| Popis: |
Overview and Aims: Postpartum Hysterectomy (PPH) is considered an obstetrical emergency. Profuse bleeding, the most common indication, may jeopardize the puerperal woman. If not controlled by conservative measures, it may require PPH. Its incidence varies between 0.13 to 5.38 per 1000 births. Women with underlying conditions such as placenta previa, fi- broleiomyomas or previous cesarean section (CS) are at increased risk. We evaluated the incidence of PPH, its indications, risk factors and complications. Material and Methods: Retrospective study of PPH conducted at a tertiary care hospital in 15 years (1997-2011). Results: We found 41 cases of PPH (0.6 per 1000 births). Twenty eight occurred after CS (1.34 /1000) and 13 followed vaginal deliveries (0.27/1000), resulting in an odds ratio of 4.94 (2.56 to 9.54, p < 0.001) for CS vs vaginal delivery. Sixteen patients had a previous uterine surgery (CS and/or curettage) and 8 were nulliparous. The most common indication was uterine atony in 18 cases (43.9 %), followed by unspecified hemorrhage in 8 (19.5 %), placenta accreta in 7 (17.1%) and uterine dehiscence/rupture in 4 (9.8%). In 30 cases it was performed a total hysterectomy, being subtotal in the remaining 11 cases. The main complications were the need for red blood cell transfusion (39), disseminated intravascular coagulation (8) and febrile syndrome (6); 21 postpartum women were admitted in Intensive Care Unit. There were no maternal deaths. Pathologic examination of uterus and placenta showed normal postpartum changes in 11 (26.8 %), placenta accreta in 12 (29.3 %), changes consistent with uterine atony in 8 (19.5 %), fibroleiomyomas in 5 (12.2%) and uterine rupture in 3 (7.3%). Conclusions: hysterectomy remains a required procedure in the treatment of postpartum bleeding resistant to conservative management, being uterine atony the most frequent indication with CS accounting for a five times higher risk than vaginal delivery. |
