Professional Documents
Culture Documents
3:
Presentacin
Conicto
de
inters
EQU
Sutura
Maran
www.emergenciasobstetricas.es
www.emergenciasobstetricas.es
HPP
intracesrea
Escenario
4,
5
y
6
Causas
:
4Descartar
T
atona
y
sangrado
las
laceraciones
de
la
Tejido
:
Ade
cre[smo
arterias
terina
en
los
ngulos
Trombina
:
Cuoagulopaha
de
las
incisiones.
Trauma
Desgarros
de
los
ngulos
/
Descartar
de
las
laceraciones
Roturas
uterinas
provenientes
de
lesiones
Lesin
traum[cas
de
plexos
tvras
aricosos
la
(plica
manipulacin
o
anejos)
vaginal
Tono
:
Atona
(***)
Otras
causas
anormalidades
en
la
placenta
como
se
muestra
en
Escenarios
9
y
10
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
de
capitonaje
www.emergenciasobstetricas.es
Hemorragia posparto
B
Lynch
Hayman
Cho
Lou
Christopher B-Lynch, MA(Oxon), MBBS,
F
LRCP, MRCS, FRCS, FRCOG, MAE,
Pro
MCIArb QDR, D.Univ
G
Consultant Obstetrician & Gynaecological
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
Surgeon
de
capitonaje
www.emergenciasobstetricas.es
For
E
Professor (visiting) Cranfield University
Th
(Health Faculty)
No
Bedfordshire, UK
www.emergenciasobstetricas.es
Tcnica de B-LYNCH
Tcnica
de
HAYMAN
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
de
capitonaje
www.emergenciasobstetricas.es
Tcnica
de
CHO
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
de
capitonaje
www.emergenciasobstetricas.es
www.emergenciasobstetricas.es
www.emergenciasobstetricas.es
Hemorragia posparto
Ligadura
de
la
hipogstrica
Tcnica
compleja
Escasas
indicaciones
si
se
dispone
de
radiologa
intervencionista
Un
25%
de
los
casos
acaba
en
histerectoma
La
combinacin
del
baln/
capitonaje
con
las
suturas
de
compresin
son
de
ecacia
parecida.
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
de
capitonaje
www.emergenciasobstetricas.es
Jun-2013
Objective: To investigate the most appropriate surgical technique for optimizing hemostasis and preservation of subsequent fertility
after postpartum hemorrhage (PPH).
Design: Systematic review of the literature.
Setting: Not applicable.
Hemorragia posparto
Objective: To investigate the most appropriate surgical technique for optimizing hemostasis and preservation of subsequent fertility
after postpartum hemorrhage (PPH).
Design: Systematic review of the literature.
Setting: Not applicable.
Patient(s): None.
Intervention(s): Review of MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library.
Main Outcome Measure(s): Comparison of the effectiveness of conservative surgical techniques, separately or together, with respect to
success rate (ability to stop bleeding and preserve the uterus), fertility rate (subsequent pregnancies or the return of regular menstrual
cycles), complication rate of the procedure, and the outcomes of subsequent pregnancies in terms of type of delivery and eventual
delivery complications.
Result(s): Compressive sutures and vessel embolization may be considered life-saving procedures by achieving the best hemostatic
efcacy. Data on restoration of menses and pregnancy rates after these procedures are limited by short-term follow-up and by the
paucity of studies, especially for vascular ligation.
Conclusion(s): Pelvic vessel embolization and compressive sutures are associated with high rates of restoration of regular menses and
successive pregnancies, even if the former is burdened by an increased rate of placental disorders and fetal growth restriction and the
latter by an increased risk of cesarean deliveries and PPH recurrence. Randomized trials would
be desirable to dene the best management of PPH. (Fertil Steril! 2013;99:2097107. "2013 by
Use your smartphone
American Society for Reproductive Medicine.)
to scan this QR code
Key Words: Uterine atony, uterine vessel ligation, hypogastric artery ligation, pelvic vessel
and connect to the
embolization, uterine compression sutures
Discuss: You can discuss this article with its authors and with other ASRM members at http://
fertstertforum.com/gizzos-fertility-rate-surgical-uterine-techniques/
Received September 23, 2012; revised and accepted February 8, 2013; published online March 15,
2013.
S.G. has nothing to disclose. C.S. has nothing to disclose. T.S.P. has nothing to disclose. S.D.G. has nothing to disclose. E.B. has nothing to disclose. S.F. has nothing to disclose. M.N. has nothing to disclose. D.D'A. has nothing to disclose. G.B.N. has nothing to disclose.
Reprint requests: Salvatore Gizzo, M.D., Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128 Padova, Italy (E-mail: ginecologia_padova@libero.it).
Fertility and Sterility Vol. 99, No. 7, June 2013 0015-0282/$36.00
Copyright 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.
http://dx.doi.org/10.1016/j.fertnstert.2013.02.013
VOL. 99 NO. 7 / JUNE 2013
2097
Tcnicas
de
capitonaje
12%
Alteraciones
de
la
placenta;
80%
Atona
Efec[vidad
:
72-100%
Complicaciones:
infeccin,
sinequias,
abortos,
rotura
uterina
Porcentaje
de
Fer[lidad:
10-100%
Parto
siguiente
mediante
cesrea
por:
CIR,
preeclapsia,
riesgo
de
recurrencia
de
HPP
Si
persiste
el
sangrado
-
Con
inestabilidad
considerar
Histerectoma
-
Estable
Radiologa
intervencionista
Hemorragia posparto
Histerectoma
posparto
Indicaciones:
Atona
uterina
refractaria
Rotura
uterina
Trauma
uterino
extenso
tero
de
Couvelaire
Sepsis
Histerectoma
posparto
La
va
abdominal
puede
estar
ya
elegida
Pfannes[el
(valorar
Cherney)
vs
Media
Los
vasos
uterinos
y
ovricos
estn
dilatados
y
los
tejidos
adyacentes
edematosos
(clamparlos
por
duplicado
y/o
puntos
por
transxin)
Si
el
crvix
o
el
istmo
no
estn
implicados
es
mejor
subtotal
Hemorragia posparto
Histerectoma
posparto
Si
hay
que
hacer
una
histerectoma
total
con
crvix
dilatado,
abrir
la
vagina
anterior
para
palpar
el
ribete
del
crvix
restante.
Sutura
hemost[ca
del
reborde
vaginal,
evitar
la
clausura
completa
de
la
cpula.
Dejar
drenajes
(monitorizar
re-sangrado)
Cuidado
con
la
vejiga.
Comprobar
su
integridad.
No
olvidar
el
alto
riesgo
tromboemblico
en
el
postoperatorio.
Taller 3:
www.emergenciasobstetricas.es
www.emergenciasobstetricas.es
Tcnica de B-LYNCH
a(ii))
Tcnica de B-LYNCH
Tcnica de B-LYNCH
(c)
Ejercicio
2
:
Tcnica
de
Hayman
(aguja
recta)
x2
Tcnica
de
HAYMAN
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
de
capitonaje
www.emergenciasobstetricas.es
Ejercicio
3:
Tcnica
de
Cho
(aguja
recta)
Tcnica
de
CHO
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
de
capitonaje
Ejercicio
2
:
Tcnica
de
Cho
(aguja
recta)
1
y
3
:
aguja
entra
de
anterior
a
posterior
2
y
4
:
aguja
entra
de
anterior
a
posterior
Tcnica
de
CHO
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
de
capitonaje
Conclusiones.
Taller
3:
Tcnicas
quirrgicas
abdominales:
B-Lynch
y
Tcnicas
de
capitonaje
Muchas
gracias.
Esperamos
que
os
sea
de
u[lidad
o
que
no