but not muscular arteries. After cuff deflation, PWVcr decreased in HP, while GH showed a blunted PWVcr response and PE showed a tendency to increase. Maximal FMD and L-FMC were observed in HP followed by GH; PE did not reach significant arterial constriction. Conclusion. Aortic BP and wave reflections as well as elastic arteries stiffness are increased in PE. PE showed both "resting and recruitable" endothelial dysfunctions.

Vaginal group B streptococcus status during intrapartum antibiotic prophylaxis.

OBJECTIVE: To assess maternal group B streptococcus (GBS) colonization status and the pharmacokinetic profile of penicillin G in the umbilical cord and amniotic fluid compartment during 4 hours of intrapartum antibiotic prophylaxis (IAP). METHODS: In a prospective study at a hospital in Montevideo, Uruguay, 60 GBS carriers in active labor after a singleton pregnancy of 37 weeks or more were enrolled between April 1, 2011, and April 30, 2012. Intravenous penicillin G was administered via a standard regimen. Rectovaginal samples were obtained before IAP initiation, and 2 and 4 hours after the initial dose. Penicillin G concentrations were measured by high-performance liquid chromatography. Samples were obtained from fetal cord blood in all cases and from amniotic fluid obtained from patients who delivered by cesarean. RESULTS: Among the 60 participants, 43 (72%) had a positive rectovaginal sample before IAP initiation. Of these women, 23 (53%) had negative cultures after 2 hours; after 4 hours, only 5 (12%) remained positive for GBS. The penicillin G concentration in amniotic fluid and cord blood was above the minimum inhibitory concentration (0.12 µg/mL) in all cases. CONCLUSION: Four hours of IAP was needed to reduce the number of women with positive GBS cultures to 12%. Therefore, 4 hours of IAP might be necessary to achieve overall effectiveness from this treatment.

Role of paclitaxel and cisplatin as the neoadjuvant treatment for locally advanced squamous cell carcinoma of the vulva.

OBJECTIVE: The therapeutic outcomes of patients with advanced vulvar cancer are poor. Multi-modality treatments including concurrent chemoradiation or different regimens of neoadjuvant chemotherapy (NACT), and surgery have been explored to reduce the extent of surgery and morbidity. The present single-institution trial aimed to evaluate the efficacy and toxicity of paclitaxel and cisplatin in locally advanced vulvar cancer. METHODS: From 2002 to 2009, 10 patients with stage III-IV locally advanced squamous cell carcinoma of the vulva were prospectively treated with 3 courses of paclitaxel-ifosfamide-cisplatin or paclitaxel-cisplatin. Nine of them subsequently underwent radical local excision or radical partial vulvectomy and bilateral inguino-femoral lymphadenectomy. RESULTS: The clinical response rate of all enrolled patients was 80%, whereas the pathological responses included 1 case with complete remission, 2 with persistent carcinoma in situ, and 6 invasive cancer cases with tumor shrinkage of more than 50%. Four patients had positive nodes. Forty percent of patients experienced grade 3-4 bone marrow toxicity, which was successfully managed with granulocyte-colony stimulating factor, even in cases of elderly patients. Median progression-free survival after surgery was 14 months (range, 5 to 44 months). Six of the 7 recurrent cases were local, and 3 of them were treated with salvage surgery while the other 3 received radiation with or without chemotherapy. After a median follow-up period of 40 months (range, 5 to 112 months), 55.5% of patients remained alive with no evidence of disease, including 2 long-term survivors after recurrence at 5 and 9 years. CONCLUSION: Based on the high response rate and manageable toxicity, NACT with paclitaxel and cisplatin with or without ifosfamide followed by surgery could be considered as a therapeutic option for locally advanced vulvar cancer.

Association between tumor diameter and lymphovascular space invasion among women with early-stage endometrial cancer.

OBJECTIVE: To investigate the association between tumor diameter and intratumoral risk factors that might predict the need for full surgical staging among women with endometrial cancer (EC). METHODS: Data from patients with early-stage EC treated at the Istituto Nazionale dei Tumori, Milan, Italy, between January 2004 and December 2012 were retrospectively analyzed. Associations between tumor diameter and tumor grade, myometrial invasion, risk group, lymphovascular space invasion (LVSI), and lower uterine segment (LUS) involvement were assessed by bivariate and multivariate analysis. RESULTS: In total, 181 patients met the inclusion criteria. The tumor diameter was 2cm or less in 110 women (60%). χ(2) analysis showed that tumor grading, myometrial invasion, risk group, and LVSI were significantly associated with tumor size (P<0.001), whereas LUS involvement was marginally associated (P=0.051). By multivariate analysis, LVSI and myometrial invasion had an independent association with tumor size greater than 2cm (P<0.018). CONCLUSION: Tumor size greater than 2cm was significantly and independently associated with LVSI and myometrial invasion among patients with early-stage EC. Given the difficulty of obtaining reliable LVSI data from frozen sections, tumor size might be used as a surrogate at the time of surgery to provide additional information to triage patients for full surgical staging.

Función endotelial y estados hipertensivos del embarazo: Velocidad de la onda del pulso carótido-radial como método alternativo para detectar disfunción endotelial en embarazadas

Resumen La preeclampsia constituye una causa mayor de morbimortalidad materno-fetal que cursa con una disfunción endotelial (DFE) generalizada. Detectar la DFE subclínica durante el embarazo contribuiría en su identificación precoz y anticiparía su tratamiento. Se ha propuesto utilizar los cambios en la velocidad de la onda del pulso carótido-radial (VOPcr) para evaluar la DFE en pacientes con enfermedad arterial. Sin embargo, se desconocen los alcances de dicha técnica en la evaluación de la DFE durante el embarazo. Objetivo: evaluar y comparar los cambios de la VOPcr en embarazadas y mujeres no embarazadas. Material y método: participaron embarazadas sanas (ES; n = 13), preeclámpticas (PE; n = 7), hipertensas sin proteinuria (HNP; n = 6) y mujeres no embarazadas (NE; n = 32). Se cuantificó la VOPcr (mecanotransductores), el diámetro arterial braquial (ultrasonido) y la velocidad sanguínea braquial (Doppler) antes (basal) y después de realizar un estímulo isquémico (esfigmomanometría). Resultados: la VOPcr disminuyó en ES (6,9 ± 1,5 a 6,0 ± 0,9 m/s, p < 0,001) y en NE (8,1 ± 0,9 a 7,4 ± 0,9 m/s; p < 0,001); no se obtuvieron cambios en HNP (6,6 ± 1,4 a 6,7 ± 1,0 m/s; p = 0,91) y en PE se observó una tendencia al aumento (6,0 ± 0,7 a 6,4 ± 0,8 m/s; p = 0,10). El DVOPcr% (porcentaje de cambio de la VOPCr basal versus postisquemia) fue distinto comparando ES con HNP (-11,9% versus +2,2%; p < 0,01), con NE (-11,9% versus -8,5%; p < 0,05) y con PE (-11,9 versus +6,2%; p < 0,01), respectivamente, sin encontrar diferencias entre HNP y PE (p = 1,00). Conclusión: las ES mostraron una reactividad vascular aumentada respecto a NE y HNP/PE evaluada por DVOPcr%, evidenciando en HNP/PE una respuesta vascular alterada. La VOPcr podría desempeñar un importante rol en el estudio de la DFE durante el embarazo, con una potencial aplicación clínica en la predicción de la preeclampsia.

Carotid-radial pulse wave velocity as an alternative tool for the evaluation of endothelial function during pregnancy: potential role in identifying hypertensive disorders of pregnancy.

UNLABELLED: Preeclampsia/eclampsia syndrome, a major cause of maternal mortality and morbidity, has been recognized as a condition with a globally impaired endothelial function (EF). The possibility of identifying early subclinical endothelial damage during pregnancy could be of value in classifying the different hypertensive states of pregnancy, and have a positive impact in the understanding of this syndrome, as well as on the appropriate treatment of these patients. Reactive hyperemia-related changes in carotid-radial pulse wave velocity (PWVcr) were proposed as an alternative tool for the evaluation of EF in patients with cardiovascular risk factors. If impaired EF, which follows hypertensive disorders of pregnancy can be assessed using PWVcr changes remains still unknown. AIMS: To assess and compare reactive hyperemia-related changes in PWVcr and FMD in pregnant women (healthy and with hypertensive disorders) and non pregnant women. METHODS: Healthy pregnant (HP; n=13), preeclamptic (PE; n=7), non-proteinuric hypertensive (NPH; n=6) and non-pregnant (NP; n=32) women were included. Left PWVcr (strain gauge mechano-transducers), left brachial arterial diameter (B-Mode ultrasound) and blood flow velocity (Doppler ultrasound) were measured before (baseline) and after the transient ischemia of the left forearm were determined. RESULTS: One minute after the cuff deflation, PWVcr decreased in HP (6.9 ± 1.5 to 6.0 ± 0.9 m/s, p<0.001) and in NP (8.1 ± 0.9 to 7.4 ± 0.9 m/s; p<0.001). NPH showed a blunted hyperemic PWVcr response (6.6 ± 1.4 to 6.7 ± 1.0 m/s; p=0.91), whereas PE showed a tendency to increase (6.0 ± 0.7 to 6.4 ± 0.8 m/s; p=0.10). Reactive hyperemia PWVcr response (ΔPWVcr in %) differed comparing HP with NPH (-12% vs. +2%; p<0.01) and with PE (-12 vs. +6%; p <0.01), whereas no differences were found between NHP and PE (p=1.00). CONCLUSION: HP showed an enhanced PWVcr reduction, whereas PE and NPH showed a blunted hyperemic PWVcr response. Carotid-radial PWVcr analysis could have a potential role in the assessment of pregnancy to study EF with a potential clinical application in predicting pregnancy induced hypertension and preeclampsia.

Rol de la laparoscopía en los cuadros agudos de abdomen inferior en la mujer: revisión últimos 10 años, Servicio de Ginecología del Hospital Británico / Role of laparoscopy in acute lower abdominal episodes in women: review of the last 10 years, British HospitalÆs Gynecology DepartmentABDOMEN, ACUTE - diagnosis

Introducción: los cuadros agudos de abdomen inferior (CAAI) en la mujer son una causa frecuente de consulta en puerta de emergencia. El rol de la laparoscopía como herramientadiagnóstica y terapéutica, más aun en la mujer, se encuentra bien establecido. Permite arribar a un diagnóstico de certeza en todos los casos al visualizar la totalidad de la cavidad abdominal mediante un abordaje mínimamente invasivo, evita retrasos diagnósticos y sus consiguientes complicaciones evolutivas. Objetivo: describir, analizar y comunicar la casuística de los últimos diez años de cirugías laparoscópicas por CAAI en el Servicio de Ginecología del Hospital Británico. Material y método: se realiza un estudio retrospectivo y descriptivo del rol de la laparoscopíaen los CAAI de la mujer en los últimos diez años de cirugías laparoscópicas realizadas en el Servicio de Ginecología del Hospital Británico. Se analizan las siguientes variables: edad depresentación, indicación de hallazgos nosológicos, resolución y complicaciones.Resultados: la máxima prevalencia de los cuadros agudos de abdomen se presentó entre los 30 y 35 años de edad; correspondiendo el embarazo ectópico, los quistes de ovario, seguidospor torsiones anexiales los hallazgos laparoscópicos más frecuentes. La resolución por vía laparoscópica pudo efectuarse en 93% de las pelviscopías patológicas. Solamente requirieron conversión laparotómica 7% de las pacientes, siendo la principal indicación de las mismas los abscesos tuboováricos.

Introduction: acute lower abdominal episodes in women are the most frequent cause of consultation at the emergency room. The role of laparoscopy as a diagnostic andtherapeutic tool, especially in women, has been well established. It allows for valid diagnosis in all cases since itenables the visualization of the entire abdominal cavity by means of a minimally invasive approach, it avoids diagnostic delays and its resulting complications in the evolution.Objective: to describe, analyze and communicate the casuistics of laparoscopic surgery for acute lower abdominal episodes at the British HospitalÆs Gynecology Departmentin the last ten years. We analyzed the following variables: age of consultation, nosological findings indication,resolution and complications. Results: maximum prevalence of acute abdominal episodes was between 30 and 35 years of age; the most frequentof which were cases of ectopic pregnancy, ovarian cysts, followed by adnexal torsions. Laparoscopic resolution could be performed in 93% of pathological pelvicoscopies. Only 7% of patients required laparothomic approach, the main indication of which was ovarian tube abscess.

Introdução: os quadros agudos de abdômen inferior (QAAI) na mulher são uma causa freqüente de consultano pronto-socorro. O papel da laparoscopia como ferramenta de diagnóstico e terapêutica, especialmente na mulher, já está estabelecido. Permite chegar a um diagnóstico de certeza em todos os casos por possibilitar avisualização da cavidade abdominal integralmente com uma abordagem minimamente invasiva, evita atrasos no diagnóstico e as complicações decorrentes desse atraso. Objetivo: descrever, analisar e comunicar a casuística dos últimos dez anos de cirurgias laparoscópicas por QAAI no Serviço de Ginecologia do Hospital Britânico. Material e método: faz-se um estudo retrospectivo e descritivo do papel da laparoscopia nos QAAI da mulher nos últimos dez anos de cirurgias laparoscópicas realizadas no Serviço de Ginecologia do Hospital Britânico. Foramanalisadas as seguintes variáveis: idade de apresentação, indicação de achados nosológicos, resolução e complicações.Resultados: a prevalência máxima dos quadros agudos de abdômen foi registrada no grupo entre 30 e 35 anos de idade; os achados mais freqüentes foram gravidez ectópica, cistos de ovário, seguidos por torções dos anexos.A resolução por via laparoscópica pode ser realizada em 93% das pelviscopias patológicas. Foi necessário realizarconversão laparatômica em somente 7% das pacientes, sendo os abscessos tuboováricos a principal indicação.

Tratamiento conservador en la hemorragia posparto refractaria al tratamiento médico: sutura de B-Lynch / Conservative treatment for postpartum hemorrhage refractory to medical treatment: B-Lynch suture

Objetivos: difundir la aplicación de una técnica quirúrgica conservadora en el tratamiento de la hemorragia posparto severa secundaria a la atonía uterina y refractaria al tratamiento médico. Material y método: reporte de tres casos clínicos de atonía uterina en los que se realizó la aplicación de la sutura quirúrgica de B-Lynch en el Centro Hospitalario Pereira Rossell. Resultados: en los tres casos se logró un control eficaz de la hemorragia posparto mediante un tratamiento conservador, sin complicaciones durante su aplicación ni en el puerperio inmediato. Conclusiones: la sutura hemostática de B-Lynch es una alternativa aceptada a nivel internacional que forma parte de los protocolos de manejo de la hemorragia posparto. Es una técnica efectiva, simple, reproducible y que permite preservar el potencial reproductivo con particular indicación en pacientes jóvenes. Este es el primer reporte a nivel nacional de la técnica de B-Lynch que pudo ser aplicada sin dificultades y con control adecuado del sangrado.

Objectives: to disseminate the application of a conservatory surgical technique to treat severe postpartum hemorrhage secondary to uterine atony refractory to medical treatment. Method: report on three clinical cases of uterine atony where B-Lynch suture was applied at the Pereira Rossell Hospital Center. Results: in all three cases postpartum hemorrhage was effectively controled through a conservative treatment, being there no complications during application ot the immediate puerperium. Conclusions: B-Lynch hemostatic suture is an alternative that has been widely accepted globally and it has been included in protocols for handling postpartum hemorrhage. It is an effective, simple and replicable technique that enables the preservation of the reproductive potential, particularly relevant in young patients. This is the first report on the B-Lynch technique, at the international level, accounting the application of the technique with no difficulties and an appropriate control of hemorrhage.

Objetivos: difundir a aplicação de una técnica cirúrgica conservadora no tratamento da hemorragia pós-parto severa secundária à atonia uterina e refratária ao tratamento médico. Material e método: descrição de três casos clínicos de atonia uterina nos quais se utilizou a sutura cirúrgica de B-Lynch no Centro Hospitalar Pereira Rossell. Resultados: nos três casos foi possível controlar a hemorragia pós-parto empregando um tratamento conservador, sem complicações no momento da aplicação e durante o puerpério imediato. Conclusões: a sutura hemostática de B-Lynch é uma alternativa internacionalmente aceita que forma parte dos protocolos de manejo da hemorragia pós-parto. É uma técnica efetiva, simples, reproduzível e que permite preservar a capacidade reprodutora da paciente estando indicado especialmente em pacientes jovens. Este é a primeira descrição nacional da técnica de BLynch que pode ser aplicada sem dificuldades e com um controle adequado do sangramento.