Ligadura de arterias hipogstricas en hemorragia postparto severa (Hypogastric artery ligation in severe post-partum haemorrhage)

摘要

Objetivo: Presentar una serie de casos de mujeres con hemorragia posparto, quienes fueron sometidas a ligadura bilateral de las arterias hipogstricas. Sujetos y mtodos: estudio descriptivo que se realiz en 27 mujeres que presentaron hemorragia posparto severa primaria, refractaria a la terapia convencional, y a las que se les realiz ligadura bilateral de las arterias hipogstricas, en La Clnica La Sagrada Familia de Armenia, Quindo, entre 2009 y 2014. Se midieron las siguientes variables: edad materna, paridad, va del parto, edad gestacional del embarazo, las circunstancias en que se aplic la tcnica de la ligadura bilateral de las arterias hipogstricas y la evolucin de las pacientes durante su estancia hospitalaria. Se hace un anlisis descriptivo. Resultados: la edad promedio de las pacientes fue de 21,9 aos (DS 7.2), la edad gestacional fue 36.3 semanas (DS 4.8), el sangrado preoperatorio fue 2 700 ml (DS 600), el tiempo quirrgico fue 21.6 minutos ( 9.3 minutos). En el 88,88% (24/27) de los casos en que se realiz la tcnica, se logr resolver el problema de la hemorragia. La evolucin postoperatoria de las pacientes fue favorable. La media de estancia hospitalaria vari entre 3 y 6 das. La demora en la realizacin de la ligadura, por encima de las tres horas, fue un predictor de mayor tiempo quirrgico en estas pacientes. No se presentaron complicaciones intraoperatorias o postoperatorias. Conclusiones: la ligadura bilateral de las arterias hipogstricas 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; y es aceptado a nivel internacional como parte de los protocolos de manejo conservador. AbstractIntroduction: 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 tonics uterus, 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, Quindo, 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. DOI: http://dx.doi.org/10.21615/cesmedicina.30.1.3