Histerectomía obstétrica. Una emergencia salvavidas
Obstetric hysterectomy: A life saving emergency.
Nooren M, Nawal R.
Indian J Med Sci [serial online] 2013 [cited 2013 Dec 5];67:99-102.
Abstract
Objective: To study the cases of obstetric hysterectomy performed over a period of 1 year (January 2008 to December 2008) in tertiary care center to estimate the incidence, indications, and maternal outcome following the procedure. Materials and Methods: A retrospective analysis of 20 cases of emergency obstetric hysterectomies performed during the study period. Results: During the study period, there were 11,356 deliveries and 20 emergency hysterectomies were done, giving an incidence of 0.17%. 75% cases were unbooked. Ruptured uterus was the most common indication for the procedure, followed by atonic Post-partum haemorrhage (PPH). Six out of 10 cases of rupture uterus had a previous cesarean delivery. Maternal mortality was 15% due to late referral. Conclusion:Emergency obstetric hysterectomy though a rare operation, still remains a life-saving procedure with which every obstetrician must be conversant. Regular antenatal care, identification of high-risk cases, and prompt referral can reduce the incidence of this operation.
Keywords: Maternal outcome, obstetric hysterectomy, rupture uterus
http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2013;volume=67;issue=5;spage=99;epage=102;aulast=Nooren
http://www.indianjmedsci.org/text.asp?2013/67/5/99/122731
Histerectomía obstétrica urgente en un hospital terciario en Sokoto, Nigeria
Emergency obstetric hysterectomy in a tertiary hospital in sokoto, Nigeria.
Nwobodo E, Nnadi D.
Department of Obstetrics and Gynecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Ann Med Health Sci Res. 2012 Jan;2(1):37-40. doi: 10.4103/2141-9248.96935.
Abstract
BACKGROUND: Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications, as a last resort, to prevent maternal mortality. OBJECTIVES: This study was designed to determine the rate, indications, and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH), Sokoto. MATERIALS AND METHODS:This retrospective study involved all the patients who had EOH at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the χ(2) test was used to analyze some of the results with the confidence limit set at 95%. RESULTS: During the 6-year period, 83 EOH were performed out of 16,249 deliveries giving the rate of the former as 0.51%, i.e. 1 in 196 deliveries. However, the case records of only 74 patients (82.9%) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2%) were unbooked for antenatal care, and the rate of the procedure among these patients (1.82%) was significantly higher than 0.07% observed amongst booked subjects (P<0.001). The main indication for the procedure was ruptured uterus (93.2%) and the majority of the patients (95.9%) had subtotal hysterectomy. Anemia (66.2%), excessive hemorrhage (35.5%), septicemia (18.9%), and wound infection (16.2%) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2%) compared to those undertaken by consultants (16.2%); P=0.03. The case fatality rate of the EOH procedure was 12.1%. However, the case fatality rates in the procedure performed by consultants and senior registrars were 6.5% and 16.3%, respectively. CONCLUSION:The rate of EOH in the centre is relatively high and ruptured uterus is responsible for the majority of the procedure. Prevention of prolonged obstructed labor, and therefore uterine rupture, through antenatal care and supervision of labor will reduce the rate of EOH whereas performance of the procedure by the most experienced surgeon will minimize the maternal morbidity and mortality.
KEYWORDS: Emergency obstetric hysterectomy, Ruptured uterus, Sokoto
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507124/
http://www.amhsr.org/downloadpdf.asp?issn=2141-9248;year=2012;volume=2;issue=1;spage=37;epage=40;aulast=Nwobodo;type=2
Uso oportuno (fuera de indicación) del factor VII activado recombinante (NovoSeven (®)) puede ayudar a evitar la histerectomía en la hemorragia obstétrica intratable complicada con coagulación intravascular diseminada
Timely 'off-label' use of recombinant activated factor VII (NovoSeven(®)) can help in avoiding hysterectomy in intractable obstetric bleeding complicated with disseminated intravascular coagulation: A case report and review of the literature.
Burad J, Bhakta P, Sharma J.
Department of Anaesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, Oman.
Indian J Anaesth. 2012 Jan;56(1):69-71. doi: 10.4103/0019-5049.93349.
Abstract
Massive intra-operative bleeding is not an infrequent occurrence in obstetrics. Worldwide obstetric bleeding remains a major cause of morbidity and mortality. Conventional management of this bleeding consists of resuscitation with fluids, blood, surgical maneuvers, and embolisation of feeding blood vessels. But in most of cases, these measures appear to be ineffective in controlling bleeding. Recently, the 'off-label' use of the recombinant activated factor VII (rFVIIa) concentrate has emerged as promising treatment for such bleeding when conventional measures fail. We came across a similar scenario in which a young lady was admitted with per-vaginal bleeding due to abruptio placentae. In spite of usual surgical and medical interventions, she continued to bleed. rFVIIa was administered as a desperate measure to avoid hysterectomy and the bleeding could be stopped. She recovered successfully without any complication. Thus, the timely use of rFVIIa, hence, can be used to save life and fertility in cases of intractable obstetric bleeding.
KEYWORDS:Disseminated intravascular coagulation, intractable obstetric bleed, recombinant activated factor VII concentrate
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327077/
http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2012;volume=56;issue=1;spage=69;epage=71;aulast=Burad;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Obstetric hysterectomy: A life saving emergency.
Nooren M, Nawal R.
Indian J Med Sci [serial online] 2013 [cited 2013 Dec 5];67:99-102.
Abstract
Objective: To study the cases of obstetric hysterectomy performed over a period of 1 year (January 2008 to December 2008) in tertiary care center to estimate the incidence, indications, and maternal outcome following the procedure. Materials and Methods: A retrospective analysis of 20 cases of emergency obstetric hysterectomies performed during the study period. Results: During the study period, there were 11,356 deliveries and 20 emergency hysterectomies were done, giving an incidence of 0.17%. 75% cases were unbooked. Ruptured uterus was the most common indication for the procedure, followed by atonic Post-partum haemorrhage (PPH). Six out of 10 cases of rupture uterus had a previous cesarean delivery. Maternal mortality was 15% due to late referral. Conclusion:Emergency obstetric hysterectomy though a rare operation, still remains a life-saving procedure with which every obstetrician must be conversant. Regular antenatal care, identification of high-risk cases, and prompt referral can reduce the incidence of this operation.
Keywords: Maternal outcome, obstetric hysterectomy, rupture uterus
http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2013;volume=67;issue=5;spage=99;epage=102;aulast=Nooren
http://www.indianjmedsci.org/text.asp?2013/67/5/99/122731
Histerectomía obstétrica urgente en un hospital terciario en Sokoto, Nigeria
Emergency obstetric hysterectomy in a tertiary hospital in sokoto, Nigeria.
Nwobodo E, Nnadi D.
Department of Obstetrics and Gynecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Ann Med Health Sci Res. 2012 Jan;2(1):37-40. doi: 10.4103/2141-9248.96935.
Abstract
BACKGROUND: Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications, as a last resort, to prevent maternal mortality. OBJECTIVES: This study was designed to determine the rate, indications, and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH), Sokoto. MATERIALS AND METHODS:This retrospective study involved all the patients who had EOH at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the χ(2) test was used to analyze some of the results with the confidence limit set at 95%. RESULTS: During the 6-year period, 83 EOH were performed out of 16,249 deliveries giving the rate of the former as 0.51%, i.e. 1 in 196 deliveries. However, the case records of only 74 patients (82.9%) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2%) were unbooked for antenatal care, and the rate of the procedure among these patients (1.82%) was significantly higher than 0.07% observed amongst booked subjects (P<0.001). The main indication for the procedure was ruptured uterus (93.2%) and the majority of the patients (95.9%) had subtotal hysterectomy. Anemia (66.2%), excessive hemorrhage (35.5%), septicemia (18.9%), and wound infection (16.2%) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2%) compared to those undertaken by consultants (16.2%); P=0.03. The case fatality rate of the EOH procedure was 12.1%. However, the case fatality rates in the procedure performed by consultants and senior registrars were 6.5% and 16.3%, respectively. CONCLUSION:The rate of EOH in the centre is relatively high and ruptured uterus is responsible for the majority of the procedure. Prevention of prolonged obstructed labor, and therefore uterine rupture, through antenatal care and supervision of labor will reduce the rate of EOH whereas performance of the procedure by the most experienced surgeon will minimize the maternal morbidity and mortality.
KEYWORDS: Emergency obstetric hysterectomy, Ruptured uterus, Sokoto
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507124/
http://www.amhsr.org/downloadpdf.asp?issn=2141-9248;year=2012;volume=2;issue=1;spage=37;epage=40;aulast=Nwobodo;type=2
Uso oportuno (fuera de indicación) del factor VII activado recombinante (NovoSeven (®)) puede ayudar a evitar la histerectomía en la hemorragia obstétrica intratable complicada con coagulación intravascular diseminada
Timely 'off-label' use of recombinant activated factor VII (NovoSeven(®)) can help in avoiding hysterectomy in intractable obstetric bleeding complicated with disseminated intravascular coagulation: A case report and review of the literature.
Burad J, Bhakta P, Sharma J.
Department of Anaesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, Oman.
Indian J Anaesth. 2012 Jan;56(1):69-71. doi: 10.4103/0019-5049.93349.
Abstract
Massive intra-operative bleeding is not an infrequent occurrence in obstetrics. Worldwide obstetric bleeding remains a major cause of morbidity and mortality. Conventional management of this bleeding consists of resuscitation with fluids, blood, surgical maneuvers, and embolisation of feeding blood vessels. But in most of cases, these measures appear to be ineffective in controlling bleeding. Recently, the 'off-label' use of the recombinant activated factor VII (rFVIIa) concentrate has emerged as promising treatment for such bleeding when conventional measures fail. We came across a similar scenario in which a young lady was admitted with per-vaginal bleeding due to abruptio placentae. In spite of usual surgical and medical interventions, she continued to bleed. rFVIIa was administered as a desperate measure to avoid hysterectomy and the bleeding could be stopped. She recovered successfully without any complication. Thus, the timely use of rFVIIa, hence, can be used to save life and fertility in cases of intractable obstetric bleeding.
KEYWORDS:Disseminated intravascular coagulation, intractable obstetric bleed, recombinant activated factor VII concentrate
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327077/
http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2012;volume=56;issue=1;spage=69;epage=71;aulast=Burad;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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