| Manejo de la hemorragia postparto |
El manejo de hemorragia post-parto (HPP) implica el tratamiento de la atonía uterina, la evacuación de la placenta retenida o fragmentos de placenta, la cirugía debido a un traumatismo del canal uterino o el parto, el taponamiento con balón, el reemplazo de volumen efectivo y la terapia de transfusión, y en ocasiones, la embolización arterial selectiva. Este artículo tiene como objetivo la introducción de la hemorragia del embarazo y los cambios inducidos en la coagulación y la fibrinólisis y sus mecanismos de compensación pertinentes, la terapia de reemplazo de volumen, transfusión óptima de los productos sanguíneos, y concentrados de factores de coagulación, y, brevemente rescate celular, el manejo de la atonía uterina, las intervenciones quirúrgicas y la embolización arterial selectiva. Se prestará especial, la gestión respectiva, y el seguimiento se requieren en las mujeres con trastornos de la coagulación, tales como la enfermedad de von Willebrand, portadoras de hemofilia A o B, y deficiencias raras de factores de coagulación. También ofrecemos una propuesta de instrucciones prácticas en el tratamiento de la hemorragia postparto.
Management of post-partum haemorrhage
J. AHONEN, V. STEFANOVIC, R. LASSILA
Acta Anaesthesiol Scand 2010; 54: 1164-1178
Management of post-partum haemorrhage (PPH) involves the treatment of uterine atony, evacuation of retained placenta or placental fragments, surgery due to uterine or birth canal trauma, balloon tamponade, effective volume replacement and transfusion therapy, and occasionally, selective arterial embolization. This article aims at introducing pregnancy- and haemorrhage-induced changes in coagulation and fibrinolysis and their relevant compensatory mechanisms, volume replacement therapy, optimal transfusion of blood products, and coagulation factor concentrates, and briefly cell salvage, management of uterine atony, surgical interventions, and selective arterial embolization. Special attention, respective management, and follow-up are required in women with bleeding disorders, such as von Willebrand disease, carriers of haemophilia A or B, and rare coagulation factor deficiencies. We also provide a proposal for practical instructions in the treatment of PPH.
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| La cesárea sin indicación médica se asocia con alto riesgo de evolución adversa a corto plazo de las madres: Encuesta mundial 2004-2008 de la OMS sobre salud materna y perinatal |
Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health
J P Souza, A M Gulmezoglu, P Lumbiganon, M Laopaiboon, G Carroli, B Fawole, P Ruyan and WHO Global Survey on Maternal and Perinatal Health Research Group
BMC Medicine 2010, 8:71doi:10.1186/1741-7015-8-71
Abstract (provisional)
Background. There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. Methods. This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. Results. A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America.
Conclusions. Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.
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