Early prognostic capacity of serum lactate for severe postpartum hemorrhage.

OBJECTIVE: To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). METHODS: A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non-SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. RESULTS: SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7-16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55-0.98); specificity was 0.76 (95% CI 0.50-0.93). CONCLUSION: Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.

Ligadura de arterias hipogástricas en hemorragia postparto severa / Hypogastric artery ligation in severe post-partum haemorrhage

Introducción: la hemorragia posparto severa ha presentado un incremento en los últimos años, hecho relacionado con el aumento de inducciones del parto y, principalmente, con el incremento en la tasa de cesáreas; siendo una de las complicaciones más graves del parto con una significativa morbimortalidad materna. Las causas más frecuentes se relacionan con la sobredistensión uterina, corioamnionitis, inercia uterina, acretismo placentario y ruptura uterina. El manejo es secuencial y dinámico, desde el masaje uterino, el arsenal farmacológico con úterotónicos, seguido de procedimientos más invasivos como la revisión dígito instrumental, laparotomía con ligadura o la embolización de las arterias uterinas, suturas uterinas compresivas, ligadura de arterias hipogástricas, y finalmente histerectomía. Objetivo: describir las características generales y los resultados postoperatorios de una serie de casos de mujeres con hemorragia postparto sometidas a ligadura bilateral de las arterias hipogástricas. Métodos: estudio descriptivo, retrospectivo, transversal que se realizó en 27 mujeres que presentaron hemorragia postparto severa primaria, refractaria a la terapia convencional y a quienes se les realizó ligadura bilateral de las arterias hipogástricas, en la Clínica La Sagrada Familia, Armenia, Quindío, Colombia, Suramérica, entre 2009 y 2014. Resultados: la edad promedio de las pacientes fue de 21,9 ±; 7,2 años; la edad gestacional fue 36,3 ±; 4,8 semanas, el sangrado preoperatorio fue 2 700 ±; 600 ml y el tiempo quirúrgico fue 21,6 ±; 9,3 minutos. En el 88,9 % de los casos en que se logró resolver el problema de la hemorragia, la evolución postoperatoria de las pacientes fue favorable. La media de estancia hospitalaria varió entre tres y seis días. La demora en la realización de la ligadura, por encima de las tres horas, determinó un mayor tiempo quirúrgico. No se presentaron complicaciones intraoperatorias o postoperatorias. Conclusiones: la ligadura bilateral de las arterias hipogástricas es un procedimiento efectivo y seguro para controlar la hemorragia posparto severa, debiendo ser considerada en las mujeres que no responden a otras modalidades de tratamiento.

Introduction: severe postpartum hemorrhage has shown an increase in recent years, a fact related to the increase of labor inductions and especially with the increase in the rate of caesarean sections; being one of the most serious complications of childbirth with significant maternal morbidity and mortality. The most common causes are related to uterine distension, chorioamnionitis, uterine inertia, placenta accreta and uterine rupture. The operation is sequential and dynamic, from uterine massage, pharmacological arsenal with uterine tonics, followed by more invasive procedures such as digit revision instrumental, laparotomy with ligation or embolization of the uterine arteries, uterine sutures compression, ligation of hypogastric arteries, and finally hysterectomy. Objective: to describe the general characteristics and postoperative results of a series of cases of women with postpartum hemorrhage under bilateral ligation of the hypogastric arteries. Methods: a descriptive, retrospective, cross-sectional study was conducted on 27 women who had primary severe postpartum hemorrhage, refractory to conventional therapy, and who underwent bilateral ligation of the hypogastric arteries in the Clinica La Sagrada Familia, Armenia, Quindío, Colombia, South America, between 2009 and 2014. Results: the average age of the patients was 21.9 years (SD ±; 7.2), gestational age was 36.3 weeks (SD ±; 4.8), preoperative blood loss was 2700 ml (SD ±; 600), operative time was 21.6 minutes (±; 9.3 minutes). In 24 of the 27 cases in which the technique was performed, it was possible to solve the problem of bleeding. The postoperative course of patients was favorable. The mean hospital stay varies between 3 and 6 days. The delay in performing ligation, over three hours, was a predictor of increased surgical time in these patients. Intraoperative or postoperative complications were not presented. Conclusions: bilateral hypogastric artery ligation is an effective and safe for severe postpartum hemorrhage control procedure that does not compromise the future reproductive capacity.