viernes, 28 de abril de 2017

Más de hemorragia obstétrica / More on obstetric hemorrhage

Abril 22, 2017. No. 2667







Actualización del protocolo de tratamiento de la hemorragia obstétrica.
An update of the obstetrics hemorrhage treatment protocol.
Rev Esp Anestesiol Reanim. 2015 Apr;62(4):229-31. doi: 10.1016/j.redar.2014.09.008. Epub 2014 Dec 17.
Resumen
La hemorragia obstétrica es aún hoy día una importante causa de morbimortalidad maternofetal en los países desarrollados. Se trata de un problema infraestimado, que generalmente aparece de forma impredecible. La morbimortalidad de la hemorragia obstétrica se considera evitable en una elevada proporción si el manejo es adecuado. Las guías clínicas de mayor difusión mundial recomiendan por consenso protocolizar el manejo, adaptarlo al ámbito local y mantenerlo actualizado en función de la experiencia y de las nuevas publicaciones científicas. Exponemos un protocolo actualizado conforme a las últimas recomendaciones y a nuestra propia experiencia, para que pueda ser utilizado como elemento base por aquellos anestesiólogos que así lo deseen, adaptado a su ámbito local de trabajo diario. Este último aspecto es muy importante para que sea eficaz, y es una labor que debe realizarse en cada centro conforme a la disponibilidad de medios, personal y características arquitectónicas.

Prácticas de transfusión de sangre en anestesia obstétrica.
Blood transfusion practices in obstetric anaesthesia.
Indian J Anaesth. 2014 Sep;58(5):629-36. doi: 10.4103/0019-5049.144674.
Abstract
Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective.
KEYWORDS: Obstetric anaesthesia; obstetric haemorrhage; postpartum haemorrhage; transfusion practices; transfusion protocol

Evaluación del cumplimiento y los resultados de un protocolo de tratamiento de hemorragia postparto masiva en un hospital de tercer nivel en Pakistán.
Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan.
BMC Pregnancy Childbirth. 2011 Apr 13;11:28. doi: 10.1186/1471-2393-11-28.
Abstract
BACKGROUND: Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated. METHODS: An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss ≥ 1500 ml) between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode of delivery, possible cause of postpartum hemorrhage and medical or surgical intervention was collected. The estimation of blood loss was made via subjective and objective assessment. RESULTS: During 2008, massive postpartum hemorrhage occurred in 0.64% cases (26/4,052). No deaths were reported. The mean blood loss was 2431 ± 1817 ml (range: 1500-9000 ml). Emergency cesarean section was the most common mode of delivery (13/26; 50%) while uterine atony was the most common cause of massive postpartum hemorrhage (14/26; 54%). B-lynch suture (24%) and balloon tamponade (60%) were used more commonly as compared to our previously reported experience. Cesarean hysterectomy was performed in 3 cases (12%) for control of massive postpartum hemorrhage. More than 80% compliance was observed in 8 out of 10 steps of the management protocol. Initiation of blood transfusion at 1500 ml blood loss (89%) and overall documentation of management (92%) were favorably observed in most cases. CONCLUSION: This report details our experience with the practical implementation of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in a developing country. With the exception of arterial embolization, relatively newer, simpler and potentially safer techniques are now being employed for the management of massive postpartum hemorrhage at our institution. Particular attention should be paid to the documentation of the management steps while ensuring a stricter adherence to the formulated protocols and guidelines in order to further ameliorate patient outcomes in emergency obstetrical practice. More audits like the one we performed are important to recognize and rectify any deficiencies in obstetrical practice in developing countries. Dissemination of the same is pivotal to enable an open discourse on the improvement of existing obstetrical strategies.

Vacante para Anestesiología Pediátrica
El Hospital de Especialidades Pediátricas de León, Guanajuato México 
ofrece un contrato laboral en el departamento de anestesiología 
Informes con la Dra Angélica García Álvarez 
angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028
Foro Internacional de Medicina Crítica
Ciudad de México, Julio 13-15, 2017
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