HISTERECTOMÍA POSPARTO: EXPERIENCIA DE CLÍNICA LAS CONDES

Objetivo: Analizar la experiencia clinica de pacientes sometidas a histerectomia posparto (HPP). Metodo: Estudio retrospectivo de la HPP efectuadas en Clinica Las Condes entre enero de 2000 y diciembre de 2009. Resultados: Hubo 15.356 partos con 34 casos de HPP (incidencia de 2,2 histerectomias/1000 partos). La edad materna promedio fue de 36 anos; 97 por ciento eran multiparas. La edad gestacional promedio al parto fue 36,1 semanas (rango: 27-40). Causas principales: acretismo placentario (61,8 por ciento), inercia uterina (20,6 por ciento) y rotura uterina (8,8 por ciento). En el 29,4 por ciento se realizo ademas la ligadura de arterias hipogastricas. Histerectomia total en el 85,3 por ciento. El 91,2 por ciento presento complicaciones, la mas frecuente correspondio a lesion vesical asociada a acretismo placentario (26,5 por ciento). En el postoperatorio inmediato hubo 29 casos de anemia, 10 casos de coagulacion intravascular diseminada, 2 casos de hemoperitoneo (reoperadas) y 2 pacientes con choque hipovolemico. Hubo 1 caso de trombosis pelviana, 1 caso de trombosis de vena ovarica y 1 caso de fasceitis necrotizante. Tardiamente hubo 3 casos de depresion, 1 tromboembolismo pulmonar, 1 fistula vesico-vaginal y 1 proceso inflamatorio pelviano. No hubo muertes maternas. Transfusion de sangre y/o hemoderivados en 76,5 por ciento. Hubo 1 mortinato y 2 mortineonatos con un 8,5 por ciento (3/35) de muerte perinatal. Conclusiones: La HPP es una intervencion de urgencia que se plantea frente a una hemorragia severa, secundaria a diversas patologias, durante o posterior al parto, asociada frecuentemente con cesarea anterior e inercia uterina.(AU) Objetive: To analyze the clinical experience of peripartum hysterectomy (PH). Method: Retrospective review of women who required PH at Las Condes Clinic since January 2000 to December 2009. Results: In the study period 15,356 patients were delivered with 34 cases of PH (incidence: 2.2/1000 deliveries). The mean age was 36 years old, 97 percent were multiparous. The mean gestational age at delivery was 36.1 weeks (range: 27-40). Causes: placenta accreta (61.8 percent), uterine atony (20.6 percent) and uterine rupture (8.8 percent). In 29.4 percent a bilateral hypogastric ligation was added to the hysterectomy. Total hysterectomy was performed in 85.3 percent of cases. There was at least one complication in 91.2 percent women. The intraopertive bladder injury associated with placenta accreta was the most frequent complication (26.5 percent). Postoperative complications: 29 cases of anemia, 10 cases of disseminated intravascular coagulopathy, 2 hemoperitoneum that required surgical reexploration, 2 cases of hypovolemic shock, 1 case of pelvic thrombosis, 1 case of ovarian vein thrombosis and 1 case of necrotizing fasceitis. Late complications included depression, pulmonary embolism, bladder-vagina fistula and pelvic inflammatory disease. 76.5 percent required transfusion. There were no cases of maternal death with 8.5 percent of perinatal death. Conclusions: PH it is performed in patients with severe bleeding during or after labor and delivery, frequently is associated with serious maternal morbidity. Previous cesarean section with abnormal placental implantation and uterine atony were the most frequent indications.(AU)