[Obstetric bleeding: an update]. / La hemorragia obstétrica. Actualización.

Massive bleeding in obstetrics still ranks among the most frequent causes of maternal morbidity and mortality worldwide. The most frequent type is primary postpartum hemorrhage, which is usually the result of an atonic uterus. The clinical priorities are to assure hemodynamic stability and to correct coagulation abnormalities. If pharmacologic treatment cannot achieve these goals, invasive methods such as interventional vascular radiology or artery ligation must be used. Hysterectomy is the last resort when the previous methods fail. For the best prognosis, in terms of preventing death, maintaining maternal fertility and minimizing morbidity, every maternity ward should have a well-defined multidisciplinary protocol that facilitates diagnosis and immediate treatment.

Perioperative factors that contribute to postoperative pain and/or nausea and vomiting in ambulatory laparoscopic surgery. / Factores perioperatorios que contribuyen a la aparición de dolor o náuseas y vómitos postoperatorios en cirugía laparoscópica ambulatoria.

INTRODUCTION: Both postoperative pain and postoperative nausea and vomiting are major factors that determine the time and quality of recovery in laparoscopic surgery. OBJECTIVE: To determine the perioperative factors that contribute to the appearance of postoperative pain and postoperative nausea and vomiting in outpatient laparoscopic surgery. MATERIAL AND METHODS: A prospective study was conducted on a cohort of 297 patients undergoing laparoscopic ambulatory surgery. A record was made of preoperative factors (usual medication, anaesthetic risk, etc.), intraoperative (surgical and anaesthetic times, drugs, CO2 pressure, etc.), and postoperative factors (major and minor complications, recovery times, etc.). As dependent variables, the postoperative symptoms considered were, nausea, vomiting, and/or postoperative pain. RESULTS: Considering as a combined variable the occurrence of níusea, vomiting or moderate/severe pain (4 or more points on a visual analogue scale), one or more of these symptoms occurred in 58.7% of the patients (95% CI: 52.8-64.4). Using a logistic regression, the variables associated with the appearance of symptoms were: female gender (OR: 3.4), waiting time over 45minutes prior to surgery (OR: 4.9) and no anti-emetic prophylaxis (OR: 12.2). CONCLUSIONS: In patients undergoing ambulatory laparoscopic surgery, one in 4had postoperative nausea and vomiting, and approximately half of moderate-intensity pain before discharge. Considering the overall the occurrence of pain and/or postoperative níusea and vomiting, these symptoms affect more than half of the patients being operated on, and are more frequent in women and in those who have to wait to access the operating room.