Uterine necrosis following hemostatic compression suture: case report and review of the literature / Necrosis uterina tras sutura de compresión hemostática: reporte de caso y revisión de la literatura

Objectives: To present a case of uterine necrosis following hemostatic suturing to control postpartum bleeding, and to review the literature in order to identify the suture techniques employed, clinical findings, diagnostics and treatment in the clinical cases described. Material and methods: A 34-year-old woman presenting with abdominal pain eight days after cesarean delivery due to placenta previa who required B-Lynch compression suture due to uterine atony, and who was diagnosed with uterine necrosis. The patient underwent total abdominal hysterectomy with a satisfactory recovery. A systematic literature search was conducted in the Medline vía Pubmed, Embase and Web of Science databases. The search included case series and reports, and cohorts of women with uterine necrosis following the use of uterine compression sutures for postpartum bleeding. The analysis included sociodemographic and clinical variables at the time of diagnosis, suturing technique, diagnostic tests and treatment. Results: Overall, 23 studies with 24 patients were included. Of all necrosis cases, 83% occurred following cesarean section. B-Lynch was the suturing technique most frequently used (66 %), followed by the Cho suture (25 %). The most frequent symptoms were fever and abdominal pain. The most commonly used diagnostic test was computed tomography (9/24 cases). Hysterectomy was performed in the majority of cases (75 %). Conclusions: Although rare, uterine wall necrosis is a serious complication. It would be advisable to design follow-up cohort studies of women undergoing these procedures in order to determine the incidence of associated complications.

Objetivos: presentar un caso de necrosis uterina tras técnica de sutura hemostática por hemorragia posparto y hacer una revisión de la literatura para determinar la técnica de sutura utilizada, los hallazgos clínicos, la técnica diagnóstica y el tratamiento realizado en los casos clínicos descritos. Materiales y métodos: se presenta el caso de una mujer de 34 años que consultó por dolor abdominal al octavo día tras cesárea por placenta previa, que precisó sutura de B-Lynch por atonía uterina y cuyo diagnóstico fue necrosis uterina. La paciente requirió histerectomía abdominal total, con evolución satisfactoria. Se realizó una búsqueda sistemática de la literatura en las bases de datos Medline vía Pubmed, Embase y Web of Science. Se buscaron series y reportes de casos y cohortes de mujeres con necrosis uterina posterior al uso de suturas de compresión uterina para control de hemorragia posparto. Se analizaron variables sociodemográficas y clínicas al diagnóstico, técnica de sutura, pruebas diagnósticas y tratamiento. Resultados: se incluyeron 23 estudios con 24 pacientes. El 83 % de las necrosis ocurrieron tras cesárea. La técnica más utilizada fue B-Lynch (66 %), seguida de Cho (25 %). Los síntomas más frecuentes fueron fiebre y dolor abdominal. La prueba diagnóstica más utilizada fue la tomografía computarizada (9 de 24 casos). En la mayoría de casos se realizó histerectomía (75 %). Conclusiones: la necrosis de la pared uterina es una complicación infrecuente pero grave. Sería recomendable el diseño de cohortes de seguimiento de mujeres sometidas a estos procedimientos para determinar la incidencia de complicaciones asociadas.

Effect of Milking Maneuver in Preterm Infants: A Randomized Controlled Trial.

OBJECTIVE: To assess the short and medium-term effects of milking maneuver (MM) compared with early cord clamping for infants born before 37 weeks of pregnancy. MATERIAL AND METHODS: 138 infants between 24+0 and 36+6 weeks of gestation were allocated to MM or early cord clamping. Primary outcomes were the requirement of red blood cell transfusions or phototherapy. RESULTS: Initial hemoglobin was significantly higher in the MM group by 1.675 g/dL (p < 0.05) and initial hematocrit by 5.36% (p < 0.05), but no differences in the need of transfusion during the first 30 days after delivery were found (RR 0.8; 95% CI 0.22-2.85). Peak serum bilirubin was similar in both groups (11,097 ± 3.21 vs. 11,247 ± 3.56 mg/dL, p = 0.837). Phototherapy requirements were higher in the MM group (RR 1.62; 95% CI 1.1-2.38). No differences regarding the need of oral iron supplementation, platelet transfusion, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, meconium aspiration syndrome, use of surfactant, days of oxygen supplementation, need of vasopressors, length of stay in the neonatal intensive care unit, or postpartum hemorrhage were found. CONCLUSION: MM does not reduce the need for red blood cell transfusions and increases phototherapy requirements in preterm infants.

Síndrome de encefalopatía posterior reversible durante el puerperio / Posterior reversible encephalopathy and puerperium

El síndrome de encefalopatía posterior reversible se describió por primera vez en 1996 por Hinchey y cols. Puede presentarse durante la gestación y puerperio. Se expone un caso clínico y se revisa la evidencia para el diagnóstico, tratamiento y pronóstico de la encefalopatía posterior reversible. Se realizó una búsqueda electrónica en término de diagnóstico, tratamiento y pronóstico del síndrome de encefalopatía posterior reversible durante y fuera de la gestación. No se encontró ningún estudio analítico, únicamente se hallaron series de casos, lo que no aporta suficiente evidencia científica para establecer recomendaciones sólidas acerca de esta entidad. Poco se conoce acerca del síndrome de encefalopatía posterior reversible y de su comportamiento en la gestación por lo que es necesario acumular mayor evidencia respecto a este síndrome (AU)

Posterior reversible encephalopathy was introduced into clinical practice in 1996 by Hinchey and cols. Clinically can be expressed during pregnancy and postpartum. To review evidence available of diagnosis and treatment of posterior reversible encephalopathy we expose a clinical case and we carried out an electronic search in order to find the best evidence available in terms of diagnosis, treatment and prognosis of posterior reversible encephalopathy during and out of pregnancy. No analytical studies were found, only case reports. These results do not allow establishing recommendations. There is not enough information regard to Posterior reversible encephalopathy syndrome. It is mandatory to accumulate more information that allows us to comprehend and establish evidence about this entity (AU)