Prophylactic catheterization of uterine arteries with temporary blood flow occlusion in patients at high risk of pospartum hemorrhage: is it a safe technique?

BACKGROUND: Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding. OBJECTIVES: To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion. METHODS: A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding. RESULTS: The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths. CONCLUSIONS: In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique.

Cateterização profilática de artérias uterinas com oclusão temporária do fluxo sanguíneo em pacientes de alto risco para hemorragia puerperal: é uma técnica segura? / Prophylactic catheterization of uterine arteries with temporary blood flow occlusion in patients at high risk of pospartum hemorrhage: is it a safe technique?

A placenta acreta é um importante causa de morbimortalidade materna, sendo responsável por aproximadamente 64% dos casos de histerectomia de urgência e em torno de 2/3 dos casos de sangramento puerperal. Objetivos Descrever uma série de casos de cateterização uterina profilática para evitar sangramento significativo no pós-parto ou durante parto cesárea em gestantes com diagnóstico prévio de acretismo. Métodos Foi realizada uma análise retrospectiva de prontuários dos casos de cateterização da artéria uterina durante cesarianas eletivas ou de urgência em pacientes com alto risco de sangramento puerperal. Resultados O procedimento foi realizado em 14 pacientes. O tempo médio do procedimento cirúrgico e da internação foi de 214,64 minutos (± 42,16) e 7 dias, respectivamente. Todas as pacientes foram submetidas a histerectomia por indicação obstétrica. Nenhuma paciente necessitou de embolização. Não houve sangramento ou necessidade de reabordagem em nenhuma paciente e nenhuma complicação relacionada à punção. Houve apenas um caso de morte fetal e nenhuma morte materna. Conclusões Neste estudo, a cateterização profilática de artérias uterinas com oclusão temporária do fluxo sanguíneo demonstrou ser uma técnica segura, pois apresentou baixa mortalidade fetal, baixa necessidade de hemotransfusão, e nenhuma morte materna. Portanto, pode ser considerada uma estratégia terapêutica importante e eficaz para a diminuição da morbimortalidade materna, especialmente em gestantes com implantação placentária anômala. Além disso, a possibilidade de preservação uterina com o uso do método traz excelente contribuição na terapêutica nesse grupo de pacientes. Entretanto, são necessários ensaios clínicos randomizados para avaliar a eficácia do uso rotineiro da técnica

Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding. Objectives To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion. Methods A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding. Results The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths. Conclusions In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique

Effects of prokinetic drugs on the abdominal wall wound healing of rats submitted to segmental colectomy and colonic anastomosis.

PURPOSE: To assess the effect of prokinetic agents on abdominal wall wound healing in rats submitted to segmental colectomy and colonic anastomosis. METHODS: Sixty rats were randomly allocated into three groups according to the agents they would receive in the postoperative period: M (metoclopramide); B (bromopride); and C (control, saline 0.9%). Surgical procedures were performed identically in all animals, and consisted of a midline laparotomy followed by resection of a 1-cm segment of large bowel with end-to-end anastomosis. The abdominal wall was closed in two layers with running stitches. Abdominal wall samples were collected on the 3rd or 7th postoperative day for measurement of breaking (tensile) strength and histopathological assessment. RESULTS: There were no statistically significant differences in tensile strength of the abdominal wall scar between groups M, B, and C, nor between the three and seven days after surgery subgroups. On histopathological assessment, there were no statistically significant between-group differences in collagen deposition or number of fibroblasts at the wound site CONCLUSION: Use of the prokinetic drugs metoclopramide or bromopride had no effect on abdominal wall healing in rats submitted to segmental colectomy and colonic anastomosis.

Effects of prokinetic drugs on the abdominal wall wound healing of rats submitted to segmental colectomy and colonic anastomosis / Efeitos de drogas procinéticas na cicatrização da parede abdominal de ratos submetidos à colectomia segmentar e anastomose no cólon esquerdo

PURPOSE: To assess the effect of prokinetic agents on abdominal wall wound healing in rats submitted to segmental colectomy and colonic anastomosis. METHODS: Sixty rats were randomly allocated into three groups according to the agents they would receive in the postoperative period: M (metoclopramide); B (bromopride); and C (control, saline 0.9%). Surgical procedures were performed identically in all animals, and consisted of a midline laparotomy followed by resection of a 1-cm segment of large bowel with end-to-end anastomosis. The abdominal wall was closed in two layers with running stitches. Abdominal wall samples were collected on the 3rd or 7th postoperative day for measurement of breaking (tensile) strength and histopathological assessment. RESULTS: There were no statistically significant differences in tensile strength of the abdominal wall scar between groups M, B, and C, nor between the three and seven days after surgery subgroups. On histopathological assessment, there were no statistically significant between-group differences in collagen deposition or number of fibroblasts at the wound site CONCLUSION: Use of the prokinetic drugs metoclopramide or bromopride had no effect on abdominal wall healing in rats submitted to segmental colectomy and colonic anastomosis.

OBJETIVO: Avaliar os efeitos do uso de drogas prócinéticas na cicatrização da parede abdominal de ratos submetidos à colectomia segmentar e anastomose no cólon esquerdo. MÉTODOS: Foram utilizados 60 ratos, alocados aleatoriamente em três grupos para receberem as seguintes medicações no período pós-operatório: M (metoclopramida); B (bromoprida) e C (solução salina a 0,9%). Os procedimentos cirúrgicos foram idênticos em todos os animais. Foi realizada laparotomia mediana, seguida de colectomia segmentar de 1-cm e anastomose colônica. O fechamento da parede abdominal foi feito em dois planos de sutura contínua. No 3° ou no 7° dia pós-operatório foram coletadas amostras da parede abdominal para medida da força de ruptura e avaliação histopatológica. RESULTADOS: Não houve diferença significativa entre os grupos no que diz respeito à força de ruptura da parede abdominal, nem entre os subgrupos no 3º e 7º dia após a cirurgia. À análise histopatológica não houve alterações na deposição de colágeno ou na quantidade de fibroblastos no sítio da cicatriz. CONCLUSÃO: O uso de drogas prócinéticas, metoclopramida ou de bromoprida, não interferiu na cicatrização da parede abdominal de ratos submetidos à colectomia segmentar e anastomose no cólon esquerdo.

Effects of bromopride on abdominal wall healing with induced peritoneal sepsis after segmental colectomy and colonic anastomosis in rats / Efeitos da bromoprida na cicatrização da parede abdominal com sepse peritoneal induzida e submetidos à ressecção segmentar e anastomose do cólon esquerdo em ratos

PURPOSE: Evaluate the effects of bromopride on abdominal wall healing of rats with induced peritoneal sepsis after segmental colectomy and colonic anastomosis. METHODS: Forty rats underwent sectioning of the left colon and end-to-end anastomosis and were divided into two groups of 20 animals for the administration of bromopride (bromopride group - B) or saline solution (control group - C). Each group was divided into subgroups of 10 animals each to be killed on the third (GB3 and GC3) or seventh postoperative day (GB7 and GC7). It was analyzed the following characteristics: breaking strength of the abdominal wall's wound; surgical and histopathological features of the abdominal wall; and clinical features of the rats. RESULTS: There was no difference between the groups in relation to the weight of the rats and the breaking strength of the abdominal wall's wound. The GB7 group presented less edema and less quantity of fibrin during histopathological evaluation compared to the GC7 group. CONCLUSION: Bromopride did not have harmful effects on the healing of abdominal wall in rats.

OBJETIVO: Avaliar o efeito da bromoprida, na cicatrização da ferida operatória da parede abdominal de ratos com sepse peritoneal experimentalmente induzida e submetidos a ressecção segmentar e anastomose de cólon esquerdo. MÉTODOS: 40 ratos distribuídos em dois grupos contendo 20 animais, para administração de bromoprida (grupo bromoprida- B) ou solução de NaCl 0,9 por cento (grupo controle - C). Cada grupo foi dividido em subgrupos contendo 10 animais, para eutanásia no terceiro (GB3 e GC3) ou sétimo dia (GB7 e GE7) de pós-operatório. Os ratos foram submetidos à secção do cólon esquerdo e anastomose término-terminal. No dia da eutanásia foram avaliadas as características cirúrgicas da cavidade abdominal e clínicas dos ratos. Foram coletados segmentos da parede para a avaliação histopatológica e de resistência tênsil da ferida operatória. RESULTADOS: Não houve diferenças entre os pesos dos ratos e resistência tênsil da ferida operatória nos dois grupos. Em relação a análise histopatológica, o grupo GB7 apresentou menos edema e menos fibrina que o grupo GC7. Não houve outras diferenças. CONCLUSÃO: A utilização de bromoprida não resultou em distúrbios ou retardo da cicatrização no grupo de ratos submetidos à laparotomia e anastomose término-terminal em condições de sepse peritoneal.

Effects of bromopride on abdominal wall healing with induced peritoneal sepsis after segmental colectomy and colonic anastomosis in rats.

PURPOSE: Evaluate the effects of bromopride on abdominal wall healing of rats with induced peritoneal sepsis after segmental colectomy and colonic anastomosis. METHODS: Forty rats underwent sectioning of the left colon and end-to-end anastomosis and were divided into two groups of 20 animals for the administration of bromopride (bromopride group - B) or saline solution (control group - C). Each group was divided into subgroups of 10 animals each to be killed on the third (GB3 and GC3) or seventh postoperative day (GB7 and GC7). It was analyzed the following characteristics: breaking strength of the abdominal wall's wound; surgical and histopathological features of the abdominal wall; and clinical features of the rats. RESULTS: There was no difference between the groups in relation to the weight of the rats and the breaking strength of the abdominal wall's wound. The GB7 group presented less edema and less quantity of fibrin during histopathological evaluation compared to the GC7 group. CONCLUSION: Bromopride did not have harmful effects on the healing of abdominal wall in rats.

Effects of abdominal sepsis in the healing of abdominal wall: experimental study in rats.

PURPOSE: To evaluate the influence of sepsis in the process of wound healing in the abdominal wall. METHODS: 40 rats divided into two groups of twenty animals: group of study (E) - septic, and the control group (C) - not septic. The two groups were divided into subgroups of 10 to be killed on the third day (n = 10) or seventh (n = 10) postoperative. Sepsis was induced by ligation and puncture of the cecum. We performed also the section and anastomosis in left colon. The synthesis of the abdominal wall was made with 3-0 silk thread. On the day of re-laparotomy, the abdominal wall was removed for analysis of the breaking strength and histopathological analysis. RESULTS: The mean breaking strength was at third day: E group (1.44 ± 1.22) and C group (0.35 ± 0.46). At seventh day the mean breaking strength was: E group (13.01 ± 7.09) and C group (11.66 ± 7.38). There was statistical difference in tensile strength. E group at third day with control group (p = 0.019). CONCLUSION: The induction of peritoneal sepsis reduced the breaking strength of the abdominal wall on the third day after surgery.

Influence of metoclopramide on abdominal wall healing in rats subjected to colonic anastomosis in the presence of peritoneal sepsis induced.

PURPOSE: To evaluate the effects of metoclopramide on abdominal wall healing in rats in the presence of sepsis. METHODS: 40 rats divided into two groups of twenty animals, subdivided into two subgroups of 10 animals each: group (E) - treated with metoclopramide, and saline-treated control group. The two groups were divided into subgroups of 10 to be killed on the 3rd day (n = 10) or day 7 (n = 10) after surgery. Sepsis was induced by cecal ligation and puncture. We performed also the section and anastomosis in left colon. The synthesis of the abdominal wall was made with 3-0 silk thread. We measured the breaking strength of the abdominal wall and made the histopathological evaluation. RESULTS: on 3rd day postoperative, the average breaking strength in the E group was 0.83 ± 0.66 and in group C was 0.35 ± 0.46 (p = 0.010). On the seventh day, the breaking strength in group E was 11.44 ± 5.07, in group C 11.66 ± 7.38 (p = 1.000). The E7 group showed lower inflammatory infiltration, foreign body reaction, fibrin than control. CONCLUSION: animals treated with metoclopramide had a higher resistance of the abdominal wall on the 3rd postoperative day.

Study on adhesion formation and the healing of colon anastomosis in rats with induced peritoneal sepsis.

PURPOSE: To evaluate the effects of abdominal sepsis on adhesion formation and colon anastomosis healing in rats. METHODS: Forty rats were distributed in two groups containing 20 rats each for left colon anastomosis in the presence (Group S) or absence (Group N) of induced sepsis by cecal ligation and puncture. Each group was divided into subgroups for euthanasia on the third (N3 and S3) or seventh (N7 or S7) post-operative day. The amount of adhesions was evaluated and a segment of the colon was removed for histopathologic analysis, bursting strength assessment, hydroxyproline and the determination of tissue collagen. RESULTS: The subjects which underwent cecal ligation and puncture presented a higher amount of intra-abdominal adherences in both third (p=0,00) and seventh (p=0,00) post-operatory days. Smaller bursting strengths were found in the S3 subgroup, and greater bursting strengths were found in the S7 subgroup. There was no difference in the variations on the concentrations of hydroxyproline, tissue collagen and histopathology. CONCLUSIONS: The peritoneal infection which was developed by cecal ligation and puncture raised the amount of intra-cavitary adhesions. There was a decrease in the amount of colonic anastomosis on the third post-operatory day with a following raise on the seventh without any effects on other healing parameters.

Effects of abdominal sepsis in the healing of abdominal wall: experimental study in rats / Efeitos da sepse abdominal na cicatrização de parede abdominal: estudo experimental em ratos

PURPOSE: To evaluate the influence of sepsis in the process of wound healing in the abdominal wall. METHODS: 40 rats divided into two groups of twenty animals: group of study (E) - septic, and the control group (C) - not septic. The two groups were divided into subgroups of 10 to be killed on the third day (n = 10) or seventh (n = 10) postoperative. Sepsis was induced by ligation and puncture of the cecum. We performed also the section and anastomosis in left colon. The synthesis of the abdominal wall was made with 3-0 silk thread. On the day of re-laparotomy, the abdominal wall was removed for analysis of the breaking strength and histopathological analysis. RESULTS: The mean breaking strength was at third day: E group (1.44 ± 1.22) and C group (0.35 ± 0.46). At seventh day the mean breaking strength was: E group (13.01 ± 7.09) and C group (11.66 ± 7.38). There was statistical difference in tensile strength. E group at third day with control group (p = 0.019). CONCLUSION: The induction of peritoneal sepsis reduced the breaking strength of the abdominal wall on the third day after surgery.

OBJETIVO: Avaliar a influência da sepse no processo de cicatrização de feridas na parede abdominal. MÉTODOS: 40 ratos divididos em dois grupos de vinte animais: grupo de estudo (E) - séptico, e grupo controle (C) - não séptico. Os dois grupos foram divididos em subgrupos de 10 sendo os animais mortos no terceiro (n = 10) ou sétimo dia (n = 10) pós-operatório. A sepse foi induzida por ligadura e punção do ceco. Foi realizada também a secção e anastomose em cólon esquerdo. A síntese da parede abdominal foi feita com fio de seda 3-0. No dia da re-laparotomia, a parede abdominal foi retirado para análise da força de ruptura e análise histopatológica. RESULTADOS: A força média de ruptura foi: no terceiro dia, grupo E (1,44 ± 1,22) e grupo C (0,35 ± 0,46); no sétimo dia, grupo E (13,01 ± 7,09) e grupo C (11,66 ± 7,38). Houve diferença estatística na resistência à tração do grupo E do terceiro dia quando comparado ao grupo controle (p = 0,019). CONCLUSÃO: A indução de sepse peritoneal reduziu a resistência à ruptura da parede abdominal no terceiro dia após a cirurgia.

Influence of metoclopramide on abdominal wall healing in rats subjected to colonic anastomosis in the presence of peritoneal sepsis induced / Influência da metoclopramida na cicatrização da parede abdominal de ratos submetidos à anastomose colônica na vigência de sepse peritonial induzida

PURPOSE: To evaluate the effects of metoclopramide on abdominal wall healing in rats in the presence of sepsis. METHODS: 40 rats divided into two groups of twenty animals, subdivided into two subgroups of 10 animals each: group (E) - treated with metoclopramide, and saline-treated control group. The two groups were divided into subgroups of 10 to be killed on the 3rd day (n = 10) or day 7 (n = 10) after surgery. Sepsis was induced by cecal ligation and puncture. We performed also the section and anastomosis in left colon. The synthesis of the abdominal wall was made with 3-0 silk thread. We measured the breaking strength of the abdominal wall and made the histopathological evaluation. RESULTS: on 3rd day postoperative, the average breaking strength in the E group was 0.83 ± 0.66 and in group C was 0.35 ± 0.46 (p = 0.010). On the seventh day, the breaking strength in group E was11.44 ± 5.07, in group C 11.66 ± 7.38 (p = 1.000). The E7 group showed lower inflammatory infiltration, foreign body reaction, fibrin than control. CONCLUSION: animals treated with metoclopramide had a higher resistance of the abdominal wall on the 3rd postoperative day.

OBJETIVO: Avaliar os efeitos da metoclopramide na cicatrização da parede abdominal de ratos na vigência de sepse. METHODS: 40 ratos divididos em dois grupos de 20 animais, subdivididos em dois subgrupos de 10 animais cada: grupo (E) - tratado com metoclopramida, e o grupo controle tratado com solução fisiologica. Os dois grupos foram divididos em subgrupos de de 10 para serem mortos no dia 3 (n = 10) ou o dia 7 (n = 10) após a cirurgia. A sepse foi induzida por ligadura e perfuração cecal. Foi realizada também a secção e anastomose em cólon esquerdo. A síntese da parede abdominal foi feita com fio de seda 3-0. Mediu-se a força de ruptura da parede abdominal e foi feita uma avaliação histopatológica. RESULTADOS: No dia 3 pós-operatório, a força média de ruptura no grupo E foi de 0,83 ± 0,66 e no grupo C foi de 0,35 ± 0,46 (p = 0,010). No sétimo dia, a força de ruptura no grupo E foi 11.44 ± 5,07; no grupo C, 11,66 ± 7,38 (p = 1,000). O grupo E7 apresentou menor infiltração inflamatória e reação de corpo estranho do que o controle de fibrina. CONCLUSÃO: Animais tratados com metoclopramida apresentaram uma maior resistência da parede abdominal no 3º dia pós-operatório.

Study on adhesion formation and the healing of colon anastomosis in rats with induced peritoneal sepsis / Estudo da formação de aderências e da cicatrização de anastomoses colônicas em ratos com sepse peritoneal induzida

PURPOSE: To evaluate the effects of abdominal sepsis on adhesion formation and colon anastomosis healing in rats. METHODS: Forty rats were distributed in two groups containing 20 rats each for left colon anastomosis in the presence (Group S) or absence (Group N) of induced sepsis by cecal ligation and puncture. Each group was divided into subgroups for euthanasia on the third (N3 and S3) or seventh (N7 or S7) post-operative day. The amount of adhesions was evaluated and a segment of the colon was removed for histopathologic analysis, bursting strength assessment, hydroxyproline and the determination of tissue collagen. RESULTS: The subjects which underwent cecal ligation and puncture presented a higher amount of intra-abdominal adherences in both third (p=0,00) and seventh (p=0,00) post-operatory days. Smaller bursting strengths were found in the S3 subgroup, and greater bursting strengths were found in the S7 subgroup. There was no difference in the variations on the concentrations of hydroxyproline, tissue collagen and histopathology. CONCLUSIONS: The peritoneal infection which was developed by cecal ligation and puncture raised the amount of intra-cavitary adhesions. There was a decrease in the amount of colonic anastomosis on the third post-operatory day with a following raise on the seventh without any effects on other healing parameters.

OBJETIVO: Avaliar os efeitos da sepse abdominal sobre a formação de aderências e a cicatrização de anastomoses colônicas em ratos. MÉTODOS: 40 ratos distribuídos em dois grupos contendo 20 animais, para anastomose do cólon esquerdo na presença (grupo S) ou ausência (grupo N) de indução de sepse por ligadura e punção do ceco (CLP). Cada grupo foi dividido em subgrupos para eutanásia no terceiro (N3 e S3) ou sétimo (N7 e S7) dia de pós-operatório (DPO). Foi avaliada a quantidade de aderências e removido um segmento colônico contendo a anastomose para análise histopatológica, força de ruptura, hidroxiprolina e conteúdo de colágeno tecidual. RESULTADOS: Os animais submetidos à CLP apresentaram maior quantidade de aderências intra-abdominais tanto no 3° DPO (p=0,00) quanto no 7° DPO (p=0,00). Tiveram menores valores de força de ruptura no 3° DPO (p=0,00), porém maiores valores no 7° DPO (p=0,00). Não houve diferença na variação da concentração de hidroxiprolina, conteúdo de colágeno e histopatologia. CONCLUSÕES: A infecção peritoneal desencadeada por CLP aumentou a quantidade de aderências intra-cavitárias. Houve diminuição da resistência de anastomoses cólicas no 3° DPO, com posterior aumento no 7° DPO, sem efeito sobre os outros parâmetros da cicatrização.